Tonsillectomy for Obstructive Sleep Apnea in Obese Children
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.