Children with obstructive sleep apnea (OSA) and hypertension experienced significant improvements in blood pressure after adenotonsillectomy, according the results of a retrospective case series study published in JAMA Otolaryngology—Head & Neck Surgery.
Cho-Hsueh Lee, MD, from the Department of Otolaryngology, National Taiwan University, College of Medicine and National Taiwan University Hospital in Taipei, and colleagues analyzed preoperative and postoperative polysomnographic data of children (age, <18 years) with symptoms of OSA (apnea-hypopnea index, >1) treated at National Taiwan University Hospital between January 1, 2010, and April 30, 2016. All children with OSA underwent adenotonsillectomy. Blood pressure (BP) was measured in a sleep center before (nocturnal BP) and after (morning BP) polysomnography.
A total of 240 nonobese children with OSA and a mean age of 7.3 years were recruited (66.7% boys).The apnea-hypopnea index decreased significantly from 12.1 to 1.7 events per hour after adenotonsillectomy (95% CI of difference, −12.3 to −8.4 events per hour). All patients experienced a significant decrease in nocturnal diastolic BP (from 66.9 to 64.5 mm Hg; 95% CI of difference, −4.1 to −0.7 mm Hg) and morning diastolic BP (from 66.9 to 64.4 mm Hg; 95% CI of difference, −4.2 to −0.8 mm Hg). The percentage of patients with diastolic BP in the >95th percentile decreased significantly from 20.0% to 13.8% (nocturnal BP; 95% CI of difference, −12.1% to −0.4%) and from 21.7% to 14.2% (morning BP; 95% CI of difference, −13.6% to −1.4%).
Postoperatively, children with hypertension had a significant decrease in all BP measures including systolic BP index (nocturnal, −4.3; morning, −5.7) and diastolic BP index (nocturnal, −10.7; morning, −11.6). In contrast, children without hypertension had a slight increase in nocturnal systolic BP (103.8 to 105.9 mm Hg). A generalized estimating equation model for subgroup comparisons found that children with hypertension had greater improvement in all BP measures than children without hypertension.
The authors argued that these findings point to the need to screen children with OSA for hypertension. Furthermore, they recommended treating children with OSA and hypertension with adenotonsillectomy to improve their OSA symptoms and possibly prevent future cardiovascular problems.
There were a number of limitations to this study, including the retrospective medical record review study design, which precluded collection of other cardiovascular measurements, such as arterial stiffness and carotid intima thickness, which may have improved the analysis. BP was measured in a hospital sleep center rather than as 24-hour ambulatory BP, and selection bias may have occurred, as only children who received surgery were included. The authors noted the need for further study.
Lee C-H, Kang K-T, Chiu S-N, et al. Association of adenotonsillectomy with blood pressure among hypertensive and nonhypertensive children with obstructive sleep apnea [published online February 15, 2018]. JAMA Otolaryngol Head Neck Surg. doi:10.1001/jamaoto.2017.3127