Adenotonsillectomy improves BP, cardiovascular outcomes in children with sleep apnea

Children who suffer from obstructive sleep apnea (OSA) and who undergo adenotonsillectomy may improve their 24-hour ambulatory blood pressure parameters and left ventricular hypertrophy within 24 months after surgery.

The findings were presented at the American Thoracic Society 2011 International Conference in Denver.

According to researchers, OSA and snoring in children with enlarged tonsils and adenoids is causally linked to elevated nighttime and daytime blood pressure (BP). Persistent high BP in children also can lead to damage of the heart and other internal organs.

In the study, researchers evaluated 115 children aged 7 to 13 years, including 28 children with mild OSA, 27 with severe OSA, and 60 healthy controls. Participants received initial polysomnography to determine OSA levels. All children with OSA had enlarged tonsils and adenoids and underwent adenotonsillectomies. Blood pressure, rest and activity levels, and 2-dimensional echocardiography, used to measure the heart’s relative wall thickness and left ventricular mass index, were recorded at baseline and during follow-up at 12 to 24 months.

At follow-up, data showed that BP levels during sleep had decreased for children after adenotonsillectomy compared with measurements at baseline, and normal nighttime dips in BP relative to daytime BP measures were restored. A subset of children with moderate to severe OSA also showed a decrease in heart size after the procedure.

Because children who display elevated BP throughout childhood often develop high BP as adults, treating OSA in childhood is especially critical, the researchers say. They hope that by identifying and treating elevated BP at an early age through treatment of OSA, clinicians will be able to prevent the development of cardiovascular diseases in this population later in life.

Burns L, Vandyke R, Fenchel M, Somers V, Daniels S, Amin RS. Effect of adenotonsillectomy on activity adjusted ambulatory blood pressure and left ventricular geometry in children with obstructive sleep apnea. Presented at: American Thoracic Society (AST) International Conference; May 13-18, 2011; Denver, CO. Abstract 20107.