Effects of adenotonsillectomy on R–R interval and brain natriuretic peptide levels in children with sleep apnea: A preliminary report

Sleep Medicine
Volume 12, Issue 7 , Pages 646-651, August 2011

Athanasios G. Kaditis,  Konstantinos Chaidas, Emmanouel I. Alexopoulos, Vasiliki Varlami, Georgia Malakasioti, Konstantinos Gourgoulianis

Objectives

Obstructive sleep apnea is associated with decreased R–R interval length and overall R–R interval variability in the electrocardiogram along with increased morning brain natriuretic peptide (BNP) blood levels. These findings indicate enhanced sympathetic tone and cardiac strain. In this study, it was hypothesized that adenotonsillectomy (AT) in children with sleep apnea is accompanied by improvement in polysomnography indices, increase in length and variability of R–R interval, and reduction in BNP levels.

Methods

Polysomnography and measurements of morning BNP levels were performed before and 4–6months after AT. Mean and standard deviation of R–R interval were calculated from polysomnography electrocardiogram recordings.

Results

Twenty-one children were studied. Apnea-hypopnea index and log-transformed BNP levels decreased postoperatively from 8.4±7.6episodes/h and 2.2±0.7, to 1.8±1.4episodes/h and 1.9±0.3, respectively (p<0.05). Mean R–R interval increased from 703.2±137.4ms (Stage 2), 699.3±135.8ms (Stage 3), 707.4±128.9ms (Stage 4) and 660.5±140.1ms (Stage REM), to 773.5±122.7ms (Stage 2), 765.7±73.7ms (Stage 3), 771.2±71.6ms (Stage 4), and 738.6±81.7ms (Stage REM), respectively (p<0.05 for comparisons pre- vs. post-operatively). Standard deviation of R–R in Stage 2 increased from 88.5±29.6 to 122.7±67ms (p=0.045).

Conclusions

Increase in nocturnal length of R–R interval and decrease in BNP levels after AT for sleep apnea may reflect postoperative reduction in sympathetic tone and cardiac strain.

Snoring and obstructive sleep apnea.

Med Clin North Am. 2010 Sep;94(5):1047-55.

Ulualp SO.

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9035, USA. seckin.ulualp@utsouthwestern.edu

Abstract

Obstructive sleep apnea (OSA) may be associated with myriad clinical consequences such as increased risk of systemic hypertension, coronary vascular disease, congestive heart failure, cerebrovascular disease, glucose intolerance, impotence, obesity, pulmonary hypertension, gastroesophageal reflux, and impaired concentration. Nonetheless, OSA remains undiagnosed in 82% of men and 93% of women with the condition. Early identification and treatment of OSA provides significant relief for individuals, prevents complications of OSA, and reduces overall health care costs. Better understanding of the pathogenesis, risk factors, diagnosis, and treatment of OSA has the potential to improve early recognition of OSA and prevention of adverse effects on the individual and society.