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Impacts of body weight after surgery for obstructive sleep apnea in children

Abstract

Objective:

To investigate the impacts of body weight status on surgical outcomes and shifts of body weight status after adenotonsillectomy(T&A) in children with obstructive sleep apnea (OSA).

Methods:

From 2009 to 2011, 161 children (mean age, 7.0±3.4 years; 78% boys) were included. All the children had clinical symptoms and preoperative polysomnographic evaluations diagnosis of OSA. Children were divided into four weight status groups (underweight, normal weight, overweight and obese), based on age and gender corrected body mass index (BMI).

Results:

Following T&A, the four different weight status groups significantly improved in apnea/hypopnea index (AHI) and minimum oxygen saturation. However, 49.1% of the children (79/161) had residual OSA (AHI 1). The incidence of residual OSA (AHI 1) in the obese group was 75%, which was significantly higher than the other three groups (P<0.01). Weight status changes after T&A were documented, and 54% (13/24) of the underweight children shifted to normal weight status within 6 months after surgery.

Conclusion:

Although sleep parameters improved in all weight statuses, obese children had a higher incidence of residual OSA postoperatively. About half of the underweight children shifted to normal weight status after T&A.

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References

  1. American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 1996; 153: 866–878.

    Article  Google Scholar 

  2. Schechter MS . Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002; 109: e69.

    Article  Google Scholar 

  3. Amin RS, Carroll JL, Jeffries JL, Grone C, Bean JA, Chini B et al. Twenty-fourhour ambulatory blood pressure in children with sleep-disordered breathing. Am J Respir Crit Care Med 2004; 169: 950–956.

    Article  PubMed  Google Scholar 

  4. Chervin RD, Dillon JE, Bassetti C, Ganoczy DA, Pituch KJ . Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep 1997; 20: 1185–1192.

    Article  CAS  PubMed  Google Scholar 

  5. Nieminen P, Löppönen T, Tolonen U, Lanning P, Knip M, Löppönen H . Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea. Pediatrics 2002; 109: e55.

    Article  PubMed  Google Scholar 

  6. Brietzke SE, Gallagher D . The effectiveness of tonsillectomy and adenoidectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a meta-analysis. Otolaryngol Head Neck Surg 2006; 134: 979–984.

    Article  PubMed  Google Scholar 

  7. Friedman M, Wilson M, Lin HC, Chang HW . Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 2009; 140: 800–808.

    Article  Google Scholar 

  8. Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D . Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc 2008; 5: 274–282.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kang KT, Lee PL, Weng WC, Hsu WC . Body weight status and obstructive sleep apnea in children. Int J Obes (Lond) 2012; 36: 920–924.

    Article  Google Scholar 

  10. Costa DJ, Mitchell R . Adenotonsillectomy for obstructive sleep apnea in obese children: a meta-analysis. Otolaryngol Head Neck Surg 2009; 140: 455–460.

    Article  Google Scholar 

  11. Marcus CL, Carroll JL, Koerner CB, Hamer A, Lutz J, Loughlin GM . Determinants of growth in children with the obstructive sleep apnea syndrome. J Pediatr 1994; 125: 556–562.

    Article  CAS  Google Scholar 

  12. Tauman R, Gulliver TE, Krishna J, Montgomery-Downs HE, O’Brien LM, Ivanenko A et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr 2006; 149: 803–808.

    Article  Google Scholar 

  13. Bonuck KA, Freeman K, Henderson J . Growth and growth biomarker changes after adenotonsillectomy: systematic review and meta-analysis. Arch Dis Child 2009; 94: 83–91.

    Article  CAS  PubMed  Google Scholar 

  14. Major MP, Flores-Mir C, Major PW . Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a systematic review. Am J Orthod Dentofacial Orthop 2006; 130: 700–708.

    Article  Google Scholar 

  15. Brodsky L, Moore L, Stanievich JF . A comparison of tonsillar size and oropharyngeal dimensions in children with obstructive adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 1987; 13: 149–156.

    Article  CAS  Google Scholar 

  16. Chen W, Chang MH . New growth charts for Taiwanese children and adolescents based on World Health Organization standards and health-related physical fitness. Pediatr Neonatol 2010; 51: 69–79.

    Article  PubMed  Google Scholar 

  17. Lee P, Su YN, Yu CJ, Yang PC, Wu HD . Phox2b mutation-confirmed congenital central hypoventilation syndrome in a chinese family: presentation from newborn to adulthood. Chest 2009; 135: 537–544.

    Article  Google Scholar 

  18. Iber C, Ancoli-Israel S, Chesson AL, Quan SF . The AASM Manual for the scoring of sleep and associated events. American Academy of Sleep Medicine: Darien, IL, 2007.

    Google Scholar 

  19. Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med 2010; 182: 676–683.

    Article  Google Scholar 

  20. Alexiou VG, Salazar-Salvia MS, Jervis PN, Falagas ME . Modern technology-assisted vs conventional tonsillectomy: a meta-analysis of randomized controlled trials. Arch Otolaryngol Head Neck Surg 2011; 137: 558–570.

    Article  PubMed  Google Scholar 

  21. O’Brien LM, Sitha S, Baur LA, Waters KA . Obesity increases the risk for persisting obstructive sleep apnea after treatment in children. Int J Pediatr Otorhinolaryngol 2006; 70: 1555–1560.

    Article  PubMed  Google Scholar 

  22. Mitchell RB, Kelly J . Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children. Otolaryngol Head Neck Surg 2007; 137: 43–48.

    Article  PubMed  Google Scholar 

  23. Mitchell RB, Boss EF . Pediatric obstructive sleep apnea in obese and normal-weight children: impact of adenotonsillectomy on quality-of-life and behavior. Dev Neuropsychol 2009; 34: 650–661.

    Article  PubMed  Google Scholar 

  24. Mitchell RB . Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography. Laryngoscope 2007; 117: 1844–1854.

    Article  PubMed  Google Scholar 

  25. Ye J, Liu H, Zhang GH, Li P, Yang QT, Liu X et al. Outcome of adenotonsillectomy for obstructive sleep apnea syndrome in children. Ann Otol Rhinol Laryngol 2010; 119: 506–513.

    Article  PubMed  Google Scholar 

  26. Bate TW, Price DA, Holme CA, McGucken RB . Short stature caused by obstructive apnoea during sleep. Arch Dis Child 1984; 59: 78–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Everett AD, Koch WC, Saulsbury FT . Failure to thrive due to obstructive sleep apnea. Clin Pediatr (Phila) 1987; 26: 90–92.

    Article  CAS  Google Scholar 

  28. Brouillette RT, Fernbach SK, Hunt CE . Obstructive sleep apnea in infants and children. J Pediatr 1982; 100: 31–40.

    Article  CAS  PubMed  Google Scholar 

  29. Schiffmann R, Faber J, Eidelman AI . Obstructive hypertrophic adenoids and tonsils as a cause of infantile failure to thrive: reversed by tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol 1985; 9: 183–187.

    Article  CAS  PubMed  Google Scholar 

  30. American Academy of Pediatrics. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Section on pediatric pulmonology, subcommittee on obstructive sleep apnea syndrome. Pediatrics 2002; 109: 704–712.

    Article  Google Scholar 

  31. Bonuck K, Parikh S, Bassila M . Growth failure and sleep disordered breathing: a review of the literature. Int J Pediatr Otorhinolaryngol 2006; 70: 769–778.

    Article  PubMed  Google Scholar 

  32. Black MM, Dubowitz H, Krishnakumar A, Starr RH . Early intervention and recovery among children with failure to thrive: follow-up at age 8. Pediatrics 2007; 120: 59–69.

    Article  Google Scholar 

  33. Darrow DH, Siemens C . Indications for tonsillectomy and adenoidectomy. Laryngoscope 2002; 112: 6–10.

    Article  PubMed  Google Scholar 

  34. Mitchell RB, Kelly J . Outcome of adenotonsillectomy for severe obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol 2004; 68: 1375–1379.

    Article  PubMed  Google Scholar 

  35. Mitchell RB, Kelly J . Outcome of adenotonsillectomy for obstructive sleep apnea in children under 3 years. Otolaryngol Head Neck Surg 2005; 132: 681–684.

    Article  PubMed  Google Scholar 

  36. Wang RC, Elkins TP, Keech D, Wauquier A, Hubbard D . Accuracy of clinical evaluation in pediatric obstructive sleep apnea. Otolaryngol Head Neck Surg 1998; 118: 69–73.

    Article  CAS  PubMed  Google Scholar 

  37. Bar A, Tarasiuk A, Segev Y, Phillip M, Tal A . The effect of adenotonsillectomy on serum insulin-like growth factor-I and growth in children with obstructive sleep apnea syndrome. J Pediatr 1999; 135: 76–80.

    Article  CAS  PubMed  Google Scholar 

  38. Kiris M, Muderris T, Celebi S, Cankaya H, Bercin S . Changes in serum IGF-1 and IGFBP-3 levels and growth in children following adenoidectomy, tonsillectomy or adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2010; 74: 528–531.

    Article  PubMed  Google Scholar 

  39. Hashemian F, Farahani F, Sanatkar M . Changes in growth pattern after adenotonsillectomy in children under 12 years old. Acta Med Iran 2010; 48: 316–319.

    PubMed  Google Scholar 

  40. Soultan Z, Wadowski S, Rao M, Kravath RE . Effect of treating obstructive sleep apnea by tonsillectomy and/or adenoidectomy on obesity in children. Arch Pediatr Adolesc Med 1999; 153: 33–37.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Staff of the Center of Sleep Disorder, National Taiwan University Hospital for their technical support.

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Correspondence to W-C Hsu.

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The authors declare no conflict of interest.

Additional information

Presented at the 11th International Congress of the European Society of Pediatric Otorhinolaryngology (ESPO2012), Amsterdam, 20-23 May, 2012.

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Hsu, WC., Kang, KT., Weng, WC. et al. Impacts of body weight after surgery for obstructive sleep apnea in children. Int J Obes 37, 527–531 (2013). https://doi.org/10.1038/ijo.2012.194

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  • DOI: https://doi.org/10.1038/ijo.2012.194

Keywords

  • body weight status
  • obese
  • underweight
  • obstructive sleep apnea
  • adenotonsillectomy
  • child

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