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Paediatric Obstructive Sleep Disordered Breathing: Cardiovascular Changes After Adenotonsillectomy

Francisco Alves de Sousa1,2, Marta Rios3, Paula Branco1

  • 1Otorhinolaryngology and Head & Neck surgery, Unidade Local de Saúde de Santo António, Porto, Portugal.

Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
|August 8, 2025
PubMed

Insights

Adenotonsillectomy significantly reduced heart rate and cardiac output in children with obstructive sleep disordered breathing (OSDB) and adenotonsillar hypertrophy (ATH). Younger children experienced a more pronounced decrease in cardiac output post-surgery.

Area of Science:

  • Pediatric Cardiology
  • Sleep Medicine
  • Otolaryngology

Background:

  • Obstructive sleep disordered breathing (OSDB) is common in children, frequently linked to adenotonsillar hypertrophy (ATH).
  • Adenotonsillectomy is a primary treatment for OSDB in children with ATH.

Purpose of the Study:

  • To prospectively evaluate the cardiovascular effects of adenotonsillectomy in children with ATH and OSDB.
  • To analyze changes in heart rate, blood pressure, and cardiac output using advanced statistical methods.

Main Methods:

  • Prospective study of 90 children (4-14 years) with ATH and clinical OSDB undergoing adenotonsillectomy.
  • Pre- and post-operative measurements of resting heart rate, blood pressure, and estimated cardiac output.
  • Generalized estimating equation (GEE) models used to analyze cardiovascular parameter changes, accounting for repeated measures and confounders.

Main Results:

  • Adenotonsillectomy led to a significant reduction in resting heart rate (p=0.028) and estimated cardiac output (p=0.003).
  • No significant changes were observed in systolic or diastolic blood pressure (p>0.05).
  • A significant negative correlation between the change in estimated cardiac output and age was noted (p<0.001), with younger children showing greater reductions.

Conclusions:

  • Adenotonsillectomy can significantly alter cardiovascular parameters, specifically heart rate and cardiac output, in children with ATH and OSDB.
  • These findings suggest a potential decrease in resting sympathetic activity post-surgery due to relieved upper airway obstruction.
  • Age appears to be a factor influencing cardiovascular responses to adenotonsillectomy in this pediatric population.
Abstract

Keywords:
adenotonsillectomyblood pressurecardiac outputcardiovascular changesheart rateobstructive sleep disordered breathing

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