To systematically review current studies on the effects of adenotonsillectomy (T&A) for obstructive sleep apnea (OSA) on cardiovascular parameters in children.
Data Sources
PubMed database.
Review Methods
A comprehensive PubMed MeSH search was done between 1970 and 2012.
Results
Fourteen articles were included. The total number of children was 418. The mean sample size was 30 (range, 1-62), and the mean age of the sample population was 6 years (range, 2-10 years). Criteria used for the diagnosis of OSA ranged from full-night polysomnography (PSG) to clinical parameters. Three studies had results from preoperative and postoperative PSG. Cardiovascular parameters studied included blood pressure, heart rate, cardiac morphology, and cardiac function. All studies reported an improvement in cardiovascular parameters and OSA symptoms after surgery. Three studies reported improvement in blood pressure, 6 reported improvement in mean pulmonary artery pressures, 7 reported improvement in echocardiographic findings, and 1 reported a decrease in pulse rate and pulse rate variability after T&A for OSA.
Conclusion
There is evidence that cardiovascular morbidities associated with OSA are potentially reversible. T&A may have a significant role in reversing the cardiovascular sequelae of OSA. However, there is a paucity of well-designed and powered studies to address this issue.
RosenfeldRMGreenRP. Tonsillectomy and adenoidectomy: changing trends. Ann Otol Rhinol Laryngol. 1990;99:187-191.
2.
RolandPSRosenfeldRMBrooksLJ. Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;145(1 suppl):S1-S15.
3.
SogutAAltinRUzunL. Prevalence of obstructive sleep apnea syndrome and associated symptoms in 3–11-year-old Turkish children. Pediatr Pulmonol. 2005;39:251-256.
4.
CastronovoVZucconiMNosettiL. Prevalence of habitual snoring and sleep-disordered breathing in preschool-aged children in an Italian community. J Pediatr. 2003;142:377-382.
5.
BixlerEOVgontzasANLinHM. Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep. 2009;32:731-736.
6.
MitchellRBKellyJ. Behavior, neurocognition and quality-of-life in children with sleep-disordered breathing. Int J Pediatr Otorhinolaryngol. 2006;70:395-406.
7.
BhattacharjeeRKheirandish-GozalLPillarGGozalD. Cardiovascular complications of obstructive sleep apnea syndrome: evidence from children. Prog Cardiovasc Dis. 2009;51:416-433.
8.
QuanSFGershBJ. Cardiovascular consequences of sleep-disordered breathing: past, present and future: report of a workshop from the National Center on Sleep Disorders Research and the National Heart, Lung, and Blood Institute. Circulation. 2004;109:951-957.
9.
GuilleminaultCEldridgeFLSimmonsFBDementWC. Sleep apnea in eight children. Pediatrics. 1976;58:23-30.
10.
GorurKDovenOUnalMAkkusNOzcanC. Preoperative and postoperative cardiac and clinical findings of patients with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2001;59:41-46.
11.
MarcusCLGreeneMGCarrollJL. Blood pressure in children with obstructive sleep apnea. Am J Respir Crit Care Med. 1998;157:1098-1103.
12.
MimanMCKirazliTOzyurekR. Doppler echocardiography in adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2000;54:21-26.
13.
NgDKWongJCChanCHLeungLCLeungSY. Ambulatory blood pressure before and after adenotonsillectomy in children with obstructive sleep apnea. Sleep Med. 2010;11:721-725.
14.
PacAKaradagAKurtaranHAktasD. Comparison of cardiac function and valvular damage in children with and without adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2005;69:527-532.
15.
ConstantinEMcGregorCDCoteVBrouilletteRT. Pulse rate and pulse rate variability decrease after adenotonsillectomy for obstructive sleep apnea. Pediatr Pulmonol. 2008;43:498-504.
16.
SieKCPerkinsJAClarkeWR. Acute right heart failure due to adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 1997;41:53-58.
17.
CohenSSpringerCPerlesZKoplewitzBZAvitalARevel-VilkS. Cardiac, lung, and brain thrombosis in a child with obstructive sleep apnea. Pediatr Pulmonol. 2010;45:836-839.
18.
CullenKAHallMJGolosinskiyA. Ambulatory surgery in the United States, 2006. Natl Health Stat Rep. 2009;11:1-25.
19.
FriedmanMWilsonMLinHCChangHW. Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2009;140:800-808.
20.
SackettDL. Rules of evidence and clinical recommendations for the management of patients. Can J Cardiol. 1993;9:487-489.
21.
ApostolidouMTAlexopoulosEIDamaniE. Absence of blood pressure, metabolic, and inflammatory marker changes after adenotonsillectomy for sleep apnea in Greek children. Pediatr Pulmonol. 2008;43:550-560.
22.
AminRAnthonyLSomersV. Growth velocity predicts recurrence of sleep-disordered breathing 1 year after adenotonsillectomy. Am J Respir Crit Care Med. 2008;177:654-659.
23.
TalALeibermanAMargulisGSoferS. Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment. Pediatr Pulmonol. 1988;4:139-143.
24.
SoferSWeinhouseETalA. Cor pulmonale due to adenoidal or tonsillar hypertrophy or both in children: noninvasive diagnosis and follow-up. Chest. 1988;93:119-122.
25.
DumanDNaibogluBEsenHSTorosSZDemirtuncR. Impaired right ventricular function in adenotonsillar hypertrophy. Int J Card Imaging. 2008;24:261-267.
26.
YilmazMDOnratEAltuntasA. The effects of tonsillectomy and adenoidectomy on pulmonary arterial pressure in children. Am J Otolaryngol. 2005;26:18-21.
27.
NaibogluBDeveciSDumanD. Effect of upper airway obstruction on pulmonary arterial pressure in children. Int J Pediatr Otorhinolaryngol. 2008;72:1425-1429.
28.
TezerMSKaranfilAAktasD. Association between adenoidal-nasopharyngeal ratio and right ventricular diastolic functions in children with adenoid hypertrophy causing upper airway obstruction. Int J Pediatr Otorhinolaryngol. 2005;69:1169-1173.
29.
AtiqMMasoodFIkramMHaqqeeR. Reversible obstructive sleep apnea and right heart failure due to massive tonsillar hypertrophy. J Ayub Med Coll Abbottabad. 2004;16:66-68.
30.
UgurMBDoganSMSogutA. Effect of adenoidectomy and/or tonsillectomy on cardiac functions in children with obstructive sleep apnea. ORL. 2008;70:202-208.
GuilleminaultCKhramsovAStoohsRA. Abnormal blood pressure in prepubertal children with sleep-disordered breathing. Pediatr Res. 2004;55:76-84.
33.
AminRSCarrollJLJeffriesJL. Twenty-four-hour ambulatory blood pressure in children with sleep-disordered breathing. Am J Respir Crit Care Med. 2004;169:950-956.
34.
NgDKChanCChowASChowPKwokK. Childhood sleep-disordered breathing and its implications for cardiac and vascular diseases. J Paediatr Child Health. 2005;41:640-646.
35.
KwokKLNgDKChanCH. Cardiovascular changes in children with snoring and obstructive sleep apnoea. Ann Acad Med Singapore. 2008;37:715-721.
36.
AminRSKimballTRKalraM. Left ventricular function in children with sleep-disordered breathing. Am J Cardiol. 2005;95:801-804.
37.
AminRSKimballTRBeanJA. Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. Am J Respir Crit Care Med. 2002;165:1395-1399.
38.
ChanJYLiAMAuCT. Cardiac remodelling and dysfunction in children with obstructive sleep apnoea: a community based study. Thorax. 2009;64:233-239.
39.
DengZDPoonCSArzenoNMKatzES. Heart rate variability in pediatric obstructive sleep apnea. Conf Proc IEEE Eng Med Biol Soc. 2006;1:3565-3568.
40.
BaharavAKotagalSRubinBKPrattJAkselrodS. Autonomic cardiovascular control in children with obstructive sleep apnea. Clin Auton Res. 1999;9:345-351.
41.
AljadeffGGozalDSchechtmanVLBurrellBHarperRMWardSL. Heart rate variability in children with obstructive sleep apnea. Sleep. 1997;20:151-157.
42.
FordESMokdadAHAjaniUA. Trends in risk factors for cardiovascular disease among children and adolescents in the United States. Pediatrics. 2004;114:1534-1544.
43.
ThompsonDRObarzanekEFrankoDL. Childhood overweight and cardiovascular disease risk factors: the National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr. 2007;150:18-25.
44.
MitchellRBKellyJ. Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children. Otolaryngol Head Neck Surg. 2007;137:43-48.
45.
RudnickEFWalshJSHamptonMCMitchellRB. Prevalence and ethnicity of sleep-disordered breathing and obesity in children. Otolaryngol Head Neck Surg. 2007;137:878-882.
46.
MitchellRBPereiraKDFriedmanNR. Sleep-disordered breathing in children: survey of current practice. Laryngoscope. 2006;116:956-958.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
