Paediatric Obstructive Sleep Disordered Breathing: Cardiovascular Changes After Adenotonsillectomy

IF 1.5 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology Pub Date : 2025-08-08 DOI:10.1111/coa.70018

Francisco Alves de Sousa, Marta Rios, Paula Branco, Sara Raquel Azevedo, Mariline Santos, Manuel Ferreira de Magalhães

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Abstract

Introduction

Obstructive sleep disordered breathing (OSDB) is prevalent in children and often associated with adenotonsillar hypertrophy (ATH). This prospective study investigated the impact of adenotonsillectomy on cardiovascular parameters in children with ATH and suspected OSDB, employing a generalised estimating equation (GEE) approach to account for repeated measures and potential confounders.

Methods

Children (4–14 years) with ATH and clinical OSDB undergoing adenotonsillectomy were included. Pre- and post-operative resting heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, and estimated cardiac output (COEst) were assessed. Paired t-tests and Wilcoxon signed-rank tests were used for pre-post comparisons, while GEE models examined the influence of time (surgery), age, gender, and their interactions on the outcomes.

Results

A total of 90 children (mean age: 6.86 ± 2.78 years) participated. Adenotonsillectomy resulted in a significant decrease in HR (p = 0.028) and COEst (p = 0.003). No significant changes were observed in SBP or DBP (p > 0.05). A significant negative correlation was found between the change in COEst and age (Spearman's rho = −0.349, p < 0.001), indicating a more pronounced reduction in COEst in younger children.

Conclusion

Adenotonsillectomy in children with ATH and clinical OSDB may lead to significant variations in resting heart rate and estimated cardiac output after surgery. This suggests a potential reduction in resting sympathetic activity following the resolution of upper airway obstruction, with a possible contribution of age-related factors to the observed cardiovascular responses to adenotonsillectomy.

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儿童阻塞性睡眠呼吸障碍：腺扁桃体切除术后的心血管变化。

梗阻性睡眠呼吸障碍（OSDB）在儿童中很普遍，通常与腺扁桃体肥大（ATH）有关。这项前瞻性研究调查了腺扁桃体切除术对ATH和疑似OSDB儿童心血管参数的影响，采用广义估计方程（GEE）方法来考虑重复测量和潜在混杂因素。方法：对行腺扁桃体切除术的ATH和临床OSDB患儿（4-14岁）进行分析。评估术前和术后静息心率（HR）、收缩压（SBP）、舒张压（DBP）、体重和估计心输出量（COEst）。配对t检验和Wilcoxon符号秩检验用于前后比较，而GEE模型检验了时间（手术）、年龄、性别及其相互作用对结果的影响。结果：共有90名儿童参与，平均年龄：6.86±2.78岁。腺扁桃体切除术导致HR （p = 0.028）和COEst （p = 0.003）显著降低。收缩压和舒张压无明显变化（p < 0.05）。COEst变化与年龄呈显著负相关（Spearman’s rho = -0.349, p）。结论：ATH患儿腺扁桃体切除术和临床OSDB可能导致术后静息心率和估计心输出量发生显著变化。这表明在上呼吸道阻塞解除后，静息交感神经活动可能会减少，可能与年龄相关的因素对腺扁桃体切除术后观察到的心血管反应有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Otolaryngology 医学-耳鼻喉科学

CiteScore

4.00

自引率

4.80%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with: current otorhinolaryngological practice audiology, otology, balance, rhinology, larynx, voice and paediatric ORL head and neck oncology head and neck plastic and reconstructive surgery continuing medical education and ORL training The emphasis is on high quality new work in the clinical field and on fresh, original research. Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject. • Negative/null results In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.