NEW YORK (Reuters Health) – Many hypertensive children with obstructive sleep apnea (OSA) who undergo adenotonsillectomy see a reduction in blood pressure (BP), according to researchers in Taiwan.
However, some kids without hypertension experience BP increases after the operation, Dr. Wei-Chung Hsu of National Taiwan University Hospital, Taipei, and colleagues report in JAMA Otolaryngology-Head & Neck Surgery, online February 15.
The team notes that in adults, OSA, hypertension and cardiac morbidities may be related. But there is less evidence of an association between OSA and BP in children and of the possible impact of adenotonsillectomy.
To investigate further, the researchers retrospectively examined data on 240 children with OSA who underwent the procedure. None were obese, two-thirds were male and their mean age was 7 years.
All underwent preoperative and postoperative overnight polysomnography and measurement of nocturnal and morning BP. Overall, 71 children (29.6%) were deemed to be hypertensive.
The apnea-hypopnea index decreased significantly from a mean of 12.1 events per hour before surgery to 1.7 events/hour after surgery, and there was also a significant decrease in nocturnal and morning diastolic BP.
Specifically, the proportion of patients with diastolic BP greater than the 95th percentile decreased significantly both nocturnally (from 20% to 13.8%) and in the morning (from 21.7% to 14.2%).
Moreover, the hypertensive children had a significant decrease in all BP measures, including nocturnal and morning SBP. A total of 47 of these children (66.2%) became nonhypertensive after surgery.
However, 36 children (21.3%) who were nonhypertensive before surgery became hypertensive afterwards.
The researchers concede that “although we observed improvements in BP measures within 6 months after surgery for hypertensive children with OSA, the long-term effects of surgery on BP remain uncertain.”
Notwithstanding these and other limitations, the researchers “recommend screening and treating hypertensive children with OSA by adenotonsillectomy because proper treatment not only eases OSA symptoms but also potentially prevents future cardiovascular and end-organ disease.”
Pediatric otolaryngologist Dr. Mary Frances Musso, who was not involved in the research, told Reuters Health by email, “It is known that treatment of OSA, particularly in severe OSA, is important to prevent such long-term effects as cardiovascular changes including hypertension. Children with diagnosed hypertension, OSA and enlarged tonsils and adenoids would benefit from adenotonsillectomy.”
Dr. Musso of Texas Children’s Hospital, Houston, added, “A follow-up study looking at children with increased body-mass index is recommended. Up to 40% of obese children are at risk of persistent OSA after adenotonsillectomy. Secondary to excess calories in diet and sodium intake playing a factor in obesity it is suspected these children would also be at risk for persistent hypertension post adenotonsillectomy.”
Dr. Hsu did not respond to requests for comments.
SOURCE: http://bit.ly/2omPyWl
JAMA Otolaryngol Head Neck Surg 2018.
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