Growth after adenotonsillectomy for obstructive sleep apnea: an RCT

Abstract

Background and objectives: Adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) may lead to weight gain, which can have deleterious health effects when leading to obesity. However, previous data have been from nonrandomized uncontrolled studies, limiting inferences. This study examined the anthropometric changes over a 7-month interval in a randomized controlled trial of adenotonsillectomy for OSAS, the Childhood Adenotonsillectomy Trial.

Methods: A total of 464 children who had OSAS (average apnea/hypopnea index [AHI] 5.1/hour), aged 5 to 9.9 years, were randomized to Early Adenotonsillectomy (eAT) or Watchful Waiting and Supportive Care (WWSC). Polysomnography and anthropometry were performed at baseline and 7-month follow-up. Multivariable regression modeling was used to predict the change in weight and growth indices.

Results: Interval increases in the BMI z score (0.13 vs. 0.31) was observed in both the WWSC and eAT intervention arms, respectively, but were greater with eAT (P < .0001). Statistical modeling showed that BMI z score increased significantly more in association with eAT after considering the influences of baseline weight and AHI. A greater proportion of overweight children randomized to eAT compared with WWSC developed obesity over the 7-month interval (52% vs. 21%; P < .05). Race, gender, and follow-up AHI were not significantly associated with BMI z score change.

Conclusions: eAT for OSAS in children results in clinically significant greater than expected weight gain, even in children overweight at baseline. The increase in adiposity in overweight children places them at further risk for OSAS and the adverse consequences of obesity. Monitoring weight, nutritional counseling, and encouragement of physical activity should be considered after eAT for OSAS.

Trial registration: ClinicalTrials.gov NCT00560859.

Keywords: BMI; height; weight.

FIGURE 1

Flow diagram of subject enrollment for whom anthropometric data were available.

FIGURE 2

Change in the A, BMI z score, and B, absolute BMI for both treatment groups as a function of baseline BMI z score percentile. The change in BMI z score for children who had a baseline BMI z score either <10% or between the 10th and 85th percentile was significantly increased in the eAT group compared with the WWSC group. The absolute change in BMI for children who had a baseline BMI z score >85th percentile was significantly greater in the eAT group compared with the WWSC group.