Key result
Adenotonsillectomy is associated with shortened P-wave duration, falling from 84.4 to 81.2 ms at 3 months.
Why the study?
Adenotonsillar hypertrophy is the primary driver of pediatric obstructive sleep-disordered breathing and may lead to cardiac remodeling, but the impact of adenotonsillectomy on ECG parameters and their correlation with sleep metrics is not well defined.
Does adenotonsillectomy alter electrocardiographic parameters in children with symptomatic adenotonsillar hypertrophy?
Observational
Does adenotonsillectomy alter electrocardiographic parameters in children with symptomatic adenotonsillar hypertrophy?
Absolute Event Rate: 81.2% vs 84.4%
p-value: p=0.043
Adenotonsillectomy in children with obstructive sleep-disordered breathing is associated with significant changes in ECG parameters that correlate with improved nocturnal respiratory events.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The clinical significance of these findings remains to be explored. They may implicate a reduction in resting sympathetic activity following the resolution of upper airway obstruction.”
AT-linked ECG shifts in pediatric OSDB may mark respiratory gains; leaves open utility as recovery biomarkers pending larger controlled trials.
Background/Objectives: Adenotonsillar hypertrophy (ATH) is the primary driver of pediatric obstructive sleep-disordered breathing (OSDB), potentially leading to cardiac remodeling. This study evaluated the impact of adenotonsillectomy (AT) on electrocardiographic (ECG) parameters and correlated these changes with sleep metrics. Methods: This prospective study evaluated ECG parameters (P-wave and QRS morphology) in children (>3 years) with symptomatic ATH before and three months after AT. A subset underwent sleep analysis via Cardiopulmonary Coupling (CPC) at both time points. Pre- and postoperative data were compared using paired t-tests and Linear Mixed Models (LMMs). The link between ECG and sleep modifications was also analyzed using Pearson and Spearman correlations of their respective variations (Δ). Results: Significant reductions were observed in the maximum RR interval (p = 0.027). Mean P-wave duration significantly shortened (84.40 ± 6.51 ms to 81.20 ± 3.32 ms; p = 0.043) and mean amplitude increased (0.076 ± 0.008 mV to 0.080 ± 0.004 mV; p < 0.001). Mean, minimum, and maximum QRS amplitudes increased significantly (p ≤ 0.018). Exploratory LMM confirmed that these modifications remained significant after adjusting for age and sex. Furthermore, post hoc analyses revealed that Δ QRS maximum amplitude exhibited negative correlations that survived false discovery rate (FDR) adjustment with Δ AHI 4% max (r = −0.727, p = 0.045), Δ ODI 3% max (r = −0.765, p = 0.045), Δ ODI 4% mean (r = −0.819; p = 0.033), and Δ maximal hypoxic burden (r = −0.730; p = 0.045). Conclusions: AT may alter ECG parameters. QRS amplitude increments correlated well with a decrease in nocturnal respiratory events. These findings may represent preliminary ECG changes associated with postoperative respiratory improvement. Larger controlled studies are needed to determine whether these ECG parameters can serve as markers of post-operative cardiopulmonary recovery.
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Sousa et al. (2026) conducted an observational in Obstructive sleep-disordered breathing secondary to adenotonsillar hypertrophy. Adenotonsillectomy vs. Pre-operative baseline was evaluated on Mean P-wave duration (ms) (p=0.043). Adenotonsillectomy significantly shortened mean P-wave duration (84.40 to 81.20 ms; p=0.043) and increased mean amplitude (0.076 to 0.080 mV; p<0.001) at 3 months.
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