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Effect of surgical intervention for childhood OSA on blood pressure: A randomized controlled study
Chun Ting Au1, Kate Ching-Ching Chan2, Dennis Lip Yen Lee3
1Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special administrative region of China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong Special administrative region of China; Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special administrative region of China; Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Adenotonsillectomy did not significantly improve 24-h blood pressure in children with obstructive sleep apnea (OSA). However, surgery showed benefits for severe OSA cases, though weight gain partially masked blood pressure improvements.
Area of Science:
- Pediatric Pulmonology
- Cardiovascular Health in Children
- Sleep Medicine
Background:
- Obstructive sleep apnea (OSA) in children is linked to cardiovascular issues, including elevated blood pressure.
- Surgical intervention, specifically adenotonsillectomy, is a common treatment for pediatric OSA.
- The impact of surgery on 24-h ambulatory blood pressure (ABP) in children with OSA requires further investigation.
Purpose of the Study:
- To evaluate the effect of early surgery versus watchful waiting on 24-h ABP in children with OSA.
- To determine if adenotonsillectomy improves blood pressure parameters in pediatric OSA patients.
- To explore correlations between OSA severity, surgical intervention, and blood pressure changes.
Main Methods:
- A two-centered, investigator-blinded randomized controlled trial involving non-obese, pre-pubertal children (aged 6-11 years) with OSA.
- Participants underwent 24-h ABP monitoring at baseline and 9 months post-intervention (Early Surgery or Watchful Waiting).
- Intention-to-treat analysis was performed on 137 randomized subjects, with 62 in the Early Surgery group and 47 in the Watchful Waiting group completing the study.
Main Results:
- No significant differences in nighttime systolic or diastolic blood pressure z-scores were observed between the Early Surgery and Watchful Waiting groups.
- A reduction in nighttime diastolic blood pressure z-score correlated with improved OSA severity indices.
- Significant improvement in nighttime diastolic blood pressure z-score was noted in severe OSA cases post-surgery, alongside a significant increase in BMI z-score.
Conclusions:
- Adenotonsillectomy did not yield significant 24-h ABP improvements in the overall pediatric OSA population studied.
- Surgical intervention demonstrated a benefit for children with severe OSA, specifically in nighttime diastolic blood pressure.
- Post-surgical weight gain may have partially masked potential blood pressure improvements in the overall cohort.
Objective:
To investigate the effect of surgical intervention on 24-h ABP in children with OSA. It was hypothesized that blood pressure would improve following adenotonsillectomy.
Methods:
This was a two-centered investigator-blinded randomized controlled trial. Non-obese pre-pubertal children aged 6-11 years with OSA (obstructive apnea-hypopnea index, OAHI >3/h) underwent 24-h ABP monitoring at baseline and 9 months after the randomly assigned intervention, i.e. Early Surgery (ES) or Watchful Waiting (WW). Intention-to-treat analysis was performed.
Results:
137 subjects were randomized. Sixty-two (Age: 7.9y ± 1.3, 71% boys) and 47 (Age: 8.5y ± 1.6, 77% boys) participants from the ES and WW groups, respectively completed the study. Changes in ABP parameters were similar in the ES and WW groups (nighttime systolic BP z-scores: +0.03 ± 0.93 vs. -0.06 ± 1.04, p = 0.65; nighttime diastolic BP z-scores: -0.20 ± 0.95 vs. -0.02 ± 1.00, p = 0.35) despite a greater improvement in OSA in the ES group. However, a reduction in nighttime diastolic BP z-score correlated with improvements in OSA severity indexes (r = 0.21-0.22, p < 0.05), and a significant improvement in nighttime diastolic BP z-score [-0.43 ± 1.01, p = 0.027] following surgery was observed in participants with severe preoperative OSA (OAHI ≥10/h). The ES group had a significant increase in body mass index z-score after surgery [+0.27 ± 0.57, p < 0.001], which correlated with the increase in daytime systolic BP z-score (r = 0.2, p < 0.05).
Conclusion:
Surgical treatment did not lead to significant improvements in ABP in OSA children except in those with more severe disease. The improvement in BP was partially masked by the weight gain following surgery.
Clinical Trial Registration:
The trial was registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn.
Registration Number:
ChiCTR-TRC-14004131).
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