ASSESSMENT OF RELATIONSHIP BETWEEN OBSTRUCTIVE ADENOTONSILLAR ENLARGEMENT AND MEAN PULMONARY ARTERIAL PRESSURE IN CHILDREN ATTENDING THE ENT CLINICS OF LAGOS UNIVERSITY TEACHING HOSPITAL
Obstructive adenotonsillar enlargement may result in obstructive sleep apnea which may vary in frequency. During sleep, apnoea may cause sympathetic stimulationresulting in increase in pulmonary and systemic elevation of blood pressures.This is as a result of obstruction of the airway by thee adenotonsillar tissue.Adenotonsillectomy has been found to reduce elevated mean pulmonary arterial pressure. There is paucity of data on the relationship between obstructive adenotonsillar enlargementandmeanpulmonary arterial pressure.
OBJECTIVE: The relationship between adenotonsillar enlargement and mean pulmonary arterial pressure was assessed before and 3 weekspost adenotonsillectomy.
METHOLOGY: A prospective study of children that attended the ENT Clinic of LUTH within the age of 3-12yearswith obstructive adenotonsillar enlargement and had adenotonsillectomy. Nasopharyngeal obstruction was assessed using Fujioka technique, tonsillar grade usingBrodsky’s method and sleep related breathing disorder using Chervin’s pediatric sleep questionnaire. The children had an echocardiogram before and 3weeks post adenotonsillectomy to measure mean pulmonary arterial pressure (MPAP) and correlated it with the severity of obstruction
RESULTS: 27 children with mean age 4.85±1.81 years old were studied. Themean preoperative MPAP was 18.7±12.0 mmHg while the mean pressure difference post adenotonsillectomy was 3.32 ± 7.86 mmHg. Mean AN ratiowas 0.75±0.11.SRBD risk was presentin 22 children (81.5%) before surgery and persisted in 3 children (11.1%) postadenotonsillectomy.Grade II paired tonsils were seen in10 children (37.0%).Grade III pairedtonsilswere seen in 14 children
(51.9.0%) and grade IV paired tonsils were seen in 3children (11.1%). There was astatistically significantdifference in MPAP after adenotonsillectomy and in the relationship ofAN ratio with MPAP.There was also a statistically significant relationship of the tonsillar size with the MPAP. There was no statistically significant correlation of SRBD risk with MPAP.
CONCLUSION: The mean pulmonary arterial pressure in children with obstructive adenotonsillar enlargement reduced 3 weeks post adenotonsillectomy. There was a significant relationship between the tonsillar size,AN ratio and MPAP difference but not with SRBD risk usingChervin’s sleep questionnaire.
KEYWORD: Obstructive adenotonsillar enlargement, Obstructive sleep apnea, Mean Pulmonary Arterial Pressure, Sleep RelatedBreathing Disorder (SRBD).