Growth After Adenotonsillectomy for Obstructive Sleep Apnea: Revisited

Abstract

Objectives/Hypothesis: To reanalyze the growth trajectory and assess longitudinal changes of children undergoing adenotonsillectomy (AT) versus watchful waiting (WW) enrolled in the Childhood Adenotonsillectomy Trial (CHAT) study and to determine if an AT increases the risk of obesity in children.Study Design: Reanalysis of prospective cohort investigation. Methods:The study analyzed publicly available data from CHAT, including 3 months visit data not previously included in a prior publication. Statistical comparisons and mixed-effects modeling were done using age-and sex-specific BMI expressed as a percentage of the 95th percentile (%BMIp95). P < .05 was considered significant.Results: Children in the AT group, especially if underweight at baseline, had an increased rate of weight gain, with 100% of underweight children in the AT group becoming normal weight compared to 20% for WW. However, the rate of weight gain, as measured by the %BMIp95 trajectory for both AT and WW groups, was not significantly different when baseline weight status and obstructive sleep apnea (OSA) resolution were accounted for. Comparisons of %BMIp95 between treatment groups at baseline, 3-and 7-month follow-up visits also failed to identify statistically significant differences (P > .05). Overall for the entire cohort, resolution of OSA was associated with a decreased weight trajectory (P < .001).Conclusions: AT compared to WW is not associated with an increased risk of excessive weight gain. Otolaryngologists should be aware of this updated analysis when discussing AT surgical outcomes with families.

The Effects of Adenotonsillectomy for Obstructive Sleep Apnea on Growth Trajectory in Children With Obesity

“…7 The same data was revisited by converting the BMI z scores into %BMI p95 and a longitudinal analysis was completed, showing that individuals undergoing surgery did not gain significantly additional weight as compared to the watchful weighting group up to 7 months after surgery. 29,30 In our investigation, OSA resolution or persistence did not influence either the growth trajectory by itself or any of the other variables which were explored as potential variables that may influence weight changes postoperatively. Subsequently, postoperative OSA status was not included in our final analysis model.…”

“…A randomized controlled trial by Katz et al demonstrated greater than expected relative BMI increase after T&A as compared to the control group as measured by BMI z score 7 . The same data was revisited by converting the BMI z scores into %BMI p95 and a longitudinal analysis was completed, showing that individuals undergoing surgery did not gain significantly additional weight as compared to the watchful weighting group up to 7 months after surgery 29,30 …”

Short-Term Weight Gain after Tonsillectomy Does Not Lead to Overweight: A Systematic Review

“…The PRISMA flow diagram ( Figure 1 ) summarizes the study screening process. A summary of the studies included in this systematic review and the grading of evidence is reported in Table 1 [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

“…The baseline BMI z-score was reported as normal in three studies [ 17 , 37 , 40 ]. At the same time, in the other 11, the population was classified according to percentiles in two or more among these classes: underweight (Uw), normal weight (Nw), overweight (Ow), and obese (Ob); for these studies, the postoperative data were analyzed accordingly [ 16 , 22 , 23 , 24 , 25 , 27 , 32 , 33 , 35 , 36 , 39 ]. Two studies analyzed data from the same cohort of an RCT named Childhood Adenotonsillectomy trial (CHAT) [ 35 , 36 ].…”

Adenotonsillectomy: the good, the bad and the unknown

“…Jensen et al [15] have re-analyzed somatic growth data of the CHAT study using changes in age-specific and sex-specific BMI expressed as a percentage of the 95th percentile. Weight gain rates for both the adenotonsillectomy and WWSC groups were similar after adjustments for baseline weight and resolution status of OSAS [15]. Thus, the authors indicated that adenotonsillectomy is not related to increased risk of excessive weight gain compared with WWSC.…”