Adenotonsillectomy for obstructive sleep apnea in obese children: A meta‐analysis

Costa, Dary J.; Mitchell, Ron B.

doi:10.1016/j.otohns.2008.12.038

Cited by 229 publications

(165 citation statements)

References 43 publications

Supporting

Mentioning

154

Contrasting

Unclassified

Order By: Relevance

“…38 In CHAT, obese children in both groups had lower rates of normalization of polysomnographic findings than did nonobese children, although the prevalence of residual obstructive sleep apnea syndrome in the obese group postoperatively (33% of children) was lower than has been reported in some studies, 5,38,39 possibly because CHAT was limited to preadolescents and excluded extremely obese patients. Polysomnographic findings, as well as symptoms and behavior, improved more with early adenotonsillectomy than with watchful waiting, however, in both obese and nonobese children.…”

Section: Discussionmentioning

confidence: 83%

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

Marcus

Moore

Rosen

et al. 2014

Survey of Anesthesiology

229

438

View full text Add to dashboard Cite

BACKGROUND-Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes.

show abstract

Section: Discussionmentioning

confidence: 83%

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

Marcus

Moore

Rosen

et al. 2014

Survey of Anesthesiology

229

438

View full text Add to dashboard Cite

show abstract

“…Our success rate of treating SDB with weight loss of 71% stresses the important role of adiposity in the pathogenesis of SDB in childhood obesity. When comparing this treatment success rate with literature regarding adenotonsillectomy, we can conclude that weight loss might be more effective in treating SDB in a highly morbid obese population (10)(11)(12). Weight loss treatment can therefore be considered as a first line treatment, but based on our data of tonsillar hypertrophy in residual SDB the combination of both adenotonsillectomy or pharmacological treatment and weight loss treatment in selected patients needs to be studied.…”

Section: Discussionmentioning

confidence: 91%

Weight Loss and Sleep‐Disordered Breathing in Childhood Obesity: Effects on Inflammation and Uric Acid

Hoorenbeeck

Franckx²,

Debode³

et al. 2012

Obesity

View full text Add to dashboard Cite

Sleep‐disordered breathing (SDB) is prevalent in childhood obesity. It may be an independent risk factor for the metabolic syndrome. Possible mechanisms are inflammation and oxidative stress. Adenotonsillectomy in childhood obesity is associated with a high recurrence rate and risk of postoperative weight gain. Therefore, this study assessed the effects of SDB on inflammation and oxidative stress in childhood obesity before and after weight loss. We included 132 obese subjects between 10 and 18 years consecutively. Median age was 15.4 years (10.1–18.0). Mean BMI z‐score was 2.72 ± 0.42. Leukocytes and differentiation, high sensitivity C‐reactive protein (hs‐CRP), and uric acid (UA) were determined at baseline and subjects underwent a sleep assessment. SDB was diagnosed in 39%. Linear regression analysis showed an association between UAlog and oxygen desaturation indexlog (ODIlog) (r = 0.20; P = 0.03), between leukocyteslog and respiratory disturbance indexlog (RDIlog) (r = 0.23; P = 0.01), and between lymphocyteslog and RDIlog (r = 0.19; P = 0.04). Follow‐up was organized after 4–6 months of treatment. Median decrease in BMI z‐score was 32%. Laboratory measurements were repeated. Subjects with SDB at baseline underwent a second sleep study. Of these 49 subjects, 12 showed residual SDB. This corresponds with a treatment success rate of 71%. Unlike changes in inflammatory markers, improvements in UA were associated with improvements in RDI and ODI (respectively: r = 0.44; P = 0.007, r = 0.41; P = 0.01). In conclusion, weight loss is effective in treating obese children with SDB. At baseline, a link exists between inflammation and SDB. Oxidative stress is reflected by UA at baseline and the concentration decreases after treatment according to improvements in SDB.

show abstract

“…Another retrospective review of 26 morbidly obese patients, all of whom were sent to the ICU after AT as per routine, found that 14 patients (54%) had an uncomplicated postoperative course, and 12 (45%) required respiratory intervention, including 1 requiring intubation and 2 requiring BPAP. 196 Costa and Mitchell 131 evaluated the response to AT in a meta-analysis of 4 studies that included 110 obese children who had OSAS (level III). They found that OSAS improved but did not resolve after AT, with 88% of children having an AHI >1/hour and 51% of children having an AHI >5/hour postoperatively.…”

Section: Surgical Treatment Of Osas In the Obese Childmentioning

confidence: 99%

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

Marcus¹,

Brooks²,

Ward³

et al. 2012

Pediatrics

1,467

1,504

View full text Add to dashboard Cite

OBJECTIVE: This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS). METHODS: The literature from 1999 through 2011 was evaluated. RESULTS AND CONCLUSIONS: A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.

show abstract

Adenotonsillectomy for obstructive sleep apnea in obese children: A meta‐analysis

Abstract: T&A improves but does not resolve OSA in the majority of obese children. The efficacy and role of additional therapeutic options require more study. The high incidence of obesity in children makes this a public health priority.

Cited by 229 publications

References 43 publications

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

Weight Loss and Sleep‐Disordered Breathing in Childhood Obesity: Effects on Inflammation and Uric Acid

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

Contact Info

Product

Resources

About