Association of adenotonsillectomy with blood pressure among hypertensive and nonhypertensive children with obstructive sleep apnea
Journal
JAMA Otolaryngology - Head and Neck Surgery
Journal Volume
144
Journal Issue
4
Pages
300-307
Date Issued
2018
Author(s)
Abstract
IMPORTANCE Hypertension in childhood may continue into adulthood and lead to adverse cardiovascular outcomes. Evidence suggests that adenotonsillectomy for childhood obstructive sleep apnea (OSA) may be associated with blood pressure (BP) improvement. However, how adenotonsillectomy is associated with BP in hypertensive and nonhypertensive children with OSA remains unclear. OBJECTIVE To investigate disparities in BP changes after adenotonsillectomy in hypertensive and nonhypertensive children with OSA. DESIGN, SETTING, AND PARTICIPANTS From January 1, 2010, to April 30, 2016, children (aged <18 years) with symptoms of OSA treated at National Taiwan University Hospital were enrolled in this retrospective case series study. INTERVENTIONS Children underwent polysomnography for diagnosis of OSA (apnea-hypopnea index >1). All children with OSA underwent adenotonsillectomy. MAIN OUTCOMES AND MEASURES Preoperative and postoperative overnight polysomnographic data were obtained. Office BP was measured in a sleep center before (nocturnal BP) and after (morning) polysomnography. RESULTS A total of 240 nonobese children (mean [SD] age, 7.3 [3.0] years; 160 [66.7%] male and 80 [33.3%] female) with OSA were recruited. Postoperatively, the apnea-hypopnea index decreased significantly from 12.1 to 1.7 events per hour (95%CI of difference,-12.3 to-8.4 events per hour). The whole cohort had a significant decrease in nocturnal diastolic BP (66.9 to 64.5mmHg; 95%CI of difference,-4.1 to-0.7mmHg) and morning diastolic BP (66.9 to 64.4mmHg; 95%CI of difference,-4.2 to-0.8mmHg). The number (percentage) of patients with diastolic BP in the greater than 95th percentile decreased significantly nocturnally (48 [20.0%] to 33 [13.8%]; 95%CI of difference,-12.1% to-0.4%) and in the morning (52 [21.7%] to 34 [14.2%]; 95%CI of difference,-13.6%to-1.4%). Postoperatively, hypertensive children had a significant decrease in all BP measures, including mean (SD) nocturnal and morning systolic BP (nocturnal: 107.5 [8.6]mmHg; morning: 106.0 [9.4] mmHg), systolic BP index (nocturnal:-4.3 [8.6]; morning:-5.7 [8.5]), diastolic BP (nocturnal: 65.1 [11.5]mmHg; morning: 64.4 [10.1]mmHg), and diastolic BP index (nocturnal:-10.7 [17.3]; morning:-11.6 [15.7]), whereas the nonhypertensive group had a slight increase in nocturnal systolic BP (103.8 to 105.9mmHg; 95%CI of difference, 0.4-3.9 mmHg). A generalized estimating equation model for subgroup comparisons revealed that children with hypertension, compared with those without, had greater improvement in all BP measures. CONCLUSIONS AND RELEVANCE Hypertensive children with OSA had a significant improvement in BP after adenotonsillectomy. Hypertensive children with OSA should be screened and treated by adenotonsillectomy because proper treatment not only eases OSA symptoms but also potentially prevents future cardiovascular and end-organ disease. ? 2018 American Medical Association.
SDGs
Other Subjects
adenotonsillectomy; adolescent; apnea hypopnea index; Article; blood pressure; blood pressure measurement; child; controlled study; diastolic blood pressure; female; human; hypertension; major clinical study; male; outcome assessment; polysomnography; postoperative period; retrospective study; sleep disordered breathing; systolic blood pressure; adenoidectomy; blood pressure; case control study; complication; hypertension; pathophysiology; physiology; sleep disordered breathing; Taiwan; tonsillectomy; Adenoidectomy; Blood Pressure; Case-Control Studies; Child; Female; Humans; Hypertension; Male; Polysomnography; Retrospective Studies; Sleep Apnea, Obstructive; Taiwan; Tonsillectomy
Publisher
American Medical Association
Type
journal article