Effect of surgical intervention for childhood OSA on blood pressure: A randomized controlled study

Objective: To investigate the effect of surgical intervention on 24-h ABP in children with OSA. It was hypothesized that blood pressure would improve following adenotonsillectomy.Methods: This was a two-centered investigator-blinded randomized controlled trial. Non-obese pre-pubertal children aged 6-11 years with OSA (obstructive apnea-hypopnea index, OAHI >3/h) underwent 24-h ABP monitoring at baseline and 9 months after the randomly assigned intervention, i.e. Early Surgery (ES) or Watchful Waiting (WW). Intention-to-treat analysis was performed.Results: 137 subjects were randomized. Sixty-two (Age: 7.9y +/- 1.3, 71% boys) and 47 (Age: 8.5y +/- 1.6, 77% boys) participants from the ES and WW groups, respectively completed the study. Changes in ABP pa-rameters were similar in the ES and WW groups (nighttime systolic BP z-scores: +0.03 +/- 0.93 vs.-0.06 +/- 1.04, p = 0.65; nighttime diastolic BP z-scores:-0.20 +/- 0.95 vs.-0.02 +/- 1.00, p = 0.35) despite a greater improvement in OSA in the ES group. However, a reduction in nighttime diastolic BP z-score correlated with improvements in OSA severity indexes (r = 0.21-0.22, p < 0.05), and a significant improvement in nighttime diastolic BP z-score [-0.43 +/- 1.01, p = 0.027] following surgery was observed in participants with severe preoperative OSA (OAHI >= 10/h). The ES group had a significant increase in body mass index z-score after surgery [+0.27 +/- 0.57, p < 0.001], which correlated with the increase in daytime systolic BP z-score (r = 0.2, p < 0.05).Conclusion: Surgical treatment did not lead to significant improvements in ABP in OSA children except in those with more severe disease. The improvement in BP was partially masked by the weight gain following surgery. Clinical trial registration: The trial was registered with the Chinese Clinical Trial Registry (http://www. chictr.org.cn. Registration number: ChiCTR-TRC-14004131).(c) 2023 Elsevier B.V. All rights reserved.