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 Ն1 before and 12 months after they all received adenotonsillectomy (T&A). We measured their height, weight, percentage overweight (patient BMI Ϫ BMI at 50th percentile)/ BMI at 50th percentile * 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 overweight increased 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. (OSDB) occurs in ϳ3% of children. 1-3 Adenotonsillar hypertrophy is the most common cause of OSDB in young children, and adenotonsillectomy (T&A) is the primary treatment of obstructive sleep apnea in children. [4][5][6] OSDB in children has been associated with a variety of comorbidities, including hypertension, enuresis, poor scholastic performance, hyperactivity, and attentiondeficit/hyperactivity disorder, and these conditions are also ameliorated with successful treatment of OSDB via T&A. 7,8 OSDB has also been reported to influence somatic growth. Several studies have shown that OSDB is associated with reduced growth in height and weight 5,6,[9][10][11][12] and failure to thrive in infants. 13 These growth alterations have been related to a number of factors, including reduced secretion of growth hormone and insulinlike growth factor-I, 11,14,15 low energy intake as a result of difficulty swallowing, 16 and increased energy expenditure during sleep. 5,16 All of these factors are reported to improve after T&A. 6,11,[14][15][16] Other studies, however, have reported that growth in children with adenotonsillar hypertrophy and OSDB is normal or that these children are actually overweight before treatment. 4,17,18 After T&A, normal-weight and overweight children with or without OSDB rapidly gain weight. 17,18 Thus, although T&A has a beneficial effect on OSDB symptoms 4 and improves the other...

This is the first report to quantify volumetric changes in the upper airway in obese children with OSAS after adenotonsillectomy showing significant residual adenoid tissue and an increase in the volume of the tongue and soft palate. These findings could explain the low success rate of AT reported in obese children with OSAS and are important considerations for clinicians treating these children.

No abstract

Short or variable time in bed and nightly snoring or higher apnea hypopnea index predicted impaired vocabulary and similarities scores in children with adenotonsillar hypertrophy suspected of having obstructive sleep-disordered breathing. The degree of cognitive impairment attributable to short time in bed and obstructive sleep-disordered breathing is clinically very significant.

Risk of impaired cognitive function and behavior can be predicted from snoring history, sleep efficiency, sleep latency, and race but not tonsil size. The combination of snoring history and polysomnographic variables predicted impaired cognitive scores better than did either alone. The snoring history predicted more test scores than the number of episodes of apnea and hypopnea per 1 hour of sleep.