Impact of adenotonsillectomy on growth trajectories in preschool children with mild obstructive sleep apnea

Abstract

Introduction: Adenotonsillectomy forms part of first-line management for pediatric obstructive sleep apnea (OSA). In nonrandomized studies of preschool-aged children, it is associated with postoperative weight gain. Being overweight or obese in childhood is a predictor of cardiovascular and metabolic disease in later life. Using longitudinal data from a multicenter randomised controlled trial, we assessed the impact of adenotonsillectomy on growth trajectory in preschool-aged children with mild-moderate OSA. Secondary aims were to assess the influence of social factors and baseline polysomnography parameters on growth trajectory. Methods: A total of 190 children (aged 3-5 years) with obstructive apnea hypopnea index ≤10 were randomly assigned to early (within 2 months) or routine (12-month wait) adenotonsillectomy. Anthropometry and polysomnography were performed at baseline, 12-month and 24-month timepoints for 126 children. Social risk factors were recorded using a questionnaire. Baseline characteristics were compared using a Mann-Whitney or t-test for continuous variables, and Fisher's exact test for categorical variables. Data were analyzed using linear mixed modelling. Results: Demographic and polysomnographic parameters were similar between groups at baseline. Baseline body mass index (BMI) z-score was 0.52 for both groups. For BMI z-score, there was a significant increase in the early surgery group between 0 and 12 months (0.4, 95%CI 0.1-0.8) but not from 12-24 months. For the routine surgery group, there was a significant BMI z-score increase following surgery between 12 and 24 months (0.45, 95%CI 0.1-0.8), but not from 0-12 months. Final BMI z-score was similar between the two groups. Findings for weight-for-age z-score were similar to the abovementioned findings for BMI z-score. Height-for-age z-score was not significantly different between different timepoints or intervention groups. Children with an unemployed primary income earner had a higher BMI z-score than those with a full-time employed income earner. No other social risk or polysomnography parameters were statistically significant. Conclusion: This study provides randomized controlled trial evidence of notable weight increase in preschool children with milder spectrum OSA that occurs in the months immediately following adenotonsillectomy. For children undergoing adenotonsillectomy, counselling regarding nutritional intake and exercise alongside weight monitoring should be considered, especially for those already at risk of becoming overweight or obese.L6359157772021-09-10 <br />