© 2008 American Thoracic Society
Blood Pressure after Adenotonsillectomy in Children with Obstructive Sleep-disordered BreathingTo the Editor:In their article (1), Dr. Amin and colleagues presented results of serial polysomnographies and body mass index (BMI) and blood pressure (BP) measurements in children undergoing adenotonsillectomy (AT) for obstructive sleep apnea, and in control participants without disturbance in respiration during sleep. The investigators nicely demonstrated that rate of postoperative BMI increase predicted late recurrence of sleep-disordered breathing (SDB). Moreover, a decline in diastolic BP was documented in children operated on for sleep apnea at 6 months after surgery, regardless of whether SDB ultimately recurred or not. Systolic BP at the 1-year follow-up increased significantly in children with recurrence of sleep apnea and rapid postoperative weight gain. No systolic BP changes were evident in children who were finally cured or in the comparison group. Data from a cohort of Greek children who underwent AT for SDB revealed similar BP trends (2). At 2 to 14 months postoperatively (mean interval approximately 6 mo), morning diastolic BP did not change in controls without SDB who had AT for recurrent tonsillitis or otitis, tended to decrease in children with residual SDB, and decreased significantly in subjects with apnea–hypopnea index of less than 1 episode/hour after surgery. At follow-up evaluation, there was a significant BMI increase in all three study groups. Morning systolic BP increased in control subjects and children with residual SDB, probably due to weight gain, whereas it did not change in children with complete resolution of sleep apnea postoperatively. It is conceivable that surgical relief of upper airway obstruction in this latter group had a lowering effect on systolic BP and prevented the increase associated with weight gain. Combining the results of the two studies, one could claim that successful treatment of obstructive sleep apnea in childhood decreases the diastolic component of BP, but the direction of changes in systolic BP is affected by the degree of postoperative weight gain. Such an interpretation is in line with 24-hour BP monitoring data in children with SDB (3), indicating that the systolic component is equally affected by BMI and severity of SDB. In contrast, the diastolic component is mainly affected by SDB, and the contribution of adiposity depends on the time that BP measurement is performed (higher contribution at night). Thus, both reports (1, 2) add strength to the accumulating evidence that successful treatment of obstructive sleep apnea in childhood can modify risk factors of future cardiovascular morbidity favorably (4, 5).
Larissa University Hospital FOOTNOTES Conflict of Interest Statement: A.K. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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