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Sleep quality, sleep apnea, and metabolic health in children treated with adenotonsillectomy

  • Pediatrics • Original Article
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Abstract

Purpose

The aim of this study was to determine if cardiopulmonary coupling (CPC) calculated sleep quality (SQI) may predict changes in metabolic health in children treated with early adenotonsillectomy (eAT) for obstructive sleep apnea (OSA).

Methods

Secondary analysis of the Childhood Adenotonsillectomy Trial (CHAT) was performed including children 5.0–9.9 years with OSA assigned to eAT. The cohort was stratified based on SQI and AHI to evaluate (1) response to eAT in children with high sleep quality (SQI ≥ 75) and mild-OSA, AHI < 5.0 (group1) and children with moderate-OSA AHI ≥ 5.0 or SQI < 75 (group2) at baseline and (2) effect of eAT therapy on metabolic health, GroupRemission (AHI < 1.0, SQI ≥ 75) compared to GroupResidual.

Results

At baseline group2 (n=124) had higher average heart rate during sleep (AHRSleep), 87 vs. 81 beats/minute (p < 0.001) compared to group1 (n=72). After surgery, group2 on average had less increase in BMI z-score 0.13 vs. 0.27, (p = 0.025), improved their SQI + 2.06 compared to decline − 3.75 in group1, (p = 0.015), decreased AHRSleep—− 2.90 vs. − 0.34 (p = 0.025) and AHI − 5.00 vs. − 0.36 (p = 0.002).

GroupRemission was younger 6.59 vs. 7.41; p < 0.001; with lower BMI z-score 0.90 vs. 1.34; p = 0.021; AHRSleep 80.60 vs. 83.50; p = 0.032; fasting insulin (µIU/ml) 7.54 vs. 12.58; p = 0.017 and glucose (mmol/L) 4.45 vs. 4.60; p = 0.049, with better lipid metabolism though not statistically significantly, low-density-lipoprotein 90.26 mg/dL vs. 97.94; p = 0.081 and cholesterol 154.66 mg/dL vs. 164.36; p = 0.076.

Conclusion

The results may indicate that children with mild-OSA and high-SQI may be less likely to benefit from eAT than children with moderate-OSA. To improve metabolic health, successfully treating both AHI and SQI is likely needed. CPC-calculated SQI may have a role to identify children less likely to benefit from eAT and to evaluate success of therapy.

Trial registration

ClinicalTrials.gov Identifier: NCT00560859.

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Data availability

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Abbreviations

AASM:

American Academy of Sleep Medicine

ANCOVA:

Analysis of covariance

ANS:

Autonomic nervous system

AHI:

Apnea hypopnea index

BMI:

Body mass Index

CRP:

C-reactive protein

CMD:

Cardiometabolic disease

CPC:

Cardiopulmonary coupling

CVD:

Cardiovascular disease

CHAT:

Childhood Adenotonsillectomy Trial

CAP:

Cyclic alternating pattern

CVHR:

Cyclic variation of heart rate

eAT:

Early adenotonsillectomy

ECG:

Electrocardiogram

EDR:

Electrocardiogram-derived respiration

EEG:

Electroencephalographic

FDA:

Food and Drug Administration

HRV:

Heart rate variability

HIPAA:

Health Insurance Portability and Accountability Act

HDL:

High-density lipoprotein

HFC:

High-frequency coupling

LDL:

Low-density lipoprotein

LFC:

Low-frequency coupling

MS:

Metabolic syndrome

NREM:

Non-rapid eye movement sleep

OSA:

Obstructive sleep apnea

OAI:

Obstructive apnea index

oSDB:

Obstructive sleep-disordered breathing

OLS:

Ordinary least squared

PLETH:

Plethysmogram

PSG:

Polysomnography

PDR:

Pulse-derived respiration

PRV:

Pulse rate variability

QL:

Quality of life

RCT:

Randomized controlled clinical trial

REM:

Rapid eye movement

SQI:

Sleep quality index

SaMD:

Software as medical device

WWSC:

Watchful waiting with supportive care

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Acknowledgements

This analysis was made possible by National Sleep Research Resource, with access to the Childhood Adenotonsillectomy Trial (CHAT) database—https://sleepdata.org/datasets/chat. CHAT was supported by the National Institutes of Health (HL083075, HL083129, UL1-RR-024134) UL1 RR024989). The National Sleep Research Resource was supported by the National Heart, Lung, and Blood Institute (R24 HL114473, 75N92019R002).

Author information

Authors and Affiliations

  1. MyCardio LLC, SleepImage®, 3003 E 3rd Avenue, Denver, CO, 80206, USA

    Solveig Magnusdottir & Hugi Hilmisson

  2. University of Alberta, Edmonton, Alberta, AB T6G, Canada

    Manisha Witmans

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Contributions

Solveig Magnusdottir: conceptualized and drafted the initial manuscript. Critically reviewed the manuscript for cardiopulmonary coupling (CPC) content. Manisha Witmans: reviewed, edited, and approved the overall content of the final manuscript. Hugi Hilmisson: CPC-analysis and sAHI calculations, statistical analysis, and final approval of the manuscript. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Solveig Magnusdottir.

Ethics declarations

The CHAT study protocol was approved by the Institutional Review Board of all sites participating in the study, specific for each site and recruitment procedures met local HIPAA rules. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants in the CHAT study or their caretakers.

Conflict of interest

Dr. Magnusdottir is Medical Director of MyCardio LLC and has a partial ownership. SleepImage is the brand name of MyCardio LLC, a privately held entity. MyCardio LLC is a licensee of the CPC- algorithm, a method to phenotype sleep and sleep apnea, from the Beth Israel Deaconess Medical Center, Boston, MA, USA. Dr. Witmans has no conflict of interest. Mr. Hilmisson is a Director of Research & Development for MyCardio LLC and has no conflict of interest to declare.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 Protocol – The Children Adenotonsillectomy Trial. (PDF 1447 KB)

11325_2022_2747_MOESM2_ESM.pdf

Supplementary file2 Sleep Quality Reports from a sleep study of a 5 year old child randomized to early adenotoncillectomy (eAT) in the CHAT study at baseline and 7-month follow-up. (PDF 369 KB)

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Magnusdottir, S., Witmans, M. & Hilmisson, H. Sleep quality, sleep apnea, and metabolic health in children treated with adenotonsillectomy. Sleep Breath 27, 1527–1540 (2023). https://doi.org/10.1007/s11325-022-02747-3

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