Paediatric Obstructive Sleep Disordered Breathing: Cardiovascular Changes After Adenotonsillectomy

Obstructive sleep disordered breathing (OSDB) is prevalent in children and often associated with adenotonsillar hypertrophy (ATH). This prospective study investigated the impact of adenotonsillectomy on cardiovascular parameters in children with ATH and suspected OSDB, employing a generalised estimating equation (GEE) approach to account for repeated measures and potential confounders.

Children (4-14 years) with ATH and clinical OSDB undergoing adenotonsillectomy were included. Pre- and post-operative resting heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, and estimated cardiac output (COEst) were assessed. Paired t-tests and Wilcoxon signed-rank tests were used for pre-post comparisons, while GEE models examined the influence of time (surgery), age, gender, and their interactions on the outcomes.

A total of 90 children (mean age: 6.86 ± 2.78 years) participated. Adenotonsillectomy resulted in a significant decrease in HR (p = 0.028) and COEst (p = 0.003). No significant changes were observed in SBP or DBP (p > 0.05). A significant negative correlation was found between the change in COEst and age (Spearman's rho = -0.349, p < 0.001), indicating a more pronounced reduction in COEst in younger children.

Adenotonsillectomy in children with ATH and clinical OSDB may lead to significant variations in resting heart rate and estimated cardiac output after surgery. This suggests a potential reduction in resting sympathetic activity following the resolution of upper airway obstruction, with a possible contribution of age-related factors to the observed cardiovascular responses to adenotonsillectomy.