Adenotonsillectomy for OSA in Kids Can Lead to Weight Gain (Medscape)

Wed, 30 Jul 2014

from Medscape:

Adenotonsillectomy for OSA in Kids Can Lead to Weight Gain

By Rob Goodier
July 29, 2014

NEW YORK (Reuters Health) - Children who undergo adenotonsillectomy for obstructive sleep apnea (OSA) may be at risk for weight gain, according to a new paper.

The authors say their trial data confirm long-held suspicions of this side effect.

"There are large increases in body weight likely following adenotonsillectomy, even in children that are overweight or obese to begin with. Weight gain leads to a recurrence of OSA, mitigating the beneficial effects of surgery. Thus, we recommend that a nutritional and physical activity intervention should be routinely included in the regimen," lead author Dr. Eliot Katz of Boston Children's Hospital told Reuters Health by email.

As reported online July 28 in Pediatrics, his analysis focused on a secondary outcome of the randomized multi-center Childhood Adenotonsillectomy Study (CHAT), in which 464 children with OSA received either adenotonsillectomy or non-surgical supportive care. The CHAT results were initially reported last year in The New England Journal of Medicine (see Reuters Health story of May 21, 2013).

"The primary outcomes of the CHAT study were cognitive and behavioral," Dr. Katz noted. He added that 46% of patients in the control group had a resolution of OSA without surgery - although kids who had surgery had "very large improvements in behavior . . . in both parent and teacher reports."

What the present study adds, he continued, is the finding that children in both groups gained weight, but those who underwent surgery gained more, on average.

Looking at standard deviation changes in the children's body mass index (their BMI z-score), the z-score increased by 0.13 in the group that did not have surgery, and 0.31 in the surgery group.

The effect seems pronounced in children who are overweight before the procedure, the authors say.

More than half of the children who were overweight before surgery were obese seven months later, compared to little more than a fifth of the children who did not undergo surgery.

Statistical analysis bore out the observation, finding a positive relationship between weight gain and higher BMI at baseline. The same goes for children who have worse sleep apnea at baseline, as measured by the apnea hypopnea index.

But other factors such as race, gender and age did not appear to predict weight gain, the study found.

"This study demonstrates the profound influence that obstructive sleep apnea has on the metabolic processes in children, that is at least partially reversible with treatment," Dr. Katz said.

He added, "We are recommending that a comprehensive dietary and activity history be included in the preoperative evaluation of children with obstructive sleep apnea undergoing adenotonsillectomy, and that an appropriate anticipatory intervention to improve nutritional intake and increase physical activity be instituted postoperatively."


Pediatrics 2014.