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Effect of adenotonsillectomy on blood pressure in children with obstructive sleep apnea: a meta-analysis

Kun-Tai Kang1, Shuenn-Nan Chiu2, Chia-Hsuan Lee3

  • 1Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.

Sleep Medicine
|July 5, 2021
PubMed

Insights

Adenotonsillectomy (T&A) for pediatric obstructive sleep apnea (OSA) shows minimal impact on blood pressure (BP) overall. However, children with hypertension experience a notable BP reduction post-T&A.

Area of Science:

  • Pediatric Sleep Medicine
  • Cardiovascular Health in Children
  • Surgical Outcomes

Background:

  • Adenotonsillectomy (T&A) is the primary treatment for pediatric obstructive sleep apnea (OSA).
  • The impact of T&A on blood pressure (BP) in children with OSA is not well-established.
  • This study addresses the uncertainty surrounding T&A's effects on pediatric BP.

Purpose of the Study:

  • To evaluate the association between adenotonsillectomy (T&A) and blood pressure (BP) changes in children diagnosed with obstructive sleep apnea (OSA).
  • To analyze both office and ambulatory BP measurements before and after T&A surgery.
  • To investigate potential differences in BP response based on pre-existing hypertension.

Main Methods:

  • A systematic meta-analysis of 12 studies involving 1193 children with OSA.
  • Searched PubMed, Medline, EMBASE, and Cochrane databases using keywords related to sleep apnea syndromes, adenotonsillectomy, and children.
  • Applied a random-effects model to analyze changes in office systolic BP (SBP), diastolic BP (DBP), and 24-h ambulatory BP.

Main Results:

  • Adenotonsillectomy significantly reduced the apnea-hypopnea index by 9.4 events/h.
  • No significant changes were observed in overall office SBP or DBP, or in 24-h ambulatory BP post-T&A.
  • Subgroup analysis revealed a significant decrease in office SBP and DBP among children with hypertension, but a slight increase in those without hypertension.

Conclusions:

  • Adenotonsillectomy (T&A) demonstrates trivial changes in office and ambulatory blood pressure (BP) for children with obstructive sleep apnea (OSA).
  • Children with pre-existing hypertension show a significantly greater reduction in office BP after T&A compared to those without hypertension.
  • The findings suggest a differential BP response to T&A in pediatric OSA patients, particularly concerning hypertension status.
Abstract

Keywords:
AdenotonsillectomyBlood pressureChildHypertensionMeta-analysisSleep apnea syndromes

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