title: Severity of childhood obstructive sleep apnea and hypertension improved after adenotonsillectomy.
abstract: OBJECTIVE
  To report improvements in childhood obstructive sleep apnea (OSA) and hypertension after adenotonsillectomy.
  
  
  METHODS
  Case series with planned data collection.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Fifty consecutive patients (36 boys and 14 girls; median age, 7.0 years) who underwent plasma knife-assisted total tonsillectomy and adenoidectomy for OSA between January 2010 and March 2013 were assessed with the body mass index z score, apnea-hypopnea index (AHI), systolic blood pressure (BP), and diastolic BP at baseline and at ≥6 months postoperatively. Changes in these parameters were statistically analyzed using nonparametric tests with the bootstrap approach.
  
  
  RESULTS
  The median follow-up period was 9.6 months. Postoperatively, the median AHI significantly reduced from 9.8 to 1.6 (P<.001). Although the median systolic BP and diastolic BP insignificantly changed in the overall group, both were significantly reduced in children with preoperative hypertension (systolic: from 119.0 to 113.0 [P=.038]; diastolic: from 79.0 to 68.0 [P=.005]). Accordingly, the hypertension rate significantly reduced from 34% to 14% (P=.006). However, the change in OSA severity was not well correlated with the change in hypertension severity. In multiple logistic regression analysis with forward selection, a combination of preoperative hypertension and severe OSA was a significant predictor of postoperative hypertension (relative risk, 15.4; 95% confidence interval, 3.7-64.3; P<.001).
  
  
  CONCLUSIONS
  The decreased hypertension rate indicates that a reduction of the AHI is not all that matters after adenotonsillectomy in childhood OSA. However, patients with preoperative severe OSA and hypertension need careful management of their elevated BP despite surgical treatment.
authors.affiliation: School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Otolaryngology, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China 5738@cgmh.org.tw.
authors.forename: Li-Ang
authors.initials: LA
authors.lastname: Lee
authors.affiliation: School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Otolaryngology, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Hsueh-Yu
authors.initials: HY
authors.lastname: Li
authors.affiliation: School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Internal Medicine, Sleep Center, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Lin
authors.affiliation: School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Otolaryngology, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China.
authors.forename: Tuan-Jen
authors.initials: TJ
authors.lastname: Fang
authors.affiliation: School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Child Psychiatry, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Yu-Shu
authors.initials: YS
authors.lastname: Huang
authors.affiliation: School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Jen-Fu
authors.initials: JF
authors.lastname: Hsu
authors.affiliation: School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Otolaryngology, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Che-Ming
authors.initials: CM
authors.lastname: Wu
authors.affiliation: Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chung-Guei
authors.initials: CG
authors.lastname: Huang
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D017286:Polysomnography; D011184:Postoperative Period; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: adenotonsillectomy; children; hypertension; obstructive sleep apnea; outcome