Growth Velocity Predicts Recurrence of Sleep-disordered Breathing 1 Year after Adenotonsillectomy

Abstract

Rationale: Adenotonsillectomy, the first line of treatment of sleepdisordered breathing (SDB), is the most commonly performed pediatric surgery. Predictors of the recurrence of SDB after adenotonsillectomy and its impact on cardiovascular risk factors have not been identified. Objectives: Demonstrate that gain velocity in body mass index (BMI) defined as unit increase in BMI/year confers an independent risk for the recurrence of SDB 1 year after adenotonsillectomy. Methods: Children with SDB and hypertrophy of the tonsils and a comparison group of healthy children were followed prospectively for 1 year. Measurements and Main Results: Serial polysomnographies, BMI, and blood pressure were obtained before adenotonsillectomy and 6 weeks, 6 months, and 1 year postoperatively. Gain velocity in BMI, BMI and being African American (odds ratios, 4-6/unit change/yr; 1.4/unit and 15, respectively) provided equal amounts of predictive power to the risk of recurrence of SDB. In the group that experienced recurrence, systolic blood pressure at 1 year was higher than at baseline and higher than in children who did not experience recurrence. Conclusions: Three clinical parameters confer independent increased risk for high recurrence of SDB after adenotonsillectomy: gain velocity in BMI, obesity, and being African American. A long-term follow-up of children with SDB and monitoring of gain velocity in BMI are essential to identifying children at risk for recurrence of SDB and in turn at risk for hypertension. Keywords: growth velocity; adenotonsillectomy; sleep-disordered breathingOne of the most frequently encountered conditions associated with obesity is sleep-disordered breathing (SDB). In adults, the risk of SDB increases by 1.14 for every unit increase in body mass index (BMI) (1). In the pediatric population, the risk for developing SDB is fourfold greater in obese children than in children who are not obese (2). Although the prevalence of SDB in all children is believed to range from 2 to 3% (3-5), the prevalence in adolescents who are morbidly obese exceeds 50% (6, 7). Obesity is therefore strongly associated with abnormal upper airway control during sleep across all age groups.Adenotonsillectomy, the first line of treatment in the management of childhood SDB, is the most commonly performed surgical procedure in children. The annual rate of adenotonsillectomy in children aged 0 to 14 years ranges from 19 per 10,000 in Canada to 115 per 10,000 in the Netherlands (8). At least half of these procedures are performed to relieve symptoms of SDB. In the first few weeks after adenotonsillectomy, obese children with SDB have a less favorable response to surgery than lean children. However, neither the long-term outcome nor the factors that contribute to recurrence of the disorder after adenotonsillectomy are clearly understood. Moreover, the impact of recurrence of SDB on important cardiovascular risk factors, such as blood pressure (BP), has never been examined.Research investigating the relationship between adiposity and SDB h...

Population prevalence of obstructive sleep apnoea in a community of German third graders

“…However, adenoidectomy was a risk (and not a preventive) factor for habitual snoring in one study [50] and adenotonsillectomy did not decrease the risk for habitual snoring in another study [51]. Moreover, adenotonsillectomy was found to be ineffective in 50% of cases on 1-yr follow-up [52], and, in the present study, neither adenoidectomy nor tonsillectomy was a preventive factor for OSA. Hence, it remains speculative if high rates of adenoidectomy and/or tonsillectomy would substantially reduce the prevalence of OSA in a population.…”

Sleep Apnea and Cardiovascular Disease

“…In a recent longitudinal study of serial polysomnography in children after adenotonsillectomy (at 6 weeks, 6 months, and 1 year postoperatively), BMI, rapidity of increase in BMI, and black race each conferred increased risk of recurrence of SDB. 375 The epidemic of childhood obesity may be changing the epidemiology of OSA in children. 376 There is no clear consensus in the pediatric community regarding which patients deserve an evaluation in the sleep laboratory, and decisions are made on a patientindividualized basis.…”

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

“…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.…”