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Surgery for Obstructive Sleep Apnea in Obese Children: Literature Review and Meta-analysis

Patrick Scheffler1, Nikolaus E Wolter1, Indra Narang2

  • 11 Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|February 20, 2019
PubMed

Insights

Surgical treatments for obstructive sleep apnea (OSA) in obese children improve key metrics but have high persistent OSA rates. Patient selection and weight management are crucial for better outcomes in this population.

Area of Science:

  • Pediatric Otolaryngology
  • Sleep Medicine
  • Bariatric Surgery

Background:

  • Obstructive sleep apnea (OSA) significantly impacts overweight and obese children's health.
  • Surgical interventions for OSA in this population may have variable efficacy compared to normal-weight children.

Purpose of the Study:

  • To systematically review and meta-analyze the effectiveness of surgical interventions for OSA in obese children.
  • To compare the outcomes of different surgical procedures for pediatric OSA in overweight and obese populations.

Main Methods:

  • A systematic literature search was conducted across PubMed, Ovid, and Cochrane databases.
  • Studies on adenotonsillectomy, uvulopalatopharyngoplasty, supraglottoplasty, and tongue base surgeries were included.
  • Adenotonsillectomy data underwent meta-analysis using a random-effects model based on polysomnographic findings.

Main Results:

  • Adenotonsillectomy significantly improved apnea-hypopnea index and respiratory disturbance index, but persistent OSA rates ranged from 51% to 66%.
  • Uvulopalatoplasty showed limited effectiveness (12.5%), while tongue base surgery had higher persistent OSA rates (74%-88%).
  • Surgical interventions reduce OSA severity but demonstrate higher persistent OSA rates in obese children.

Conclusions:

  • Surgical interventions for pediatric OSA in overweight and obese children effectively reduce OSA severity but are associated with higher persistent OSA rates.
  • The effectiveness varies by surgical procedure, highlighting the need for careful patient selection and preoperative weight management.
  • Setting realistic postoperative expectations for parents is essential for this challenging patient group.
Abstract

Keywords:
adenotonsillectomyapnealingual tonsillectomymeta-analysismidline posterior glossectomyobesityoutcomessupraglottoplastysurgeryuvulopalatopharyngoplasty

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