The effect of adenotonsillectomy for apnea CARDIOMETABOLIC The Effect of Adenotonsillectomy for Childhood Sleep Apnea on Cardiometabolic Measures

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. randomized controlled Childhood Adenotonsillectomy Trial (CHAT). 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 CO 2 were estimated to reduce heart rate by 1 and 1.5 bpm, N3 also was associated with small reductions in systolic Conclusions: little in cardiometabolic 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. 30 showed a significant reduction in heart rate during sleep in association with a reduction in AHI after adenotonsillectomy with a decrease in sympathetic balance as demonstrated by heart rate variability. It has been proposed that an accelerated heart rate induced by sympathetic nervous system over activity is responsible for the reported risk of long-term cardiovascular events and all-cause mortality. 50,51 Our results extend those reports by showing that OSAS is associated not only with heart rate measures during sleep as well as during wakefulness, al-beit changes are small.

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