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An Exploratory Retrospective Study of Clinical Outcomes Following Adenotonsillectomy in Children With Obstructive
Zoë A Burton1, Claire Nissenbaum1, Manjeevan Singh2
1Sheffield Children's NHS Foundation Trust, Sheffield, UK.
Insights
Adenotonsillectomy (AT) improved obstructive sleep disordered breathing (oSDB) in severely obese children, but over half still had residual symptoms. Preoperative lifestyle intervention significantly reduced BMI z-score, supporting its effectiveness before surgery.
Area of Science:
- Pediatric Surgery
- Sleep Medicine
- Obesity Research
Background:
- Adenotonsillectomy (AT) is a common procedure for pediatric obstructive sleep disordered breathing (oSDB).
- Children with severe obesity face increased risks for both oSDB and surgical complications.
- Evaluating AT's efficacy in this high-risk group is crucial.
Purpose of the Study:
- To determine if AT improves clinical oSDB symptoms in severely obese children.
- To correlate clinical improvements with objective sleep study data.
- To assess changes in BMI z-score following preoperative lifestyle intervention.
Main Methods:
- Retrospective review of electronic records for children aged 2-16 with severe obesity undergoing AT for oSDB.
- Collected demographic, BMI, and BMI z-score data preoperatively and at surgery.
- Analyzed pre- and postoperative sleep study data (AHI, ODI) and clinical outcomes.
Main Results:
- Of 55 eligible children, 30 had preoperative sleep studies. The 'cure' rate was 42.3%, with sleep studies confirming clinical resolution in some cases.
- A significant reduction in mean BMI z-score (+3.83 to -0.17) was observed after a mean 6.0-month lifestyle intervention.
- Nine children with both pre- and postoperative studies showed varied AHI/ODI improvements.
Conclusions:
- More than half of severely obese children experienced residual oSDB symptoms post-AT.
- Objective sleep studies are valuable for identifying patients who may benefit from further interventions.
- Preoperative lifestyle interventions show promise in reducing BMI z-score, but their impact on surgical timing and symptom resolution requires further investigation.
Introduction:
Adenotonsillectomy (AT) to improve obstructive sleep disordered breathing (oSDB) is a common paediatric surgical procedure. Children living with obesity have both an increased risk of oSDB and a higher perioperative risk.
Objectives:
We aimed to establish whether AT in children with severe obesity improves clinical symptoms, and whether this correlates with quantifiable sleep studies. A secondary outcome was preoperative change in BMI z-score amongst children attending a specialist anaesthetic clinic.
Methods:
A retrospective electronic notes review over a 2-year period identified children 2-16 years living with 'severe' obesity undergoing AT for oSDB. Demographic data, BMI and BMI z-score were collated preoperatively and at surgery. Pre- and postoperative quantifiable sleep study data and clinical episodes were examined. Postoperative AHI < 5/ODI4 < 4/h or clinical symptom resolution was considered 'curative'.
Results:
A total of 1007 tonsillectomies were performed for oSDB; 55 met inclusion criteria and 30 underwent preoperative sleep studies. Age ranged from 3 to 15 years (mean 8.7, SD 3.3) with a 2:1 ratio of males to females. Nine children (34.6%) underwent both pre- and postoperative studies with ODI4/AHI ranges of 0.5-121.2/h and 0-9.3/h, respectively. Overall 'cure' rate was 42.3%, with postoperative sleep studies confirming clinical findings. Preoperative mean BMI z-score was +3.83 (SD 1.19) with significant reduction at the time of surgery (-0.17, SD 0.29; p = 0.004) following lifestyle intervention (mean 6.0 months; SD 11.7 weeks).
Conclusion:
Over half of severely obese children undergoing AT had residual postoperative oSDB symptoms. Sleep studies might identify those benefitting from further intervention. Findings support the effectiveness of preoperative lifestyle intervention, but the impact on symptoms and surgical timing should be further delineated.
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