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Effect of tonsillectomy and adenoidectomy on obese children with sleep-associated breathing disorders
Insights
Morbidly obese children with sleep-disordered breathing improved significantly after adenoidectomy and tonsillectomy. Weight management also aided in partially resolving these breathing issues, highlighting a dual approach for treatment.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Bariatric Medicine
Background:
- Obstructive Sleep Apnea (OSA) is infrequently reported in morbidly obese children.
- Adenotonsillar hypertrophy is common in this population and can contribute to sleep-disordered breathing.
Purpose of the Study:
- To investigate sleep-associated breathing disorders in morbidly obese children.
- To evaluate the efficacy of adenoidectomy and tonsillectomy in treating these disorders.
- To assess the impact of weight control on sleep-disordered breathing.
Main Methods:
- Study included 31 morbidly obese children (age 2-14 years) with adeno-tonsillar hypertrophy.
- Sleep-associated breathing was monitored using respisomnography and pulse oximetry during natural sleep.
- Pre- and post-operative data were collected to assess changes in irregular breathing and SpO2 levels.
Main Results:
- Pre-operative irregular breathing ranged from 10% to 85% of sleeping time.
- Adenoidectomy and tonsillectomy reduced irregular breathing to near zero in all patients.
- Post-operative SpO2 levels improved and correlated with weight reduction through dietary therapy.
Conclusions:
- Adenoidectomy and tonsillectomy are highly effective in treating sleep-associated breathing disorders in severely obese children with enlarged tonsils and adenoids.
- Weight control can lead to partial resolution of sleep-disordered breathing, suggesting a combined therapeutic strategy.
- Surgical intervention shows significant benefits even when severe obesity persists.
Abstract:
In children and adolescents there have been only few reports dealing with Obstructive Sleep Apnea (OSA) associated with morbid obesity. We report here on sleep-associated breathing disorders in morbidly obese children and the effect of adenoidectomy and tonsillectomy on sleep-associated breathing disorders. The subjects were 31 children with morbid obesity. The mean patient age was 7.9 years ranging from 2 to 14 years. The percentage of expected body weight ranged from 130% to 260%. All of them had adeno-tonsillar hypertrophy. We undertook the study during the period of natural sleep. Percentage of sleeping period with irregular breathing was determined by means of respisomnogram and the percentage of sleeping period with SpO(2) > or = 90% with a pulse oximeter. The percentage of sleeping period with irregular breathing ranged from 10% to 85% before the operation. In all cases, the irregular breathing period decreased almost to zero after the adenoidectomy and tonsillectomy. The percentage of sleeping period with SpO(2) > or = 90% ranged from 1.7% to 95%. The percentage was related to reduction of body weight and it increased gradually as a result of a diet given as therapy. Our studies reveal that weight control may result in partial cure of sleep-associated breathing disorders. Operations, such as adenoidectomy and tonsillectomy, were remarkably effective in treating sleep-associated breathing disorders of severely obese children with large adenoids and tonsils, even if the severe obesity remained.