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Published on: December 6, 2016
Risk of failure of adenotonsillectomy for obstructive sleep apnea in obese pediatric patients
C J Lennon1, R Y Wang2, A Wallace2
1Department of Otolaryngology, Vanderbilt University Medical Center, United States.
Insights
Pediatric obesity is linked to poorer outcomes after adenotonsillectomy (T&A) for obstructive sleep apnea (OSA). Higher BMI z-scores correlate with less improvement in the Apnea-Hypopnea Index (AHI) post-surgery.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Pediatric Endocrinology
Background:
- Pediatric obesity is a significant risk factor for obstructive sleep apnea (OSA).
- Adenotonsillectomy (T&A) is a common treatment for pediatric OSA.
- The impact of obesity on T&A success for OSA has been hypothesized but not quantified.
Purpose of the Study:
- To investigate the relationship between perioperative Body Mass Index (BMI) and persistent OSA after T&A in children.
- To quantify the association between obesity and treatment failure of T&A for OSA.
Main Methods:
- Retrospective chart review of pediatric patients undergoing T&A for OSA between 2004 and 2016.
- Comparison of obese patients (BMI z-score >1.65) with age-matched non-obese controls (BMI <1.65).
- Analysis of pre- and post-operative polysomnography (PSG) data, including Apnea-Hypopnea Index (AHI) and oxygen saturation nadir.
Main Results:
- T&A significantly improved AHI and oxygen saturation in obese subjects.
- No significant difference in caregiver/self-reported improvement between obese and non-obese groups.
- A statistically significant inverse linear correlation was found between perioperative BMI z-score and the change in AHI post-T&A.
Conclusions:
- An inverse linear relationship exists between perioperative BMI z-score and AHI improvement following T&A in children with OSA.
- Children with BMI z-scores >3 showed minimal to no benefit from T&A alone for OSA.
- Further research is needed to explore additional procedures for managing OSA in obese children.
Introduction:
Pediatric obesity is a leading risk factor for obstructive sleep apnea (OSA), a condition commonly treated with adenotonsillectomy (T&A). It has been hypothesized that obesity increases a child's risk of failing T&A for OSA, however this relationship has not yet been quantified. The primary objective of this study was to investigate the relationship between obesity as measured by perioperative Body Mass Index (BMI) and persistent OSA following T&A as measured by polysomnography (PSG).
Study Design:
Retrospective chart review.
Methods:
Pediatric patients who underwent T&A between Jan. 2004 and Jan. 2016 were included. We recruited both obese and non-obese patients to compare caregiver/self reported improvement. Obese patients were recruited from a weight management clinic and included if they had a BMI z-score >1.65 and had pre- and post-operative polysomnograms (PSGs). Control patients included those undergoing T&A for OSA at our institution with BMI <1.65. These patients were age matched to the obese patient population. Age, gender, perioperative BMI z-score, caregiver/self reported improvement, total Apnea-Hypopnea Index (AHI), and O2 saturation nadir were collected where available. Univariate linear regressions were calculated between perioperative BMI z-score and PSG data.
Results:
26 obese study and 47 control subjects were identified for analysis. T&A resulted in statistically significant improvements in total AHI (p = 0.030) and nadir O2 saturation (p = 0.013) in obese subjects. There was no significant difference between the rate of caregiver/self reported improvement in the two groups. There was a statistically significant correlation between perioperative BMI z-score and the change in total AHI (p = 0.049). Within our population, for every increase by 0.1 in perioperative BMI z-score, the improvement in total AHI post-operatively decreased by 1.63 events/hr. Further, patients with BMI more than 3 standard deviations away from the age-derived normative mean received essentially no benefit from T&A alone.
Conclusions:
Our study established an inverse linear relationship between perioperative BMI z-score and improvement in total AHI with essentially no improvement in patients with BMI z-scores >3. Further studies are required to further elucidate this relationship and investigate the role of additional procedures in the initial management of OSA in obese children.
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