Inflammation and Growth in Young Children with Obstructive Sleep Apnea Syndrome before and after Adenotonsillectomy

Abstract

Background. Obstructive sleep apnea (OSA) is associated with growth impairment that usually improves following effective treatment. In this study we investigated the mechanisms underlying the growth processes in young children diagnosed with OSA, before and after adenotonsillectomy (T&A). Methods. Young children (6–36 months old) were enrolled and evaluated before and several months after T&A surgery for height, weight, circulating high sensitive C-reactive protein (CRP), and insulin-like growth factor 1 (IGF-1) levels. Caloric intake was assessed by a validated Short Food Frequency Questionnaire (SFFQ). Results. Following T&A, children added 4.81 cm and 1.88 kg to their height and weight, respectively (P < 0.001 for both) and had a significant increase in BMI Z score (P = 0.002). Increased caloric intake of 377 kcal/day was noted (P < 0.001), with increased protein and decreased fat intake. The decrease in CRP levels correlated with the increase in body weight in boys (P < 0.05, adjusted for caloric intake). Conclusions. Adenotonsillectomy results in enhanced somatic growth in young children that correlates with a decrease in systemic inflammation and caloric intake increment. Our findings imply that systemic inflammation may have an important role in this OSA-related morbidity.

ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children

“…However, in such cases OSAS severity may be underestimated and thus appropriate anaesthetic and post-operative care might not be available. b) Children with OSAS related to adenotonsillar hypertrophy or laryngomalacia and body mass index in the lower percentiles have symptom resolution and increased growth rate following adenotonsillectomy or supraglottoplasty [20,83,94,108,109]. c) Improvement in symptoms and/or AHI was demonstrated in infants with OSAS and adenotonsillar hypertrophy, laryngomalacia, choanal atresia, mandibular hypoplasia or craniosynostosis syndromes with or without midface hypoplasia after surgical treatment (adenoidectomy, tonsillectomy, adenotonsillectomy, supraglottoplasty, repair of choanal atresia, mandibular distraction osteogenesis and midface advancement) [20,30,38,39,44,52,94].…”

Relationships Among and Predictive Values of Obesity, Inflammation Markers, and Disease Severity in Pediatric Patients with Obstructive Sleep Apnea Before and After Adenotonsillectomy

“…Systemic inflammation is one of the most commonly proposed mechanisms, and it has been suggested to influence OSA severity and associated co-morbidities [11,12]. A study in Israel reported enhanced somatic growth after adenotonsillectomy (AT) in association with a decrease in systemic inflammation and an increase in caloric intake, showing the co-existence of systemic inflammation and OSA-related morbidities [13].…”

Evaluation and Treatment of Children and Adolescents With Excessive Daytime Sleepiness

“…22,24 Specific sleep disorders frequently accompanied by EDS have also been associated with health-related adverse effects; for example, obstructive sleep apnea (OSA) in children and adolescents has been correlated in multiple studies with growth failure and insulin resistance, as well as hypertension and inflammatory changes in systemic and central nervous system vasculature. 25,26 Children and adolescents with EDS are also more prone to being bullied, to being regarded as "lazy," "inattentive," or "unmotivated," and to having low self-esteem. 2,12 Excessive daytime sleepiness in children and adolescents is underreported by parents and underdiagnosed by physicians, possibly due to lack of recognition.…”