• Li-Ang Lee, Hsueh-Yu Li, Yu-Sheng Lin, Tuan-Jen Fang, Yu-Shu Huang, Jen-Fu Hsu, Che-Ming Wu, and Chung-Guei Huang.
• School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan Department of Otolaryngology, Sleep Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China 5738@cgmh.org.tw.
• Otolaryngol Head Neck Surg. 2015 Mar 1; 152 (3): 553-60.

ObjectiveTo report improvements in childhood obstructive sleep apnea (OSA) and hypertension after adenotonsillectomy.Study DesignCase series with planned data collection.SettingTertiary referral center.Subjects And MethodsFifty consecutive patients (36 boys and 14 girls; median age, 7.0 years) who underwent plasma knife-assisted total tonsillectomy and adenoidectomy for OSA between January 2010 and March 2013 were assessed with the body mass index z score, apnea-hypopnea index (AHI), systolic blood pressure (BP), and diastolic BP at baseline and at ≥6 months postoperatively. Changes in these parameters were statistically analyzed using nonparametric tests with the bootstrap approach.ResultsThe median follow-up period was 9.6 months. Postoperatively, the median AHI significantly reduced from 9.8 to 1.6 (P<.001). Although the median systolic BP and diastolic BP insignificantly changed in the overall group, both were significantly reduced in children with preoperative hypertension (systolic: from 119.0 to 113.0 [P=.038]; diastolic: from 79.0 to 68.0 [P=.005]). Accordingly, the hypertension rate significantly reduced from 34% to 14% (P=.006). However, the change in OSA severity was not well correlated with the change in hypertension severity. In multiple logistic regression analysis with forward selection, a combination of preoperative hypertension and severe OSA was a significant predictor of postoperative hypertension (relative risk, 15.4; 95% confidence interval, 3.7-64.3; P<.001).ConclusionThe decreased hypertension rate indicates that a reduction of the AHI is not all that matters after adenotonsillectomy in childhood OSA. However, patients with preoperative severe OSA and hypertension need careful management of their elevated BP despite surgical treatment.© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

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