The impact of sleep events on weight gain following early adenotonsillectomy compared to supportive care for pediatric OSA

Gourishetti, Saikrishna C.; Chu, Matthew L. H.; Isaiah, Amal

doi:10.1016/j.ijporl.2022.111049

Cited by 3 publications

(3 citation statements)

References 37 publications

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“…Based on these results, the investigators discussed the importance of nutritional counseling and physical activity in children after AT, especially in children with overweight. Gourishetti et al 46 demonstrated that a significant proportion of post-AT weight gain in children with OSA is mediated by reduction of fragmentation of rapid eye movement sleep and a subsequent reduction in metabolic expenditure. However, a second analysis by Kirkham et al 47 found that there were similar rates of weight gain between the eAT and WWSC groups.…”

Section: Growthmentioning

confidence: 99%

Secondary Analyses of the Childhood Adenotonsillectomy Trial

Decuzzi

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Isaiah

2022

JAMA Otolaryngol Head Neck Surg

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ImportanceAdenotonsillectomy, performed for approximately 500 000 children annually in the US alone, is the first line of treatment of pediatric obstructive sleep apnea (OSA). The Childhood Adenotonsillectomy Trial (CHAT), the first randomized clinical trial to test the efficacy of adenotonsillectomy, compared the management of pediatric nonsevere OSA by early adenotonsillectomy (eAT) vs watchful waiting with supportive care. Since the publication of the primary article in 2013, the CHAT study data set were made available via the National Sleep Research Resource, which allowed researchers to address a range of additional clinical questions relevant to the care of children with OSA. This review focuses on secondary analyses associated with the CHAT data set as grouped by the outcome of interest.ObservationsThe results of most secondary analyses suggest that children who underwent eAT experienced the greatest improvements in symptom burden, sleepiness, parent-reported behavior, and quality of life. Changes in other domains, such as cognition, cardiovascular physiology, and metabolic indicators, were modest and selective. The associations between most treatment outcomes and polysomnographic parameters were weak. Symptoms were poor predictors of OSA severity. The results from these secondary analyses benefitted from the rigor of multicenter design and centralized polysomnography interpretation in CHAT. However, the exclusion of younger preschool-aged children and children with primary snoring limited the generalizability of findings. In addition, because caregivers were not masked, some of the parent-reported outcomes may have been inflated.Conclusions and RelevanceThe results of this narrative review suggest that CHAT provides a model for future OSA-related studies in children for design, conduct, and subsequent reuse of the study data set, and its findings have advanced our understanding of the pathophysiology and management of pediatric nonsevere OSA. Directions for future research include whether the findings from this landmark study are generalizable to younger children and children with primary snoring and severe OSA. Similar studies may help address practice variability associated with pediatric OSA and help identify children who are most likely to benefit from undergoing eAT.

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Section: Growthmentioning

confidence: 99%

Secondary Analyses of the Childhood Adenotonsillectomy Trial

Decuzzi

Redline

Isaiah

2022

JAMA Otolaryngol Head Neck Surg

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“…In an attempt to investigate the pathophysiologic link between adenotonsillectomy and postoperative weight gain, Gourishetti et al [14 ▪ ] have completed secondary analysis of the CHAT dataset. They used causal mediation analysis to test the hypothesis that postadenotonsillectomy increase in BMI percentile is mediated by improvements in AHI and arousal index during REM sleep.…”

Section: The Bad: Complications Related To Adenotonsillectomy In Chil...mentioning

confidence: 99%

“…In the CHAT study, Katz et al indicated that school-age children in the early adenotonsillectomy arm had higher increases in BMI percentile during the 7-month postoperative period than the WWSC group, resulting in overweight at baseline becoming obese (52 vs. 21% in WWSC; P < 0.05) [13,14 ▪ ]. In contrast, similar proportions of children with failure to thrive in the adenotonsillectomy and WWSC arms achieved normal BMI z scores at follow-up and similar proportions of normal-weight participants in the two study arms became overweight [13].…”

Section: The Bad: Complications Related To Adenotonsillectomy In Chil...mentioning

confidence: 99%

Adenotonsillectomy: the good, the bad and the unknown

Kaditis

Gozal

2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewAdenotonsillar hypertrophy is the most common pathogenetic contributor to obstructive sleep apnea syndrome (OSAS) in childhood, and adenotonsillectomy is the standard initial treatment. Here, we summarize the most recent evidence on the efficacy and complications of adenotonsillectomy and explore knowledge gaps in clinical management. Recent findingsFavorable adenotonsillectomy effects have been reported in children with very severe OSAS [apnea-hypopnea index (AHI) >20 episodes/h] and extremely severe OSAS (AHI >100 episodes/h), without postoperative mortality, need for endotracheal intubation, prolonged hospital stay or re-admission after hospital discharge. However, the risk of residual OSAS after adenotonsillectomy, which may reach 30--60%, has not been thoroughly established. Behavior, OSAS-related symptoms and quality of life improve postoperatively even in children with AHI 1--5 episodes/h. Natural history of enuresis resolution is accelerated postadenotonsillectomy and office-based systemic blood pressure is decreased in OSAS and hypertension. However, which children younger than 2 years should undergo adenotonsillectomy instead of adenoidectomy only to prevent recurrence of OSAS symptoms and revision surgery remains unclear. Adenotonsillectomy in children with Prader--Willi syndrome is frequently accompanied by postoperative residual OSAS while complications are not uncommon.

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Growth and development in pediatric obstructive sleep apnea

Caraballo

2024

Snoring and Obstructive Sleep Apnea in Children

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The impact of sleep events on weight gain following early adenotonsillectomy compared to supportive care for pediatric OSA

Cited by 3 publications

References 37 publications

Secondary Analyses of the Childhood Adenotonsillectomy Trial

Secondary Analyses of the Childhood Adenotonsillectomy Trial

Adenotonsillectomy: the good, the bad and the unknown

Growth and development in pediatric obstructive sleep apnea

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