Removal of enlarged tonsils can prevent high blood pressure and future heart damage in a child suffering from sleep apnea, i.e. a disturbed breathing during sleep, US research indicates.
Researchers from the Medical Center of Children’s Hospital in Cincinnati, Ohio, presented their results on Monday at the American Thorax Society International Conference, held in Denver, Colorado.
As they observed, in children with obstructive sleep apnea (OSA), excision of the hypertrophied palatine and pharyngeal tonsils (the so-called third tonsils) may lead to a significant drop in blood pressure within 24 months after surgery. And persistently elevated or high blood pressure is a risk factor for damage to various organs, including the heart muscle, the authors note.
The tonsils are clusters of absorbent tissue in the mouth and throat that are designed to create a barrier to bacteria and other pathogens. These structures play a very important immune function in infants and young children, but over time their role in building human immunity disappears. Tonsil overgrowth can cause many disorders, such as reduced airflow through the respiratory tract, difficulty breathing through the nose and mouth, and snoring at night. Most often it affects the palatine tonsils and the pharyngeal tonsil (the so-called third tonsil).
As the lead author of the study, Lisa Burns, recalled, children with oversized tonsils are especially prone to developing obstructive sleep apnea. This serious disorder manifests itself as periodic pauses in breathing during sleep, resulting in hypoxia to tissues and organs, such as the nervous system and heart muscle. The best known symptom of apnea is snoring, but not all snorers suffer from apnea, although they are at a much higher risk.
Studies show that in both children and adults, apnea leads to an increase in blood pressure during the day and night, and to an increase in the heart rate. Sleep apnea can also hinder the natural fall in blood pressure at night that is natural for most people.
We know that children with sleep apnea are more likely to have higher blood pressure than peers without the disorder, even if it is within the normal range, Burns explains. Toddlers with persistently higher blood pressure often develop hypertension in adulthood, she adds. This is associated with an increased risk of other cardiovascular diseases, such as heart attacks, heart failure and strokes.
Burns and his colleagues conducted a study in a group of 115 children aged 7-13 years, of which 28 suffered from mild sleep apnea, 27 – from severe sleep apnea, and 60 were healthy. The severity of apnea symptoms was assessed in young patients using a method called polysomnography, which measures various physiological parameters during sleep, such as bioelectrical activity of the brain (electroencephalogram), airflow in the airways, recording of eye movement (electrooculogram), recording of electrical activity of the muscles ( electromyogram) and others.
All children suffering from apnea had enlarged adenoids and therefore underwent surgery to remove them. At the beginning of the study and 12 and 24 months after their tonsillectomy, their blood pressure and heart volume were measured.
The researchers observed that the blood pressure of children who underwent tonsillectomy decreased compared to baseline. The operation also restored the natural drop in blood pressure during bed rest. In addition, there was a reduction in heart size after surgery in the subgroup of children with moderate to severe sleep apnea.
We have also shown that sleep apnea has the greatest effect on diastolic (so-called lower – PAP) blood pressure, i.e. the pressure value during the relaxation of the heart muscle, adds Burns.
In her opinion, these observations highlight the need to treat severe sleep apnea in children in order to prevent chronic high blood pressure and end organ damage.
By identifying children with high blood pressure due to sleep apnea and treating them at an early age, we hope to prevent their cardiovascular disease in the future, concludes Burns. (PAP)