Absence of Blood Pressure, Metabolic, and InflammatoryMarker Changes After Adenotonsillectomy for SleepApnea in Greek Children

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Abstract

Aim:

Pediatric studies revealed associations of obstructive sleep-disordered breathing (SDB) with inflammation, metabolic dysfunction, and elevated blood pressure. Evidence about effects of adenotonsillectomy on these abnormalities is scarce. Aim of this investigation was to assess changes in C-reactive protein (CRP), circulating intercellular adhesion molecule-1 (cICAM-1), insulin and blood pressure levels after adenotonsillectomy for SDB in Greek children.

Methods:

Polysomnography was performed pre- and postoperatively in children with SDB and controls undergoing adenotonsillectomy for recurrent tonsillitis or otitis. Outcome measures were changes in serum markers and blood pressure.

Results:

Fifty-eight patients (6.2±2.5 years old) and 17 controls (6.5±2) were studied. After surgery, apnea-hypopnea index (AHI) decreased (mean: -5.9 episodes/hr; 95% confidence interval: -7.8 to -4) in patients. Patients and controls were similar regarding outcomes: CRP (-0.11 mg/dl [-0.25 to 0.02] vs. 0.13 [-0.19 to 0.46]; P=0.11), cICAM-1 (-11.6 ng/ml [-38.6 to 15.4] vs. -46.6 [-101.7 to 8.6]; P=0.23), insulin (2.49 mU/L [0.32-4.67] vs. -0.16 [-2.47 to 2.16]; P=0.21), systolic blood pressure index (5.2% [2.1-8.3] vs. 10.8 [3.6-17.9]; P=0.1) and diastolic blood pressure index (-3.2% [-7.2 to 0.8] vs. 2.8 [-5.5 to 11.2]; P=0.16). Patients with CRP>0.3 mg/dl had reduced values after AT (P=0.003) and those with postoperative AHI≤1 had a decrease in diastolic blood pressure (P=0.02).

Conclusions:

Although adenotonsillectomy improves SDB, it has variable effects on inflammatory and metabolic markers or blood pressure. Pediatr Pulmonol. 2008; 43:550-560. © 2008 Wiley-Liss, Inc.

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