Recurrence of Obstructive Sleep Apnea in Post-adenotonsillectomy Obese Pediatric Patients: A Systematic Review

Obstructive sleep apnea (OSA) is an under-recognized consequence of pediatric obesity, with adenotonsillectomy (AT) serving as the standard first-line surgical treatment. In obese pediatric patients, OSA often recurs postoperatively, raising concern for the long-term efficacy of AT. This systematic review evaluates the recurrence of OSA in post-AT obese pediatric patients, with a focus on the key risk factors contributing to residual disease. A literature search was conducted using Embase, PubMed, and Web of Science. Eligibility criteria included peer-reviewed, English articles published within the last five years that contained pediatric patients less than 18 years old who had a body mass index (BMI) ≥ 95th percentile. All patients had to have been diagnosed with sleep-disordered breathing or OSA preoperatively and must have undergone AT. Eleven studies met these criteria, of which 82% demonstrated a significant association between obesity and recurrence of OSA following AT. Key factors included higher baseline apnea-hypopnea index, postoperative weight gain, and residual upper airway obstruction. Two studies contradicted this trend, but limitations such as the use of subjective questionnaires and short follow-up durations reduced the studies' reliability. The findings indicate that AT alone is often insufficient in resolving OSA in obese pediatric patients. Given the high recurrence rates, a multidisciplinary approach, including weight management and non-invasive ventilation, may be needed to improve outcomes in this vulnerable population.