Outcome of Adenotonsillectomy for Obstructive Sleep Apnea in Obese and Normal-Weight Children

2007 ◽  
Vol 137 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Ron B. Mitchell ◽  
James Kelly
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Controlled Trial ◽  
Normal Weight ◽  
Apnea Hypopnea Index ◽  
Dramatic Improvement ◽  
Obese Children ◽  
Respiratory Parameters ◽  
Obstructive Sleep ◽  
Study Participants

OBJECTIVES: 1) To evaluate the relative severity of obstructive sleep apnea (OSA) in obese and normal-weight children; 2) to compare changes in respiratory parameters after adenotonsillectomy in obese and normal-weight children. STUDY DESIGN AND SETTING: Prospective controlled trial that included children aged 3 to 18 years. All study participants underwent pre- and postoperative polysomnography. RESULTS: The study population included 33 obese children and 39 normal-weight controls. Preoperatively, the median obstructive apnea-hypopnea index (AHI) was 23.4 (range 3.7-135.1) for obese and 17.1 (range 3.9-36.5) for controls ( P < 0.001). Postoperatively, the AHI was 3.1 (range 0-33.1) for obese and 1.9 (range 0.1-7.0) for controls ( P < 0.01). Twenty-five obese children (76%) and 11 controls (28%) had persistent OSA. CONCLUSION AND SIGNIFICANCE: AHI scores are higher in obese than in normal-weight children with OSA. Both groups show a dramatic improvement in AHI after adenotonsillectomy, but persistent OSA is more common in obese children.

Surgery for Obstructive Sleep Apnea in Obese Children: Literature Review and Meta-analysis

2019 ◽  
Vol 160 (6) ◽  
pp. 985-992 ◽  
Author(s):  
Patrick Scheffler ◽  
Nikolaus E. Wolter ◽  
Indra Narang ◽  
Reshma Amin ◽  
Theresa Holler ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Meta Analysis ◽  
Normal Weight ◽  
Tongue Base ◽  
Apnea Hypopnea Index ◽  
Obese Children ◽  
Surgical Interventions ◽  
Limited Effectiveness ◽  
Obstructive Sleep

Objectives Surgical intervention for obstructive sleep apnea (OSA) in overweight and obese children may not be as effective as it is in normal-weight children. The purpose of this study was to systematically review the effects of various surgical interventions for OSA in obese children and to meta-analyze the current data. Data Sources PubMed, OVID, and Cochrane databases. Review Methods Databases were searched for studies examining adenotonsillectomy, uvulopalatopharyngoplasty, supraglottoplasty, or tongue base surgeries and combinations in obese children with OSA. Adenotonsillectomy was the only procedure with enough data for meta-analysis; polysomnographic data were extracted and analyzed using a random-effects model. Results For adenotonsillectomy, 11 studies were included in the meta-analysis. Despite significant improvement in the apnea-hypopnea index (22.9 to 8.1 events/h, P < .001), respiratory disturbance index (24.8 to 10.4 events/h, P < .001), and oxygen saturation nadir (78.4% to 87.0%, P < .001), rates of persistent OSA ranged from 51% to 66%, depending on the outcome criterion used. There was evidence of limited effectiveness for surgical interventions to treat OSA in obese children using uvulopalatoplasty (12.5%) and tongue base surgery (74%-88%). Conclusions Surgical interventions for OSA in overweight and obese children are effective at reducing OSA but with higher rates of persistent OSA than reported for normal-weight children. However, the amount of reduction appears to vary by surgical procedure. More attention should be paid toward preoperative weight loss and patient selection, and parents should be provided with realistic postoperative expectations in this difficult-to-treat population.

The interaction of obesity and craniofacial deformity in obstructive sleep apnea

2020 ◽  
pp. 20200425
Author(s):  
Liping Huang ◽  
Xuemei Gao
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Soft Tissues ◽  
Normal Weight ◽  
The Body ◽  
Apnea Hypopnea Index ◽  
Obese Patients ◽  
Weight Group ◽  
Normal Weight Group ◽  
Obstructive Sleep

Objective: Both obesity and craniofacial deformity are important etiologies of obstructive sleep apnea (OSA). The present research aimed to explore their interaction and different impacts on OSA severity. Methods: A total of 207 consecutive OSA patients (169 males, 38 females) were included in the research. Based on the body mass index (BMI) value, patients were divided into 77 normal-weight patients (BMI <24 kg m−2), 105 overweight patients (24 ≤ BMI<28 kg m−2) and 26 obese patients (BMI ≥28 kg m−2). All accepted overnight polysomnography and standard lateral cephalogram. Cephalometric measurements involved 25 cephalometric variables. The correlations between these cephalometric variables, BMI and the apnea-hypopnea index (AHI) were evaluated. Results: For the whole sample after controlling for gender and age, stepwise regression analysis showed that the factors affecting AHI were increased BMI, narrowing posterior airway space, inferior displacement of hyoid and elongation of the tongue. When grouped by BMI, normal-weight group exhibited with more reduced maxillary length and mandible length, and steeper mandible plane than overweight and obese patients (p < 0.0167). Obese group showed least skeletal restriction and most prominent soft tissues enlargement (p < 0.0167). However, these skeletal indexes were not statistically correlated with AHI. Conclusions: Obesity and skeletal malformations were both etiological factors of OSA, but obesity seemed to have a greater influence on AHI severity in all kinds of obese and thin OSA patients. Only in normal-weight group, it was affected by both cephalometric variables and BMI.

S248 – Supraglottoplasty for Laryngomalacia with Sleep Apnea

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P158-P158
Author(s):  
Mark E Zafereo ◽  
Rodney J Taylor ◽  
Kevin D Pereira
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Apnea Hypopnea Index ◽  
Obstructive Apnea ◽  
Respiratory Parameters ◽  
Obstructive Sleep ◽  
Respiratory Disturbance ◽  
Student’S T

Objectives To determine if supraglottoplasty is effective in reversing abnormal respiratory parameters in children with laryngomalacia and obstructive sleep apnea. Methods 10 patients with laryngomalacia and obstructive sleep apnea as documented by polysomnography underwent supraglottoplasty at a tertiary referral children's hospital between 2005 and 2007. Retrospective data collection included age, findings on flexible and rigid endoscopy, type of procedure performed, and postoperative course. The postoperative polysomnographies were reviewed to identify changes in obstructive apnea index (OAI), obstructive apnea/hypopnea index (OAHI), respiratory disturbance index (RDI), and low arterial oxygen saturation (O2 nadir) after supraglottoplasty. Pre- and postoperative mean data were calculated, and comparisons were made with a Student's T-test. Results All 10 patients were successfully extubated following supraglottoplasty. There were no perioperative or postoperative complications, and no patient required a subsequent airway procedure. Each patient had a postoperative nocturnal polysomnography performed following supraglottoplasty at 11 weeks (range 2–29 weeks). Caregivers reported mild improvement (10%), significant improvement (70%), and complete resolution (20%) of stridor and nocturnal snoring at a follow-up visit 4 weeks after hospital discharge. Marked improvements were observed in OAI, OAHI, RDI and O2 nadir, all of which were statistically significant (p<0.05). Conclusions Polysomnography should be included in the initial evaluation of infants with laryngomalacia to rule out obstructive sleep apnea. Supraglottoplasty is an effective treatment for infants with laryngomalacia and obstructive sleep apnea. The significant benefits of the procedure outweigh the low morbidity. Improvement after surgery can be reliably confirmed by polysomnography.

scholarly journals Nightly Hypoxia Does Not Seem to Lead to Otolith Dysfunction in Patients With Obstructive Sleep Apnea

2020 ◽  
pp. 014556132092212
Author(s):  
Richard Birk ◽  
Miriam Dietz ◽  
Jörg Ulrich Sommer ◽  
Boris A. Stuck ◽  
Karl Hörmann ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Vestibular Function ◽  
Oxygen Desaturation ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Apnea Hypopnea Index ◽  
Horizontal Semicircular Canal ◽  
Respiratory Parameters ◽  
Obstructive Sleep

Objectives: Obstructive sleep apnea (OSA) is a common sleep disorder, which is associated with recurrent oxygen desaturation during sleep. It has already been shown that nocturnal hypoxia may lead to cochlear dysfunction in patients with OSA. Less is known whether hypoxia during sleep also impacts vestibular function in those patients. Thus, the aim of the presented study was to assess a potential vestibulotoxic effect of nightly desaturations with hypoxia in patients with OSA by investigating a possible correlation between respiratory parameters and vestibular function tests. Methods: A total of 56 patients were included in the study and underwent a fully attended cardiorespiratory polysomnography (PSG). Vestibular function was assessed using video head impulse test to evaluate horizontal semicircular canal function and cervical vestibular evoked myogenic potentials (cVEMPs) and ocular vestibular evoked myogenic potentials (oVEMPs) to measure otolith function. Descriptive data analysis was conducted and correlation analysis between selected PSG parameters and the results of vestibular testing was performed using Kendall τ coefficient. Results: A significant correlation between vestibular function and respiratory polysomnographic parameters could not be demonstrated in the study ( P > .05) but cVEMP and oVEMP results showed a trend toward a correlation with oxygen desaturation indices and apnea–hypopnea index. Additionally, otolith hypofunction was more prevalent in patients with hypertension as well as OSA. Conclusion: The results of our study show that there is no significant correlation between vestibular function and sleep apnea parameters, although otolith dysfunction might be more prevalent in patients with OSA and hypertension.

scholarly journals Postoperative morbidity after adenotonsillectomy versus adenopharyngoplasty in young children with obstructive sleep apnea: an RCT

2020 ◽  
Vol 277 (10) ◽  
pp. 2821-2827
Author(s):  
Johan Fehrm ◽  
Anna Borgström ◽  
Pia Nerfeldt ◽  
Danielle Friberg
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Postoperative Morbidity ◽  
Present Report ◽  
Controlled Trial ◽  
Pain Scale ◽  
Normal Diet ◽  
Apnea Hypopnea Index ◽  
Healthy Children ◽  
Obstructive Sleep

Abstract Purpose In our previous randomized controlled trial (RCT), comparing adenotonsillectomy (ATE) with adenopharyngoplasty (APP) in children with severe obstructive sleep apnea (OSA), there were no differences in respiratory sleep parameters or quality of life. The purpose of the present report was to evaluate postoperative morbidity from this RCT. Methods The study was a blinded RCT in 83 children (ATE = 47; APP = 36), 2–4 years of age, with an obstructive apnea–hypopnea index of ≥ 10. Pain was assessed from the first until the tenth day after surgery with a logbook that reported pain by child (FPS-R, Faces Pain Scale-Revised) and caregiver (visual analogue scale), analgesic use, return to normal diet, and weight change. Bleeding, infection, satisfaction with treatment, speech, and swallowing were assessed with a questionnaire and medical records 6 months after surgery. Results Sixty-four children (77%) returned the logbook and 65 (78%) answered the questionnaire. The median (interquartile range) day the children graded themselves as pain free (FPS-R = 0) was 7 (6–10) after ATE, compared with 9 (7 to > 10) after APP (p = 0.018). There were no other significant differences between the groups regarding any other pain-related outcomes, bleeding, infection, satisfaction, swallowing, or speech, but three children (11%) reported impaired speech after APP compared to none after ATE (p = 0.067). Conclusion The results regarding postoperative morbidity were in favor of ATE and the results from our previous report showed no advantages of APP. Therefore, APP should not be recommended in young, otherwise healthy children with OSA.

Tonsillectomy for Obstructive Sleep Apnea in Obese Children

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P69-P70
Author(s):  
Dary J Costa ◽  
Ron B Mitchell
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Weighted Mean Difference ◽  
Mean Difference ◽  
Apnea Hypopnea Index ◽  
Obese Children ◽  
Weighted Mean ◽  
Obstructive Sleep ◽  
The Mean

Objective To determine the effectiveness of adenotonsillectomy (T&A) for treating obstructive sleep apnea (OSA) in obese children. Methods Meta-analysis of studies that reported sleep parameters in obese children with OSA before and after T&A. Data was analyzed using the random effects model. Statistical significance was P less than 0.05. Results Data from four studies that included 110 children were analyzed. Mean sample size was 27.5 (range: 18 - 33). Mean body mass index (BMI) z-score was 2.81. The mean pre-and postoperative apnea-hypopnea index (AHI) was 29.0 (range 22.2 - 34.3) and 9.9 (range 6.0 - 12.2) respectively. The weighted mean difference between pre- and postoperative AHI was a significant reduction of 18.3 events per hour (95% CI 11.2–25.5). The mean pre- and postoperative oxygen saturation nadir was 78.9% (range 73.9 -81.1%) and 85.7% (83.6 -89.9%) respectively. The weighted mean difference was a significant increase in the oxygen saturation nadir of 6.3% (95% CI 3.9 to 8.7). Approximately 43% of children had a postoperative AHI less than 5, 21% of children had a postoperative AHI less than 2, and 11% of children had a postoperative AHI less than 1. Conclusions T&A improves but does not resolve OSA in the majority of obese children. Up to 89% of obese children have persistent OSA after T&A. The efficacy and role of additional therapeutic options requires more study. The high incidence of obesity in children makes this a public health priority.

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