Scoliosis Affects Sleep Breathing And Elevates Pulmonary Arterial Pressure

Part 1BACKGROUND AND PURPOSE:Whether scoliosis affects pulmonary arterial pressure is not clarified.The objective of this study is to examine the correlation between pulmonary arterial pressure and coronal Cobb angle of idiopathic scoliosis.METHODS:A total of 338 patients(82.8%female)with idiopathic scoliosis(average age,15.6 years)were included.Preoperatively,the coronal Cobb angle of curvature and the apex location and direction were determined from radiographic records.Tricuspid regurgitation velocity(TRV)and inferior vena cava diameter were also measured using Doppler echocardiography.Pulmonary arterial systolic pressure(sPAP)was calculated from the TRV according to the modified Bernoulli equation and correlations between sPAP and the features of scoliosis were identified by spearman test.RESULTS:Among the 338 patients,305 had thoracic curves,276(90.5%)of which were right curves.sPAP varied from 5.0 mmHg to 37.6 mmHg.Pulmonary hypertension could not be excluded in the case of one patient.A mild correlation(correlation coefficient = 0.187,p = 0.001)between sPAP and coronal Cobb angle of the main thoracic(MT)curves was identified.Correlations between sPAP and the degree of other curves were not significant.Patients with sPAP>20 mmHg also had larger thoracic curve angles(mean MT 42.16° vs.52.45°;U-test,p = 0.002).There were no differences in sPAP levels between patients with right and left thoracic curves.CONCLUSION:A mild positive correlation was identified between sPAP and the coronal Cobb angle of the MT curves.There was no correlation between sPAP and the direction of the curvature.Part 2BACKGROUND AND PURPOSE:Scoliosis is a severe chest-wall deformity that may cause sleep disordered breathing.The objective of this study is to investigate the difference of sleep breathing pattern between scoliotic patients and healthy population.METHODS:A total of 62 scoliotic patients with thoracic curve and 25 healthy controls were included for further investigation.Watch-PAT 200 wrist sleep monitor was used to monitor sleep breathing.Sleep breathing was described with following parameters:pRDI(Respiratory Disorders Index)indicating mean respiratory events per hour of sleep including apnea,hypoxia and respiratory effort related arousal;pAHI(Apnea and Hypopnea Index)expressing the number of Apnea and Hypopnea per hour of sleep;and mean and minimal SaO2 during sleep.Difference between scoliotic patients and healthy controls was analyzed by further statistical analysis.RESULTS:For 62 patients and 25 healthy controls investigated for sleep breathing,no difference of age,gender distribution and BMI was found between two groups.Scoliotic patients had statistical significant higher pRDI(median 10.10 vs.8.65,p=0.039)and pAHI(median 1.60 vs.0.72,p=0.029)than that of control group.The minimal SpO2 of scoliotic patients was lower(median 93%vs.94%,p=0.005)while no difference was found in mean SpO2 during sleep.In scoliotic patients,their pAHIs were higher when lying on convex side of thoracic curve during sleep than concave side(2.52 vs.2.27,p=0.045)while no such difference was observed in control group.CONCLUSION:Scoliotic patients had more respiratory events,apnea and hypopnea during sleep than control group.The minimal oxygen saturation in scoliotic patients was lower than normal population while no difference in mean oxygen saturation.Sleeping on the convex side of thoracic curve resulted higher apnea and hypoxia index than concave side.