Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Sleep Med. 2020 Jan;65:127-133. doi: 10.1016/j.sleep.2019.07.027. Epub 2019 Aug 14.
Limited information is currently available on 24-h ambulatory blood pressure (ABP) changes after adenotonsillectomy (T&A) in children with obstructive sleep apnea (OSA). In this study, the trajectory of 24-h ABP changes after surgery in children with OSA was examined at three-month and six-month follow-up.
Children aged 4-16 years with clinical symptoms of OSA and polysomnography (PSG)-diagnosed OSA (apnea-hypopnea index [AHI] >1) were included. All the children received T&A. PSG was conducted before and after surgery. Twenty four hour ABP was monitored using the linear mixed model before, three months after, and six months after surgery.
In total, 122 children were examined (mean age: 7.9 years; 71% were boys). The AHI significantly decreased from 12.7 ± 16.7 to 2.4 ± 3.2 events/h after T&A (P < 0.001). Overall diastolic blood pressure (DBP; from 65.1 to 63.4 mmHg, P = 0.01) and night-time DBP (from 57.4 to 55.4 mmHg, P = 0.032) decreased nonsignificantly during the six-month postoperative period. The OSA children with presurgical hypertension exhibited significant reductions in overall systolic blood pressure (SBP), overall DBP, daytime DBP, night-time SBP, and night-time DBP at the three-month and six-month postoperative follow-up (all P < 0.05). The three-month and six-month ABP data did not differ significantly in the entire cohort, even between children with presurgical hypertension and non-hypertensive children.
The 24-h ABP decreased significantly in the OSA children with hypertension at three and six months after surgery. Moreover, ABP findings did not differ significantly between the three- and six-month follow-up.
目前关于阻塞性睡眠呼吸暂停（OSA）儿童腺样体扁桃体切除术（T&A）后 24 小时动态血压（ABP）变化的信息有限。本研究在术后 3 个月和 6 个月随访时检查了 OSA 儿童手术后 24 小时 ABP 变化的轨迹。
纳入了有 OSA 临床症状和多导睡眠图（PSG）诊断的 OSA（呼吸暂停低通气指数[AHI]＞1）的 4-16 岁儿童。所有儿童均接受 T&A。手术前后进行 PSG。使用线性混合模型在手术前、手术后 3 个月和 6 个月监测 24 小时 ABP。
共检查了 122 名儿童（平均年龄：7.9 岁；71%为男性）。T&A 后 AHI 从 12.7±16.7 降至 2.4±3.2 事件/小时（P＜0.001）。总体舒张压（DBP；从 65.1 降至 63.4mmHg，P=0.01）和夜间 DBP（从 57.4 降至 55.4mmHg，P=0.032）在术后 6 个月期间无显著下降。术前患有高血压的 OSA 儿童在术后 3 个月和 6 个月随访时，整体收缩压（SBP）、整体 DBP、日间 DBP、夜间 SBP 和夜间 DBP 均有显著下降（均 P＜0.05）。整个队列中，3 个月和 6 个月的 ABP 数据无显著差异，即使在术前高血压和非高血压儿童之间也是如此。
高血压 OSA 儿童在手术后 3 个月和 6 个月时 24 小时 ABP 显著下降。此外，3 个月和 6 个月随访时 ABP 无显著差异。
