Utility of Cardiology Referral in Children with EKG Abnormalities on Polysomnogram

Abstract

Objectives:

1) Determine the incidence of cardiac disease in children with electrocardiogram (EKG) abnormalities on polysomnogram (PSG). 2) To assess whether demographic factors such as family history of heart disease improve the yield of cardiology referral in these subjects.

Methods:

Study Design: Case series with chart review. Setting: Tertiary childrens hospital. Children between 6 months and 18 years of age with EKG abnormalities on PSG who were referred to cardiology for evaluation were included in the study. Children with a known history of cardiac disease were excluded.

Results:

Sixty-four children had EKG abnormalities on PSG and underwent cardiology evaluation. The mean age was 6.83 years (SD 4.81), and 64% of subjects were African-American. The mean obstructive apnea hypopnea index (OAHI) was 8.8 (SD 13.2), and 43 of the children had obstructive sleep apnea (OAHI >1). The most common EKG abnormality on PSG was premature ventricular contractions. The majority of children referred to cardiology underwent echocardiogram (48/64) and Holter monitoring (44/64). Seven children (11%) had cardiac pathology, including tuberous sclerosis, mitral and aortic valve insufficiency, and bradycardia, identified during cardiology evaluation. Factors such as family history of heart disease (P = 0.87), severity of sleep apnea (P = 0.48), and history of prematurity (P = 0.50) did not increase the likelihood of diagnosing cardiac disease.

Conclusions:

Cardiac pathology in children with abnormal EKGs on PSG is common. Cardiology referral in such patients is warranted. Further research is needed to determine whether there are factors that increase the likelihood of identifying cardiac pathology on referral.