Effect of Preoperative Weight Status and Disease Presentation on Postoperative Elevated Blood Pressure After Childhood Adenotonsillectomy

Hui Shan Hsieh, Hai Hua Chuang, Li Jen Hsin, Wan Ni Lin, Chung Jan Kang, Ming Ying Zhuo, Li Pang Chuang, Yu Shu Huang, Hsueh Yu Li, Tuan Jen Fang, Li Ang Lee*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

1 Scopus citations


OBJECTIVE: To investigate the risk factors of postoperative elevated blood pressure (BP) in children with childhood obstructive sleep apnea syndrome (OSAS) after adenotonsillectomy (AT).

STUDY DESIGN: Case series with planned data collection.

SETTING: Tertiary referral center.

METHODS: Two hundred forty-five consecutive children (180 boys and 65 girls, median age 6.6 years) with polysomnography-diagnosed OSAS who underwent AT between January 2010 and August 2019. Clinical, polysomnographic, and evening BP data were assessed preoperatively and postoperatively (≥3 months after AT). Changes in the variables before and after AT and between individuals with and without hypertension were compared.

RESULTS: Postoperatively, the median (interquartile range) apnea-hypopnea index significantly decreased from 10.4 (5.3-22.6) to 2.2 (1.0-3.8) events/h. In addition, the mean (standard deviation) evening diastolic BP z-score significantly decreased from 0.7 (0.94) to 0.5 (0.81) in the overall cohort, and both systolic (2.1 [0.94]-1.0 [1.31]) and diastolic BP z-scores (1.6 [0.98]-0.7 [0.85]) significantly decreased in the preoperative elevated BP subgroup. Multivariate logistic regression analysis showed that preoperative obesity (adjusted odds ratio = 4.36, 95% confidence interval = 2.24-8.49) and mean peripheral oxygen saturation <95% during sleep (adjusted odds ratio = 2.73, 95% confidence interval = 1.29-5.79) were independently associated with postoperative elevated BP.

CONCLUSION: Preoperative obesity and mean peripheral oxygen saturation <95% during sleep were significantly associated with postoperative elevated BP in the children with OSAS, further indicating the importance of careful BP monitoring in this subgroup despite AT treatment.

Original languageEnglish
Pages (from-to)1197-1208
Number of pages12
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number5
StatePublished - 05 2023

Bibliographical note

© 2023 American Association of Otolaryngology-Head and Neck Surgery Foundation.


  • adenotonsillectomy
  • blood pressure
  • hypoxemia
  • obesity
  • obstructive sleep apnea syndrome
  • Blood Pressure/physiology
  • Humans
  • Hypertension/complications
  • Male
  • Sleep Apnea, Obstructive/complications
  • Adenoidectomy
  • Tonsillectomy
  • Obesity/complications
  • Female
  • Child


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