Effects of Adenotonsillectomy on Intermittent Hypoxia and Microalbuminuria in Children with Obstructive Symptoms

Abstract

Background: Obstructive sleep apnoea (OSA) in children, primarily caused by adenotonsillar hypertrophy, can result in intermittent hypoxia and systemic effects like cardiovascular, neurodevelopmental, and renal complications.

Objectives: To examine the impact of adenotonsillectomy on renal stress, particularly microalbuminuria, and aims to evaluate its effects on hypoxic burden and renal function in Nigerian children with obstructive symptoms.

Methods: This study prospectively and longitudinally examined 169 Nigerian children aged 3 to 8 years with adenotonsillar hypertrophy, measuring Apnoea Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), and Albumin-Creatinine Ratio (ACR) for microalbuminuria before and 36 hours after adenotonsillectomy.

Results: Adenotonsillectomy significantly reduced the AHI from a mean of 15.2 to 5.4 and ODI from 10.5 to 3.8, indicating reduced hypoxic events during sleep. The mean oxygen saturation levels improved from 88.3% preoperatively to 94.8% postoperatively (p<0.001). Microalbuminuria, as reflected by ACR, showed a significant decrease, with median values dropping from 25.5 mg/g to 10.3 mg/g. Children with severe baseline symptoms benefited more from adenotonsillectomy since respiratory and kidney indicators improved more after surgery. 

Conclusion: This study underscores adenotonsillectomy's significant respiratory and renal health benefits in children with OSA. Reduction in hypoxic burden and renal stress markers by adenotonsillectomy makes it a crucial intervention not only for alleviating respiratory symptoms but also for safeguarding against systemic impacts such as renal dysfunction. Advocacy for early surgical intervention in moderate to severe OSA cases will prevent long-term complications and reduce healthcare burdens.