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Adenotonsillectomy and Blood Pressure in Children With Mild Obstructive Sleep-Disordered Breathing: An Exploratory
Agustin J Cabrera1, Dongdong Li2, Susan Redline3
1Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, Florida.
Insights
Early adenotonsillectomy (eAT) lowered blood pressure (BP) in children with mild obstructive sleep-disordered breathing (oSDB), while watchful waiting increased BP. Overweight children showed greater BP benefits from eAT.
Area of Science:
- Pediatric Sleep Medicine
- Cardiovascular Health in Children
- Surgical Outcomes
Background:
- The impact of adenotonsillectomy on blood pressure in children with mild obstructive sleep-disordered breathing is not well understood.
- Mild obstructive sleep-disordered breathing can affect children's cardiovascular health.
Purpose of the Study:
- To compare blood pressure trajectories in children with mild obstructive sleep-disordered breathing randomized to early adenotonsillectomy versus watchful waiting with supportive care.
- To explore the effect of early adenotonsillectomy on blood pressure changes over 12 months.
Main Methods:
- Secondary outcome analysis of the Pediatric Adenotonsillectomy Trial for Snoring (PATS) randomized clinical trial.
- Included children aged 3 to 12.9 years with mild obstructive sleep-disordered breathing.
- Blood pressure was measured at baseline, 6, and 12 months; mixed-effect models analyzed treatment effects on blood pressure trajectories.
Main Results:
- Early adenotonsillectomy led to decreases in systolic and diastolic blood pressure percentiles, while watchful waiting led to increases.
- The between-group difference in changes from baseline for systolic BP was -9.02 and for diastolic BP was -6.53.
- Children with overweight/obesity (BMI > 85th percentile) experienced a greater reduction in diastolic blood pressure with early adenotonsillectomy.
Conclusions:
- Early adenotonsillectomy significantly impacts blood pressure trajectories in children with mild obstructive sleep-disordered breathing.
- Watchful waiting is associated with increasing blood pressure in this population.
- Early adenotonsillectomy offers greater cardiovascular benefits for children with overweight or obesity.
Importance:
The impact of adenotonsillectomy on blood pressure (BP) in children with mild obstructive sleep-disordered breathing (oSDB) remains unclear.
Objective:
To compare BP trajectories in children with mild oSDB randomized to early adenotonsillectomy (eAT) vs watchful waiting with supportive care (WWSC).
Design, Setting, And Participants:
This was a secondary outcome exploratory analysis of the Pediatric Adenotonsillectomy Trial for Snoring (PATS), a randomized clinical trial where children aged 3 to 12.9 years with snoring and mild oSDB (Obstructive Apnea-Hypopnea Index <3 with tonsillar hypertrophy [Brodsky scale grade ≥2]) were randomized to eAT vs WWSC and followed up for 12 months. PATS was conducted across 7 tertiary pediatric centers in the US. Participants were recruited from June 29, 2016, to February 1, 2021. Data were analyzed between July and November 2024.
Interventions:
eAT vs WWSC.
Main Outcomes And Measures:
The outcomes of interest were 12-month changes in BP percentiles from baseline and the moderating effect of covariates on these changes. BP was measured with an automated oscillometric BP device at baseline, 6 months, and 12 months after randomization. The treatment effect on BP trajectories was evaluated using mixed-effect models.
Results:
Of 458 participants included in the analysis, the mean (SD) age was 6.1 (2.3) years, 230 (50.2%) were female, and 169 (36.9%) had overweight/obesity. Mean (SD) baseline systolic BP (SBP) and diastolic BP (DBP) percentiles were 60.62 (25.22) and 53.86 (21.05), respectively, and 231 participants (50.4%) underwent eAT. From baseline to 12 months, SBP and DBP decreased in the eAT group but increased in the WWSC group. The between-group difference in changes from baseline for SBP was -9.02 (95% CI, -14.77 to -3.28) and for DBP was -6.53 (95% CI, -11.02 to -2.03). Moderation analysis showed that the effect of eAT on DBP was greater among children with body mass index higher than the 85th percentile, with an interaction effect estimate of -10.40 (95% CI, -19.69 to -1.12; P = .03).
Conclusion And Relevance:
In this exploratory analysis of the PATS randomized clinical trial, BP trajectories differed by treatment arm. eAT led to decreases in SBP and DBP percentiles, while WWSC led to increases. Children with overweight/obesity benefited more from eAT than children without.
Trial Registration:
ClinicalTrials.gov Identifier: NCT02562040.
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