• Mirja Quante, Rui Wang, Jia Weng, Carol L Rosen, Raouf Amin, Susan L Garetz, Eliot Katz, Shalini Paruthi, Raanan Arens, Hiren Muzumdar, Carole L Marcus, Susan Ellenberg, Susan Redline, and Childhood Adenotonsillectomy Trial (CHAT).
• Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA.
• Sleep. 2015 Sep 1; 38 (9): 1395-403.

Study ObjectivesObstructive 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.DesignData collected at baseline and 7-mo follow-up were analyzed from a randomized controlled trial, the Childhood Adenotonsillectomy Trial (CHAT).SettingClinical referral setting from multiple centers.ParticipantsThere were 464 children, ages 5 to 9.9 y with OSAS without severe hypoxemia.InterventionsRandomization to eAT or Watchful Waiting with Supportive Care (WWSC).Measurements And ResultsThere 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.ConclusionsThere 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.Clinical Trial RegistrationClinicaltrials.gov (#NCT00560859).© 2015 Associated Professional Sleep Societies, LLC.

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