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Original Investigation
April 2018

Association of Adenotonsillectomy With Blood Pressure Among Hypertensive and Nonhypertensive Children With Obstructive Sleep Apnea

Author Affiliations
  • 1Department of Otolaryngology, National Taiwan University, College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
  • 2Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
  • 3Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
  • 4Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
  • 5Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
JAMA Otolaryngol Head Neck Surg. 2018;144(4):300-307. doi:10.1001/jamaoto.2017.3127
Key Points

Question  How is adenotonsillectomy associated with blood pressure in hypertensive and nonhypertensive children with obstructive sleep apnea?

Finding  In this case series of 240 children with obstructive sleep apnea, hypertensive children had significant improvement in all blood pressure measures, whereas nonhypertensive children had significant improvement in diastolic blood pressure.

Meaning  Screening and treating hypertensive children with obstructive sleep apnea with adenotonsillectomy may not only ease obstructive sleep apnea symptoms but also improve blood pressure, which may prevent future cardiovascular and end-organ disease.

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 64.5 mm Hg; 95% CI of difference, −4.1 to −0.7 mm Hg) and morning diastolic BP (66.9 to 64.4 mm Hg; 95% CI of difference, −4.2 to −0.8 mm Hg). 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] mm Hg; morning: 106.0 [9.4] mm Hg), systolic BP index (nocturnal: −4.3 [8.6]; morning: −5.7 [8.5]), diastolic BP (nocturnal: 65.1 [11.5] mm Hg; morning: 64.4 [10.1] mm Hg), 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 105.9 mm Hg; 95% CI of difference, 0.4-3.9 mm Hg). 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.

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