The effect of adenotonsillectomy for childhood sleep apnea on cardiometabolic measures

Childhood Adenotonsillectomy Trial (CHAT)

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

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. Design: Data collected at baseline and 7-mo follow-up were analyzed from a randomized controlled trial, the Childhood Adenotonsillectomy Trial (CHAT). Setting: Clinical referral setting from multiple centers. Participants: There were 464 children, ages 5 to 9.9 y with OSAS without severe hypoxemia. Interventions: Randomization to eAT or Watchful Waiting with Supportive Care (WWSC). 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 CO2 were estimated to reduce heart rate by 1 and 1.5 bpm, respectively. An increase in N3 sleep also was associated with small reductions in systolic blood pressure percentile. Conclusions: There is little variation in standard cardiometabolic parameters 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.

Original languageEnglish (US)
Pages (from-to)1395-1403A
JournalSleep
Volume38
Issue number9
DOIs
StatePublished - Sep 1 2015

Fingerprint

Sleep Apnea Syndromes
Obstructive Sleep Apnea
Heart Rate
Apnea
Blood Pressure
Watchful Waiting
Random Allocation
C-Reactive Protein
Sleep
Referral and Consultation
Randomized Controlled Trials
Insulin
Pediatrics
Lipids
Glucose

Keywords

  • Adenotonsillectomy
  • Metabolism
  • Obstructive sleep apnea syndrome
  • Pediatrics

ASJC Scopus subject areas

  • Physiology (medical)
  • Clinical Neurology

Cite this

The effect of adenotonsillectomy for childhood sleep apnea on cardiometabolic measures. / Childhood Adenotonsillectomy Trial (CHAT).

In: Sleep, Vol. 38, No. 9, 01.09.2015, p. 1395-1403A.

Research output: Contribution to journalArticle

Childhood Adenotonsillectomy Trial (CHAT) 2015, 'The effect of adenotonsillectomy for childhood sleep apnea on cardiometabolic measures', Sleep, vol. 38, no. 9, pp. 1395-1403A. https://doi.org/10.5665/sleep.4976
Childhood Adenotonsillectomy Trial (CHAT). / The effect of adenotonsillectomy for childhood sleep apnea on cardiometabolic measures. In: Sleep. 2015 ; Vol. 38, No. 9. pp. 1395-1403A.
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abstract = "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. Design: Data collected at baseline and 7-mo follow-up were analyzed from a randomized controlled trial, the Childhood Adenotonsillectomy Trial (CHAT). Setting: Clinical referral setting from multiple centers. Participants: There were 464 children, ages 5 to 9.9 y with OSAS without severe hypoxemia. Interventions: Randomization to eAT or Watchful Waiting with Supportive Care (WWSC). 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 CO2 were estimated to reduce heart rate by 1 and 1.5 bpm, respectively. An increase in N3 sleep also was associated with small reductions in systolic blood pressure percentile. Conclusions: There is little variation in standard cardiometabolic parameters 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.",
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author = "{Childhood Adenotonsillectomy Trial (CHAT)} and Mirja Quante and Rui Wang and Jia Weng and Rosen, {Carol L.} and Raouf Amin and Garetz, {Susan L.} and Eliot Katz and Shalini Paruthi and Raanan Arens and Hiren Muzumdar and Marcus, {Carole L.} and Susan Ellenberg and Susan Redline and Janice Ware and Dwight Jones and Ron Mitchell and Karen Snyder and Thomas, {Nina H.} and Lisa Elden and Dean Beebe and Paul Willging and Harris, {Shelby Freedman} and Taylor, {H. Gerry} and Robert Sprecher and James Arnold and David Gozal and Ronald Chervin and Bruno Giordani and Tim Hoban and Moore, {Rene{\'e} H.} and Kim Lacy and Melissa Fernando",
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