Effect of adenotonsillectomy on blood pressure in children with obstructive sleep apnea: a meta-analysis

Abstract

BackgroundWhile adenotonsillectomy (T&A) is widely recognized as the first-line therapy for pediatric obstructive sleep apnea (OSA), effects of T&A on blood pressure (BP) remain unclear. This meta-analysis evaluates the associations between T&A and BP in children with OSA. MethodsThe study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched the PubMed, Medline, EMBASE, and Cochrane databases. The keywords used were “sleep apnea syndromes,” “adenotonsillectomy,” and “child.” A random-effects model was applied to determine office systolic BP (SBP), diastolic BP (DBP), and ambulatory BP changes. ResultTwelve studies with 1193 children were analyzed (mean age: 7.6 y; 54% boys). The apnea-hypopnea index significantly reduced of 9.4 events/h (95% CI, −12.0 to −6.8) after T&A. Office SBP (−0.24 mmHg; 95% CI, −1.64 to 1.16) and DBP (−1.65 mmHg; 95% CI, −3.47 to 0.17) did not decrease significantly after surgery. No significant decreases were observed in 24-h ambulatory BP after T&A. Subgroup analysis showed a significant postoperative decrease in office SBP (−6.23 mmHg; 95% CI, −7.78 to −4.67) and DBP (−7.93 mmHg; 95% CI, −10.37 to −5.48) among children with hypertension but a slight increase in office SBP (2.50 mmHg; 95% CI, 1.14 to 3.86) and DBP (1.98 mmHg; 95% CI, −0.02 to 3.98) in those without (P for heterogeneity < 0.001). ConclusionThis meta-analysis suggests the office and ambulatory BP changes after T&A in children with OSA are trivial. Moreover, children with hypertension experience a significantly greater decrease in office BP than children without hypertension.