Adenotonsillotomy resolving snoring ameliorates blood pressure and vascular structure in children – a preliminary report

Introduction
Adenotonsillar hypertrophy in children is the most common cause of sleep disordered breathing, which can have an impact on the cardiovascular system. The aim of the study was to assess blood pressure and carotid intima-media thickness in snoring children before and after surgery to restore patency of the upper airways.

Material and methods
In the prospective study 50 snoring children were involved (median age 7 years), who were qualified for adenotonsillotomy. They were assessed before the surgery and three and six months after. The control group comprised of 20 healthy children who were assessed once. The severity of snoring was based on a questionnaire filled in by the children’s parents. The results of office blood pressure measurements, ambulatory blood pressure monitoring, and common carotid arteries intima-media thickness (cIMT) were analysed.

Results
At baseline there were no differences between the study and the control group according to the casual systolic (SBP) and diastolic blood pressure (DBP) (z-score SBP 0.043 vs. –0.35, p = 0.7551; z-score DBP –0.07 vs. –0.51, p = 0.2232). After three and six months from the surgery casual blood pressure decreased significantly in the study group (z-score SBP 0.043 vs. –0.187 vs. –0.761, p = 0.0004; z-score DBP –0.07 vs. –0.22 vs. –0.41, p < 0.0001, respectively). There was a significant decrease of the mean ambulatory blood pressure after the surgery (p = 0.0393). Baseline cIMT was significantly greater in the study group compared to the controls (left cIMT 0.052 cm vs. 0.045 cm, p = 0.0015, right cIMT 0.053 cm vs. 0.050 cm, p = 0.0162). After intervention, cIMT decreased significantly.

Conclusions
Children snoring due to upper airways lymphoid tissue hypertrophy are normotensive but present features of subclinical vascular damage. Surgical intervention lowers the blood pressure and ameliorates arterial structure. The improvement of night breathing pattern is beneficial for the circulatory system.