Effect of adenotonsillectomy on blood pressure in children with obstructive sleep apnea: a meta-analysis

Abstract

Background: While adenotonsillectomy (T&A) is widely recognized as the first-line therapy for pediatric obstructive sleep apnea (OSA), effects of T&A on blood pressure (BP) remain unclear. This meta-analysis evaluates the associations between T&A and BP in children with OSA. Methods: The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched the PubMed, Medline, EMBASE, and Cochrane databases. The keywords used were “sleep apnea syndromes,” “adenotonsillectomy,” and “child.” A random-effects model was applied to determine office systolic BP (SBP), diastolic BP (DBP), and ambulatory BP changes. Result: Twelve studies with 1193 children were analyzed (mean age: 7.6 y; 54% boys). The apnea-hypopnea index significantly reduced of 9.4 events/h (95% CI, −12.0 to −6.8) after T&A. Office SBP (−0.24 mmHg; 95% CI, −1.64 to 1.16) and DBP (−1.65 mmHg; 95% CI, −3.47 to 0.17) did not decrease significantly after surgery. No significant decreases were observed in 24-h ambulatory BP after T&A. Subgroup analysis showed a significant postoperative decrease in office SBP (−6.23 mmHg; 95% CI, −7.78 to −4.67) and DBP (−7.93 mmHg; 95% CI, −10.37 to −5.48) among children with hypertension but a slight increase in office SBP (2.50 mmHg; 95% CI, 1.14 to 3.86) and DBP (1.98 mmHg; 95% CI, −0.02 to 3.98) in those without (P for heterogeneity < 0.001). Conclusion: This meta-analysis suggests the office and ambulatory BP changes after T&A in children with OSA are trivial. Moreover, children with hypertension experience a significantly greater decrease in office BP than children without hypertension.