Adenotonsillectomy and Blood Pressure in Children With Mild Obstructive Sleep-Disordered Breathing

The impact of adenotonsillectomy on blood pressure (BP) in children with mild obstructive sleep-disordered breathing (oSDB) remains unclear. To compare BP trajectories in children with mild oSDB randomized to early adenotonsillectomy (eAT) vs watchful waiting with supportive care (WWSC). This was a secondary outcome exploratory analysis of the Pediatric Adenotonsillectomy Trial for Snoring (PATS), a randomized clinical trial where children aged 3 to 12.9 years with snoring and mild oSDB (Obstructive Apnea-Hypopnea Index <3 with tonsillar hypertrophy [Brodsky scale grade ≥2]) were randomized to eAT vs WWSC and followed up for 12 months. PATS was conducted across 7 tertiary pediatric centers in the US. Participants were recruited from June 29, 2016, to February 1, 2021. Data were analyzed between July and November 2024. eAT vs WWSC. The outcomes of interest were 12-month changes in BP percentiles from baseline and the moderating effect of covariates on these changes. BP was measured with an automated oscillometric BP device at baseline, 6 months, and 12 months after randomization. The treatment effect on BP trajectories was evaluated using mixed-effect models. Of 458 participants included in the analysis, the mean (SD) age was 6.1 (2.3) years, 230 (50.2%) were female, and 169 (36.9%) had overweight/obesity. Mean (SD) baseline systolic BP (SBP) and diastolic BP (DBP) percentiles were 60.62 (25.22) and 53.86 (21.05), respectively, and 231 participants (50.4%) underwent eAT. From baseline to 12 months, SBP and DBP decreased in the eAT group but increased in the WWSC group. The between-group difference in changes from baseline for SBP was -9.02 (95% CI, -14.77 to -3.28) and for DBP was -6.53 (95% CI, -11.02 to -2.03). Moderation analysis showed that the effect of eAT on DBP was greater among children with body mass index higher than the 85th percentile, with an interaction effect estimate of -10.40 (95% CI, -19.69 to -1.12; P = .03). In this exploratory analysis of the PATS randomized clinical trial, BP trajectories differed by treatment arm. eAT led to decreases in SBP and DBP percentiles, while WWSC led to increases. Children with overweight/obesity benefited more from eAT than children without. ClinicalTrials.gov Identifier: NCT02562040.