Effect of surgical intervention for childhood OSA on blood pressure: A randomized controlled study

Chun Ting Au; Kate Ching-Ching Chan; Dennis Lip Yen Lee; Natalie Moon Wah Leung; Samuel Man Wai Chow; Ka Li Kwok; Yun Kwok Wing; Albert M Li

doi:10.1016/j.sleep.2023.04.006

Effect of surgical intervention for childhood OSA on blood pressure: A randomized controlled study

Sleep Med. 2023 Jul:107:9-17. doi: 10.1016/j.sleep.2023.04.006. Epub 2023 Apr 11.

Authors

Chun Ting Au¹, Kate Ching-Ching Chan², Dennis Lip Yen Lee³, Natalie Moon Wah Leung³, Samuel Man Wai Chow³, Ka Li Kwok⁴, Yun Kwok Wing⁵, Albert M Li⁶

Affiliations

¹ Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special administrative region of China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong Special administrative region of China; Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special administrative region of China; Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
² Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special administrative region of China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong Special administrative region of China; Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special administrative region of China.
³ Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special administrative region of China.
⁴ Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong Special administrative region of China.
⁵ Li Chun Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special administrative region of China.
⁶ Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special administrative region of China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong Special administrative region of China; Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special administrative region of China. Electronic address: albertmli@cuhk.edu.hk.

PMID: 37094489
DOI: 10.1016/j.sleep.2023.04.006

Abstract

Objective: To investigate the effect of surgical intervention on 24-h ABP in children with OSA. It was hypothesized that blood pressure would improve following adenotonsillectomy.

Methods: This was a two-centered investigator-blinded randomized controlled trial. Non-obese pre-pubertal children aged 6-11 years with OSA (obstructive apnea-hypopnea index, OAHI >3/h) underwent 24-h ABP monitoring at baseline and 9 months after the randomly assigned intervention, i.e. Early Surgery (ES) or Watchful Waiting (WW). Intention-to-treat analysis was performed.

Results: 137 subjects were randomized. Sixty-two (Age: 7.9y ± 1.3, 71% boys) and 47 (Age: 8.5y ± 1.6, 77% boys) participants from the ES and WW groups, respectively completed the study. Changes in ABP parameters were similar in the ES and WW groups (nighttime systolic BP z-scores: +0.03 ± 0.93 vs. -0.06 ± 1.04, p = 0.65; nighttime diastolic BP z-scores: -0.20 ± 0.95 vs. -0.02 ± 1.00, p = 0.35) despite a greater improvement in OSA in the ES group. However, a reduction in nighttime diastolic BP z-score correlated with improvements in OSA severity indexes (r = 0.21-0.22, p < 0.05), and a significant improvement in nighttime diastolic BP z-score [-0.43 ± 1.01, p = 0.027] following surgery was observed in participants with severe preoperative OSA (OAHI ≥10/h). The ES group had a significant increase in body mass index z-score after surgery [+0.27 ± 0.57, p < 0.001], which correlated with the increase in daytime systolic BP z-score (r = 0.2, p < 0.05).

Conclusion: Surgical treatment did not lead to significant improvements in ABP in OSA children except in those with more severe disease. The improvement in BP was partially masked by the weight gain following surgery.

Clinical trial registration: The trial was registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn.

Registration number: ChiCTR-TRC-14004131).

Keywords: Adenotonsillectomy; Blood pressure; Cardiovascular complications; Children; Obstructive sleep apnea.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adenoidectomy
Blood Pressure / physiology
Child
Female
Humans
Male
Polysomnography
Sleep Apnea, Obstructive* / surgery
Tonsillectomy*

Associated data

ChiCTR/ChiCTR-TRC-14004131