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Medline ® Abstracts for References 40,50-55

of 'Evaluation of suspected obstructive sleep apnea in children'

40
TI
Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children.
AU
Stradling JR, Thomas G, Warley AR, Williams P, Freeland A
SO
Lancet. 1990;335(8684):249.
 
61 snoring children selected for adenotonsillectomy, mainly for recurrent tonsillitis, were compared with a matched group of 31 healthy children for symptoms of sleep apnoea, extent of sleep hypoxaemia, and amount of sleep disturbance. The studies were repeated six months postoperatively, and after six months in the healthy children. Preoperatively, 61% of the children had degrees of sleep hypoxaemia above normal and 65% had abnormally disturbed sleep. A questionnaire administered to the parents about their children showed abnormal patterns of answers about sleep problems daytime sleepiness, hyperactivity, aggression, learning difficulties, restless sleep, and odd sleeping positions. After adenotonsillectomy, the abnormal hypoxaemia, excessive sleep disturbance, and multiple symptoms almost resolved; a growth spurt also occurred.
AD
Osler Chest Unit, Churchill Hospital, Oxford, UK.
PMID
50
TI
The effects of adenotonsillectomy on growth in young children.
AU
Williams EF 3rd, Woo P, Miller R, Kellman RM
SO
Otolaryngol Head Neck Surg. 1991;104(4):509.
 
A history of poor weight gain can often be elicited in young children with chronic upper airway obstruction resulting from adenotonsillar hypertrophy. A series of 41 consecutive children under 3 years of age, who underwent inpatient adenotonsillectomy, were reviewed for changes in weight and height. Thirty-seven patients had adequate long-term follow-up. Of these, many had dramatic improvements in growth after adenotonsillectomy. Indications for surgery in this group were recurrent infection in three patients (7%), unilateral tonsillar mass in one patient (3%), and upper airway obstruction in 37 patients (90%). A clear history of sleep apnea was elicited in 59%. At the time of surgery, 19 of 41 patients (46%) were of the fifth percentile or lower for age-corrected weight. The inpatient hospital stay averaged 3.2 days. The postoperative complication rate was 27%, with postoperative stridor as the most common complication. After surgery, 28 children (75%) showed a change to a higher percentile for weight. Twenty-four (65%) had percentile changes of 15% or more. This change is significant according to results of the Wilcoxon signed-rank test (p less than 0.001). We conclude that a relationship exists between improved growth rate and adenotonsillectomy in our study group. The rapid improvement in growth appears to be most obvious in children with upper airway obstruction resulting from adenotonsillar hypertrophy. Upper airway obstruction (including andenotonsillar hypertrophy) should be suspected as a possible cause in the workup of children with suboptimum growth.
AD
Department of Otolaryngology, State University of New York, Syracuse 13210.
PMID
51
TI
Growth after adenotonsillectomy for obstructive sleep apnea: an RCT.
AU
Katz ES, Moore RH, Rosen CL, Mitchell RB, Amin R, Arens R, Muzumdar H, Chervin RD, Marcus CL, Paruthi S, Willging P, Redline S
SO
Pediatrics. 2014 Aug;134(2):282-9.
 
BACKGROUND AND OBJECTIVES: Adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) may lead to weight gain, which can have deleterious health effects when leading to obesity. However, previous data have been from nonrandomized uncontrolled studies, limiting inferences. This study examined the anthropometric changes over a 7-month interval in a randomized controlled trial of adenotonsillectomy for OSAS, the Childhood Adenotonsillectomy Trial.
METHODS: A total of 464 children who had OSAS (average apnea/hypopnea index [AHI]5.1/hour), aged 5 to 9.9 years, were randomized to Early Adenotonsillectomy (eAT) or Watchful Waiting and Supportive Care (WWSC). Polysomnography and anthropometry were performed at baseline and 7-month follow-up. Multivariable regression modeling was used to predict the change in weight and growth indices.
RESULTS: Interval increases in the BMI z score (0.13 vs. 0.31) was observed in both the WWSC and eAT intervention arms, respectively, but were greater with eAT (P<.0001). Statistical modeling showed that BMI z score increased significantly more in association with eAT after considering the influences of baseline weight and AHI. A greater proportion of overweight children randomized to eAT compared with WWSC developed obesity over the 7-month interval (52% vs. 21%; P<.05). Race, gender, and follow-up AHI were not significantly associated with BMI z score change.
CONCLUSIONS: eAT for OSAS in children results in clinically significant greater than expected weight gain, even in children overweight at baseline. The increase in adiposity in overweight children places them at further risk for OSAS and the adverse consequences of obesity. Monitoring weight, nutritional counseling, and encouragement of physical activity should be considered after eAT for OSAS.
AD
Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts; eliot.katz@childrens.harvard.edu.
PMID
52
TI
Effect of treating obstructive sleep apnea by tonsillectomy and/or adenoidectomy on obesity in children.
AU
Soultan Z, Wadowski S, Rao M, Kravath RE
SO
Arch Pediatr Adolesc Med. 1999 Jan;153(1):33-7.
 
BACKGROUND: Obstructive sleep apnea is common in obese children who have enlarged tonsils and adenoids.
OBJECTIVE: To determine if treatment of obstructive sleep apnea by tonsillectomy and/or adenoidectomy will result in normalization of an obese child's weight, as it does in underweight children, and as it does with other signs and symptoms.
DESIGN: Retrospective cohort study. We recorded weight and height changes after tonsillectomy and/or adenoidectomy and compared changes of the obese and morbidly obese patients with those of the other patients.
SETTING: A tertiary care inner-city hospital.
PARTICIPANTS: Children (n = 45) who underwent tonsillectomy and/or adenoidectomy for obstructive sleep apnea in 1994-1995; their mean (+/-SD) age was 4.9+/-2.4 years at operation.
RESULTS: At the time of surgery, 25 children were of normal weight; 3, underweight; 7, obese; and 10, morbidly obese. Postoperatively, 31 children (69%), including 10 of the 17 who were obese or morbidly obese, had substantial weight gain: the z score +/- SD for weight of the entire group increased from 1.37+/-2.49 to 2+/-2.27 (P<.001). The mean z score +/- SD for height increased from 0.03+/-1.08 to 0.58+/-0.94 (P<.001). The body mass index (BMI or Quetelet index): calculated as weight in kilograms divided by the square of the height in meters increased in 28 patients (62%) (P = .004).
CONCLUSION: Treating obstructive sleep apnea by tonsillectomy and/or adenoidectomy is associated with increased gain in height, weight, and body mass index in most children, including the obese and morbidly obese.
AD
Division of Pediatric Pulmonology, Children's Medical Center, College of Medicine, the State University of New York, Brooklyn 11203, USA.
PMID
53
TI
Changes in growth pattern after adenotonsillectomy in children under 12 years old.
AU
Hashemian F, Farahani F, Sanatkar M
SO
Acta Med Iran. 2010 Sep;48(5):316-9.
 
The aim of the present study was to determine the effects of adenotonsillectomy on height, weight and body mass index (BMI) in children under 12 years old, with or without airway obstruction and evaluation of the risk of overweight in them. In this case-control study, 120 children with the age of 2-12 years old were studied; 60 children as case group who underwent adenotonsillectomy and 60 healthy children as control group. After collecting the data related to appetite status and sleep breathing disorder of the case group, height, weight and BMI have been measured for all children in two stages; preoperatively and 6 months later. Also in the case group, BMI percentiles, pre and postoperatively have been calculated. Patients with Low appetite in the initiation and at the end of the study in the case group were 80% and 8.3% respectively (P=0.01). Mean of height, weight and BMI variation after 6 months were significantly different between case and control groups (P<0.05). BMI percentiles in the case group preoperatively were: 20% underweight, 67% healthy weight, 10% at risk of over weight, 3% over weight. Postoperatively, after 6 months BMI percentiles in order of above frequency were: 10%, 57%, 22% and 11% (P=0.02). Analysis of the results showed that adenotonsillectomy can lead to increase of height, weight, BMI and appetite not only in the children with low weight due to airway obstruction but also in the normal weight and over weight children. Therefore risk of overweight should be mentioned as a probable undesirable outcome of adenotonsillectomy.
AD
Department of Otorhinolaryngology, Besat Hospital, Hamedan University of Medical Sciences, Hamedan, Iran. hashemianf@yahoo.com
PMID
54
TI
Increases in overweight after adenotonsillectomy in overweight children with obstructive sleep-disordered breathing are associated with decreases in motor activity and hyperactivity.
AU
Roemmich JN, Barkley JE, D'Andrea L, Nikova M, Rogol AD, Carskadon MA, Suratt PM
SO
Pediatrics. 2006 Feb;117(2):e200-8.
 
OBJECTIVE: To examine the effect of adenotonsillectomy (T&A) in children with obstructive sleep-disordered breathing on growth, hyperactivity, and sleep and waking motor activity.
METHODS: We studied 54 children who were aged 6 to 12 years and had adenotonsillar hypertrophy and an obstructive apnea-hypopnea index of>or =1 before and 12 months after they all received adenotonsillectomy (T&A). We measured their height, weight, percentage overweight (patient BMI - BMI at 50th percentile)/BMI at 50th percentile x 100) and obtained a hyperactivity score from parent report on a standardized behavior questionnaire scale. A subset of 21 of these children were also studied for motor activity by wrist actigraphy for 7 consecutive days and nights before and 12 months after T&A.
RESULTS: After T&A, mean obstructive apnea-hypopnea index decreased from 7.6 to 0.6. Height percentile did not change, but weight percentile increased; as a consequence, percentage overweightincreased from 32.0% to 36.3%. Hyperactivity scores and total daily motor activity were reduced after T&A. From linear regression, the reduction in hyperactivity scores predicted an increase in percentage overweight. Reduced motor activity was correlated with increased percentage overweight.
CONCLUSIONS: An increase in percentage overweight after T&A in children with obstructive sleep-disordered breathing is correlated to decreased child hyperactivity scores and to decreased measured motor activity in the subset studied. These associations suggest that the increase in overweight may be attributable to reductions in physical activity and fidgeting energy expenditure.
AD
Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA. roemmich@buffalo.edu
PMID
55
TI
Weight gain after adenotonsillectomy: a case control study.
AU
Lewis TL, Johnson RF, Choi J, Mitchell RB
SO
Otolaryngol Head Neck Surg. 2015 Apr;152(4):734-9. Epub 2015 Jan 28.
 
OBJECTIVE: To study the association between adenotonsillectomy (T&A) and weight gain in children.
STUDY DESIGN: Retrospective case-control series.
SETTING: Tertiary academic children's medical center.
SUBJECTS AND METHODS: A total of 154 children who underwent T&A at a tertiary care children's hospital between December 2010 and March 2011 were included. They were compared with 182 children with similar demographics who were seen in primary care clinics at the same institution (control group). Height and weight were compared at 6-month intervals over a 24-month period. Patients were divided into normal weight, overweight, and obese. A multilevel mixed-effects regression model was used for analysis. Significance was set at P≤.05.
RESULTS: Children who underwent T&A gained more weight than controls at every interval. At 24 months, they gained an additional 2.6 kg (confidence interval [CI], 0.9-3.9) but were an additional 1.8 cm (CI, 0.1-3.5) taller. There was no difference in weight gain at 6 months for obese children. At 12, 18, and 24 months, the obese group outgained the control group. At 24 months, the obese T&A group had gained an average of 14.3 kg, while the control had gained 10.1 kg, for a difference of 4.2 kg (CI, 1.3-6.1) with no difference in height changes. There were no differences in weight or height changes for the normal-weight and overweight groups at the conclusion of the study.
CONCLUSIONS: T&A leads to a significant increase in weight in obese but not normal-weight or overweight children. Efforts should be made to provide weight reduction counseling prior to T&A in obese children.
AD
Department of Otolaryngology, Head and Neck Surgery, University of Texas, Southwestern Medical Center at Dallas, Dallas, Texas, USA travis.lewis@phhs.org.
PMID