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

Abstract

Study Objectives: Adenotonsillectomy (AT) forms part of first-line management for pediatric obstructive sleep apnea. In nonrandomized studies of preschool-aged children, postoperative weight gain has been seen following AT, raising concerns regarding later obesity. Using longitudinal data from a multicenter randomized controlled trial, we assessed the impact of AT on growth trajectories in preschool-aged children with mild–moderate obstructive sleep apnea. Methods: A total of 190 children (aged 3–5 years) with obstructive apnea-hypopnea index ≤ 10 events/h were randomly assigned to early (within 2 months) or routine (12-month wait) AT. Anthropometry and polysomnography were performed at baseline, 12-month, and 24-month time points for 126 children. Baseline characteristics were compared using a Mann-Whitney or t test for continuous variables and Fisher’s exact test for categorical variables. Longitudinal data underwent linear mixed modeling. Results: For body mass index (BMI) z-score there was a significant increase in the early surgery group between 0 and 12 months (0.4, 95% confidence interval 0.1–0.8) but not from 12–24 months. For the routine surgery group there was an identical significant BMI z-score increase in the first 12 months following surgery, ie, between 12- and 24-month time points (0.45, 95% confidence interval 0.1–0.8) but not from 0–12 months (preoperative time). Final BMI z-score was similar between groups. Findings for weight-for-age z-score were similar to the findings for BMI z-score. Height-for-age z-score was not significantly different between different time points or intervention groups. Conclusions: This study provides randomized controlled trial evidence of notable, but time-limited, increase in the BMI and weight of preschool children with mild–moderate obstructive sleep apnea in the months immediately following AT.