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

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 (groups(1)) and children with moderate-OSA AHI >= 5.0 or SQI < 75 (group(2)) at baseline and (2) effect of eAT therapy on metabolic health, Group(Remission) (AHI < 1.0, SQI >= 75) compared to Group(Residual). Results At baseline group2 (n=124) had higher average heart rate during sleep (AHR(Sleep)), 87 vs. 81 beats/minute (p < 0.001) compared to groups(1) (n=72). After surgery, group(2) 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 group(1), (p = 0.015), decreased AHR(sleep)-- 2.90 vs. - 0.34 (p= 0.025) and AHI - 5.00 vs. - 0.36 (p= 0.002). Group(Remission) was younger 6.59 vs. 7.41; p <0.001; with lower BMI z-score 0.90 vs. 1.34; p =0.021; AHR(sleep) 80.60 vs. 83.50; p = 0.032; fasting insulin (mu IU/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.