Evaluation of systemic and pulmonary hypertension, cardiacfunctions and the factors affecting them in pre and post adenotonsillectomy periods in children with obstructive sleep apnea secondary to adenotonsillar hypertrophy,

It is estimated that obstructive sleep apnea syndrome (OSAS) is seen with a frequency of 2- 3.5% in children. Adenotonsillar hypertrophy (ATH) is the most common cause of OSAS in children. OSAS leads to cardiovascular comorbidities such as hypertension, right heart failure, left heart failure, pulmonary hypertension, arrhythmia and increased oxidative stress. Adenotonsillectomy operation is applied as the first treatment option in patients who develop OSAS secondary to ATH. In our study, it was planned to investigate the presence of cardiovascular changes, hypertension and oxidative stress before and after adenotonsillectomy operation in patients with OSAS secondary to adenotonsillar hypertrophy and without additional internal disease. This study included 28 patients with adenotonsillar hypertrophy who admitted to otolaryngology clinics between November 2018 and October 2019. The mean age ± standard deviation value of the patients was found to be 8.2 ± 2.06 (4.51-12.69). OSAS was diagnosed by polysomnography (PSG). Echocardiography (ECHO) and electrocardiography (ECG) was performed on patients diagnosed with OSAS, and 24-hour ambulatory blood pressure measurement (ABPM) was performed. Oxidant and antioxidant parameters were evaluated in blood serum samples from patients. Adenotonsillectomy operation was applied to all patient. At the 6th postoperative month (3-9 month) 22 of the patients applied for control evaluation. In the control evaluation, PSG, ECHO, ECG and ABPM were reapplied, and control blood serum sample was taken. Among the PSG parameters; Apnea-hypopnea index (AHI) (p <0.001), oxygen desaturation index (p = 0.042), percentage of oxygen desaturation (p = 0.019), snoring time (p = 0.013) and percentage of snoring (p = 0.010) values decreased statistically significant postoperatively. In ECHO; the systolic motion of the tricuspid annulus plane (TAPSE) (p = 0.010), which evaluates the right ventricular function, increased in the postoperative period. The trans-mitral E wave velocity (mitral E) value (p = 0.014), which evaluates left ventricular function, increased in the postoperative period. Left ventricular global longitudinal peak systolic strain - average (GLPS –AVG) (p = 0.002) value decreased statistically significantly in the postoperative period. Significant positive correlation between GLPS-AVG and percentage of oxygen desaturation (r: 0.518, p: 0.016) and significant negative correlation (r:-0.553, p: 0.009) was detected between TAPSE and AHI. No statistically significant relationship was found between preoperative and postoperative ECG data. In serum samples, total oxidant status (TOS) and malonildialdehyde (MDA) levels were measured to determine the oxidant level and total antioxidant status (TAS), reduced glutathione (GSH) level, superoxide dismutase (SOD) activity, catalase (CAT) levels were measured to determine the antioxidant activity. In postoperative period TOS (p<0,001) and MDA (p<0,001) levels decreased statistically significant and TAS (p<0,001), SOD (p<0,001), CAT (p<0,001) and GSH (p=0,001) levels increased statistically significant. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) parameters were evaluated with ABPM. Average daytime wakefullnes values of SKB, DKB, MAP, HR parameters between 8.00 and 20.00, average night sleep values of these parameters between 00.00 and 6.00 and day long average values of these parameters were calculated with all data recorded by ABPM. The values obtained were translated into standard deviation deviation score (SDS) according to the height of the patients. There was a statistically significant decrease in 24 hours HR and daytime wakefulness HR. There was no decrease in hypertension finding in the postoperative period. No significant relationship was found between hypertension and AHI. There were patients who were normotensive in the preoperative period but were observed hypertensive after the adenotonsillectomy operation. As a result; the patients with OSAS secondary to ATH are recommended to be evaluated in terms of hypertension and cardiovascular pathologies by applying ECHO and ABPM. Even if patients are observed normotensive in the preoperative period, it is important to evaluate for hypertension in the postoperative period. Because it isn't known how long the baroreceptor functions recover after adenotonsillectomy operation. Adenotonsillectomy operation should be performed before irreversible damage develops in the cardiovascular system. It is recommended to perform adenotonsillectomy operation before the irreversible damage develops in the cardiovascular system and to repeat ECHO and ABPM evaluations in the postoperative period.