title: The Effect of Adenotonsillectomy for Childhood Sleep Apnea on Cardiometabolic Measures.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Data collected at baseline and 7-mo follow-up were analyzed from a randomized controlled trial, the Childhood Adenotonsillectomy Trial (CHAT).
  
  
  METHODS
  Clinical referral setting from multiple centers.
  
  
  METHODS
  There were 464 children, ages 5 to 9.9 y with OSAS without severe hypoxemia.
  
  
  METHODS
  Randomization to eAT or Watchful Waiting with Supportive Care (WWSC).
  
  
  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.
  
  
  BACKGROUND
  Clinicaltrials.gov (#NCT00560859).
authors: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA.|Harvard Medical School, Boston, MA.
authors: Mirja
authors: M
authors: Quante
authors: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA.|Harvard Medical School, Boston, MA.
authors: Rui
authors: R
authors: Wang
authors: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA.
authors: Jia
authors: J
authors: Weng
authors: Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals-Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
authors: Carol L
authors: CL
authors: Rosen
authors: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors: Raouf
authors: R
authors: Amin
authors: Department of Otolaryngology, Head and Neck Surgery and Sleep Disorders Center, University of Michigan Medical Center, Ann Arbor, MI.
authors: Susan L
authors: SL
authors: Garetz
authors: Harvard Medical School, Boston, MA.|Department of Pediatrics, Boston Children's Hospital, Boston, MA.
authors: Eliot
authors: E
authors: Katz
authors: Department of Pediatrics, Cardinal Glennon Children's Hospital, Saint Louis University, St Louis, MO.
authors: Shalini
authors: S
authors: Paruthi
authors: Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
authors: Raanan
authors: R
authors: Arens
authors: Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
authors: Hiren
authors: H
authors: Muzumdar
authors: Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
authors: Carole L
authors: CL
authors: Marcus
authors: Department of Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors: Susan
authors: S
authors: Ellenberg
authors: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA.|Harvard Medical School, Boston, MA.|Beth Israel Deaconess Medical Center, Boston, MA.
authors: Susan
authors: S
authors: Redline
mesh_terms: D000233:Adenoidectomy; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D005260:Female; D005947:Glucose / Q000378:metabolism; D006339:Heart Rate; D006801:Humans; D007328:Insulin / Q000378:metabolism; D050356:Lipid Metabolism; D008297:Male; D017286:Polysomnography; D012890:Sleep / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000378:metabolism* / Q000503:physiopathology*; D014068:Tonsillectomy
chemical_list: D007328:Insulin; D002097:C-Reactive Protein; D005947:Glucose
keywords: adenotonsillectomy; metabolism; obstructive sleep apnea syndrome; pediatrics