Format

Send to

Choose Destination
Sleep. 2015 Sep 1;38(9):1395-403. doi: 10.5665/sleep.4976.

The Effect of Adenotonsillectomy for Childhood Sleep Apnea on Cardiometabolic Measures.

Author information

1
Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA.
2
Harvard Medical School, Boston, MA.
3
Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals-Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
4
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
5
Department of Otolaryngology, Head and Neck Surgery and Sleep Disorders Center, University of Michigan Medical Center, Ann Arbor, MI.
6
Department of Pediatrics, Boston Children's Hospital, Boston, MA.
7
Department of Pediatrics, Cardinal Glennon Children's Hospital, Saint Louis University, St Louis, MO.
8
Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
9
Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
10
Department of Biostatistics, University of Pennsylvania, Philadelphia, PA.
11
Beth Israel Deaconess Medical Center, Boston, MA.

Abstract

STUDY OBJECTIVES:

Obstructive sleep apnea syndrome (OSAS) has been associated with cardiometabolic disease in adults. In children, this association is unclear. We evaluated the effect of early adenotonsillectomy (eAT) for treatment of OSAS on blood pressure, heart rate, lipids, glucose, insulin, and C-reactive protein. We also analyzed whether these parameters at baseline and changes at follow-up correlated with polysomnographic indices.

DESIGN:

Data collected at baseline and 7-mo follow-up were analyzed from a randomized controlled trial, the Childhood Adenotonsillectomy Trial (CHAT).

SETTING:

Clinical referral setting from multiple centers.

PARTICIPANTS:

There were 464 children, ages 5 to 9.9 y with OSAS without severe hypoxemia.

INTERVENTIONS:

Randomization to eAT or Watchful Waiting with Supportive Care (WWSC).

MEASUREMENTS AND RESULTS:

There was no significant change of cardiometabolic parameters over the 7-mo interval in the eAT group compared to WWSC group. However, overnight heart rate was incrementally higher in association with baseline OSAS severity (average heart rate increase of 3 beats per minute [bpm] for apnea-hypopnea index [AHI] of 2 versus 10; [standard error = 0.60]). Each 5-unit improvement in AHI and 5 mmHg improvement in peak end-tidal CO2 were estimated to reduce heart rate by 1 and 1.5 bpm, respectively. An increase in N3 sleep also was associated with small reductions in systolic blood pressure percentile.

CONCLUSIONS:

There is little variation in standard cardiometabolic parameters in children with obstructive sleep apnea syndrome (OSAS) but without severe hypoxemia at baseline or after intervention. Of all measures, overnight heart rate emerged as the most sensitive parameter of pediatric OSAS severity.

CLINICAL TRIAL REGISTRATION:

Clinicaltrials.gov (#NCT00560859).

KEYWORDS:

adenotonsillectomy; metabolism; obstructive sleep apnea syndrome; pediatrics

PMID:
25669177
PMCID:
PMC4531407
DOI:
10.5665/sleep.4976
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center