Increases in Overweight After Adenotonsillectomy in Overweight Children With Obstructive Sleep-Disordered Breathing Are Associated With Decreases in Motor Activity and Hyperactivity

Abstract

OBJECTIVE. To examine the effect of adenotonsillectomy (T&A) in children with obstructive sleep-disordered breathing on growth, hyperactivity, and sleep and waking motor activity.METHODS. We studied 54 children who were aged 6 to 12 years and had adenotonsillar hypertrophy and an obstructive apnea-hypopnea index of Ն1 before and 12 months after they all received adenotonsillectomy (T&A). We measured their height, weight, percentage overweight (patient BMI Ϫ BMI at 50th percentile)/ BMI at 50th percentile * 100) and obtained a hyperactivity score from parent report on a standardized behavior questionnaire scale. A subset of 21 of these children were also studied for motor activity by wrist actigraphy for 7 consecutive days and nights before and 12 months after T&A.RESULTS. After T&A, mean obstructive apnea-hypopnea index decreased from 7.6 to 0.6. Height percentile did not change, but weight percentile increased; as a consequence, percentage overweight increased from 32.0% to 36.3%. Hyperactivity scores and total daily motor activity were reduced after T&A. From linear regression, the reduction in hyperactivity scores predicted an increase in percentage overweight. Reduced motor activity was correlated with increased percentage overweight.CONCLUSIONS. An increase in percentage overweight after T&A in children with obstructive sleep-disordered breathing is correlated to decreased child hyperactivity scores and to decreased measured motor activity in the subset studied. These associations suggest that the increase in overweight may be attributable to reductions in physical activity and fidgeting energy expenditure. (OSDB) occurs in ϳ3% of children. 1-3 Adenotonsillar hypertrophy is the most common cause of OSDB in young children, and adenotonsillectomy (T&A) is the primary treatment of obstructive sleep apnea in children. [4][5][6] OSDB in children has been associated with a variety of comorbidities, including hypertension, enuresis, poor scholastic performance, hyperactivity, and attentiondeficit/hyperactivity disorder, and these conditions are also ameliorated with successful treatment of OSDB via T&A. 7,8 OSDB has also been reported to influence somatic growth. Several studies have shown that OSDB is associated with reduced growth in height and weight 5,6,[9][10][11][12] and failure to thrive in infants. 13 These growth alterations have been related to a number of factors, including reduced secretion of growth hormone and insulinlike growth factor-I, 11,14,15 low energy intake as a result of difficulty swallowing, 16 and increased energy expenditure during sleep. 5,16 All of these factors are reported to improve after T&A. 6,11,[14][15][16] Other studies, however, have reported that growth in children with adenotonsillar hypertrophy and OSDB is normal or that these children are actually overweight before treatment. 4,17,18 After T&A, normal-weight and overweight children with or without OSDB rapidly gain weight. 17,18 Thus, although T&A has a beneficial effect on OSDB symptoms 4 and improves the other...

Growth After Adenotonsillectomy for Obstructive Sleep Apnea: An RCT

“…16,21,22 Weight gain measured using population z scores has been reported to increase after AT in some uncontrolled studies, 12 but not others. [30][31][32] However, the observation that untreated children in the WWSC group also significantly increased their weight and BMI z scores during the 7-month follow-up interval underscores the importance of the randomized controlled design of the study in quantifying treatment effects.…”

“…[1][2][3][4][5] Adenotonsillar hypertrophy is the primary cause of OSAS in children, and is usually treated with adenotonsillectomy (AT). AT has been reported to accelerate weight [6][7][8][9][10][11][12][13][14] in children with baseline failure to thrive (FTT), 1,3,4,15 normal weight patients, 9,11,14,[16][17][18][19][20] obese individuals, 9,13,16,21,22 and infants. 10 The majority of studies also have demonstrated an increase in the height growth rate after AT for OSAS, 3,6,11,17,23,24 but other studies reported no significant differences.…”

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

“…Goldstein et al 55 IV 450 All showed behavior improvement except Davis et al 49 Goldstein et al 243 Long-term behavior improvement in Mitchell et al 53 Hogan et al 48 Li et al 238 Roemmich et al 191 Tran et al 58 Wei et al 245 Mitchell et al 53 Davis et al 49 Aggression, oppositional, and social problems 54 Long-term improvements ≥1 y 52 , 53 Goldstein et al 55 Sohn et al 56 Silva and Leite 57 Tran et al 58 Chervin et al 37 I 105 Long-term improvements at 1 y Sleep quality Constantin et al 54 IV 590 Improved in both studies Wei et al 245 …”

“…There were 9 recent level III or IV studies, most of which showed a correlation between the presence/ 40 Galland et al 237 Golan et al 239 Gottlieb et al 213 Johnson and Roth 45 LeBourgeois et al 230 Mitchell and Kelly 240 Owens et al 189 Roemmich et al 191 Urschitz et al 229 Montgomery 240 Mitchell and Kelly 241 Rudnick and Mitchell 242 Suratt et al 43 III 114 O'Brien et al 24 I 118 Behavior problems, general Goldstein et al 55 IV 1946 Behavior generally measured by using parent questionnaire Goldstein et al 243 Hogan et al 48 Li et al 238 Mitchell and Kelly 241 Mulvaney et al 32 Owens et al 189 Roemmich et al 191 Rosen et al 244 Rudnick and Mitchell 242 Tran et al 58 Wei et al 245 Aggression, oppositional and social problems…”

“…238 Mitchell and Kelly 240 Mitchell and Kelly 241 Roemmich et al 191 Chervin et al 37 I 105 Long-term improvement in hyperactivity Somatization, depression…”