Ambulatory blood pressure before and after adenotonsillectomy in children with obstructive sleep apnea

Ng, Daniel K.; Wong, J.Y.C.; Chan, Chung-hong; Leung, Lettie Chuk-Kwan; Leung, Shuk-Yu

doi:10.1016/j.sleep.2009.10.007

Cited by 88 publications

(87 citation statements)

References 31 publications

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“…21 Three pediatric studies have examined the effect of adenotonsillectomy on BP; two of these studies used office BP measurements and did not demonstrate significant improvements in BP, 13,22 whereas one study used 24-hour ambulatory BP measurements (ABPM) and did show improvement. 23 The effect of PAP treatment on 24-hour BP in children with SDB has not been evaluated.…”

mentioning

confidence: 99%

Insulin Resistance and Hypertension in Obese Youth With Sleep-Disordered Breathing Treated With Positive Airway Pressure: A Prospective Multicenter Study

Katz

MacLean

Hoey

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: There is evidence that cardiometabolic disease associated with obesity and sleep-disordered breathing (SDB) in adults is present in youth. SDB is often treated with positive airway pressure (PAP) in youth with obesity. Our aims were to determine: (1) the prevalence of cardiometabolic disease and (2) whether PAP improves markers of cardiometabolic disease, in youth with obesity and newly diagnosed moderate-severe SDB. Methods: A prospective multicenter cohort study was conducted in youth (8 to 16 years old) with obesity, prescribed PAP therapy for newly diagnosed moderate-severe SDB. Assessments occurred at baseline and at 6 and 12 months. Outcomes included markers of insulin resistance (change in homeostasis model assessment of insulin resistance (HOMA-IR) at 6 months = primary outcome), hypertension (24-hour ambulatory/blood pressure) and inflammation (high-sensitivity C-reactive protein: hs-CRP). Results: Twenty-seven participants were enrolled. Of those with baseline testing available, 10/25 (40%) had HOMA-IR above the 97th percentile, 10/23 (44%) were hypertensive, 16/23 (70%) had loss of nocturnal blood pressure dip and hs-CRP was elevated in 16/27 (64%). There were no significant changes over time in markers of metabolic dysfunction or blood pressure, nor between PAP-adherent and non-adherent subgroups. Conclusions:In youth with obesity and SDB, metabolic dysfunction and hypertension were highly prevalent. There were no statistically significant improvements in cardiometabolic markers 1 year after the prescription of PAP therapy, although clinically relevant improvements were seen in insulin resistance and systolic blood pressure load, important predictors of future risk of cardiovascular disease. Larger, longer-term studies are needed to determine whether PAP improves cardiometabolic outcomes in obese youth. I NTRO DUCTI O NThe fivefold increase in prevalence of childhood obesity in North America over the past 20 years has led to an increasing number of pediatric cases of obesity-related sleep-disordered breathing (SDB), which includes both obstructive sleep apnea (OSA) and nocturnal hypoventilation.1 The prevalence of SDB, particularly OSA, is significantly higher among obese children (13% to 66%) compared with the general population (1% to 3%).2 Routine treatment for SDB with adenotonsillectomy is not curative in 70% to 80% of children with obesity.3 Thus, positive airway pressure (PAP) treatment is usually prescribed. 2Additional obesity-related complications are also increasingly recognized in children, including metabolic disturbances with insulin resistance (IR) and hypertension. 4,5 This is concerning, as IR is an identified surrogate measure of future obesity-related sequelae, including diabetes, , hypertension, and systemic inflammation) is highly prevalent at the time of SDB diagnosis in youth with obesity. We were unable to detect statistically significant improvements in cardiometabolic markers 1 year after prescription of PAP therapy. There were, however, clinically relevan...

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mentioning

confidence: 99%

Insulin Resistance and Hypertension in Obese Youth With Sleep-Disordered Breathing Treated With Positive Airway Pressure: A Prospective Multicenter Study

Katz

MacLean

Hoey

et al. 2017

Journal of Clinical Sleep Medicine

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“…However, the few interventional studies of metabolic outcome in children with OSA after adenotonsillectomy (T&A, the gold standard pediatric OSA treatment) have had similarly contradictory results. [19][20][21][22] Thus, we set out to prospectively study a cohort of children with OSA and examine the contribution of OSA to IR, glucose homeostasis, and dyslipidemia independently of body habitus by assessing changes in metabolic and anthropometric parameters following T&A.…”

mentioning

confidence: 99%

Impact of Adenotonsillectomy on Insulin Resistance and Lipoprotein Profile in Nonobese and Obese Children

Koren

Gozal

Bhattacharjee

et al. 2016

Chest

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“…Obesity is a well-established risk factor for OSA, 16,17 which has been demonstrated to lead to elevated BP. [18][19][20][21] Obesity itself is also a wellknown risk factor of elevated BP. 22 In the current study, we used more stringent criteria to minimize the confounding effects of obesity and OSA so as to focus on the independent relationship between sleep duration and BP.…”

Section: Resultsmentioning

confidence: 99%

“…6,7,[9][10][11][12]14,15 OSA has been documented to lead to elevated BP in children and adolescents. [18][19][20][21] Therefore, in assessing the relationship between sleep duration and BP, the OSA status has to be ascertained and controlled for. Most of the previous studies included both obese and nonobese subjects and analyzed the 2 groups together.…”

Section: Table 3 Abp Of Different Sleep Duration Groupsmentioning

confidence: 99%

Acute and Chronic Effects of Sleep Duration on Blood Pressure

Au¹,

Wing

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Inconsistent results have been reported on the association between sleep duration and blood pressure (BP) in children, likely as a result of inadequate adjustment for confounders and the use of different time frames in assessing sleep duration.WHAT THIS STUDY ADDS: Short sleep duration and poor sleep quality are associated with higher BP in normal-weight adolescents. One night of adequate sleep may partially ameliorate the risk of high BP but cannot completely reverse the effect of chronic sleep insufficiency. abstract OBJECTIVE: To evaluate the association between ambulatory blood pressure (ABP) and sleep duration as measured by 7-day sleep diary and nocturnal polysomnography in normal-weight adolescents without significant obstructive sleep apnea. METHODS:Subjects aged 10 to 17.9 years with an obstructive apnea hypopnea index ,5 underwent polysomnography for 9.5 hours and 24-hour ABP monitoring commencing at noon on the same day. ABP was divided into prepolysomnography, in bed during polysomnography, and postpolysomnography periods for separate analyses. Sleep duration (SpD 7 ) was obtained from a 7-day sleep diary, reflecting the sleep pattern in the week before admission. Total sleep time (TST) and sleep efficiency (SpE) were obtained from polysomnography. RESULTS:A total of 143 adolescents participated. SpD 7 was inversely associated with systolic blood pressure (SBP) in prepolysomnography, in-bed, and postpolysomnography periods (all b = 22 mm Hg) and with diastolic blood pressure (DBP) in prepolysomnography and in-bed periods (all b = 21 mm Hg). TST was inversely associated with SBP in the postpolysomnography period (b = 21.5 mm Hg). SpE was inversely associated with SBP in in-bed period (b = 20.1 mm Hg) and with DBP in in-bed (b = 20.1 mm Hg) and postpolysomnography (b = 20.2 mm Hg) periods. Neither TST nor SpE was associated with SBP and DBP in prepolysomnography period.CONCLUSIONS: Short sleep duration as reflected by 7-day sleep diary was associated with higher blood pressure in normal-weight adolescents. Occasional adequate sleep may partially ameliorate the risk of high blood pressure but may not completely reverse the effect of long-term sleep insufficiency. Pediatrics 2014;133:e64-e72

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Ambulatory blood pressure before and after adenotonsillectomy in children with obstructive sleep apnea

Cited by 88 publications

References 31 publications

Insulin Resistance and Hypertension in Obese Youth With Sleep-Disordered Breathing Treated With Positive Airway Pressure: A Prospective Multicenter Study

Insulin Resistance and Hypertension in Obese Youth With Sleep-Disordered Breathing Treated With Positive Airway Pressure: A Prospective Multicenter Study

Impact of Adenotonsillectomy on Insulin Resistance and Lipoprotein Profile in Nonobese and Obese Children

Acute and Chronic Effects of Sleep Duration on Blood Pressure

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