Severity of Childhood Obstructive Sleep Apnea and Hypertension Improved after Adenotonsillectomy

Abstract

Objectives:

Report improvements of childhood obstructive sleep apnea (OSA) and hypertension after adenotonsillectomy.

Methods:

Case series with planned data collection of 50 consecutive OSA patients (36 boys and 14 girls; mean age, 7.6 ± 2.8 years) who underwent plasma knife total tonsillectomy and adenoidectomy between January 2010 and March 2013. Body mass index (BMI), apnea-hypopnea index (AHI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were assessed at baseline and at ≥6 months postoperatively. Changes of these parameters were statistically analyzed.

Results:

The mean values of BMI z-score, AHI, SBP, and DBP were 1.91 ± 0.27, 15.9 ± 17.2, 102.8 ± 16.8 (mm Hg), and 67.4 m ± 12.6 (mm Hg), respectively. The median follow-up period was 12 months. Eighteen patients (36%) were cured after adenotonsillectomy. Postoperatively, adenotonsillectomy reduced AHI (Δ = −13.3 ± 17.7, P < .001) significantly but not BMI z-score, SBP, and DBP (all P > .05). Although the proportion of obesity remained similar (32% vs 30%, P = .56) after operation, the proportion of hypertension significantly reduced from 34% to 14% (P = .004). At baseline, obesity, severe OSA, and hypertension were significantly associated with postoperative hypertension. In multiple logistic regression analysis, severe OSA and hypertension were independent predictors of postoperative hypertension.

Conclusions:

Hypertension is not uncommon in children with OSA. Decreasing hypertension rate indicates that reduction of AHI is not all that matters after adenotonsillectomy in childhood OSA. However, pediatric patients with severe OSA and hypertension need careful management of their elevated BP despite surgical treatment.