Washington, Mar 16 : Kids who put on weight rapidly after having their tonsils and adenoids removed to treat sleep-disordered breathing (SDB) may improve in the short-term, but over time they may relapse, says a new research.
Adenotonsillectomy is the most commonly performed surgery in children. It is the first line of treatment for SDB in children. For many kids, undergoing this major surgery provides only temporary relief.
"The high rate of recurrence we observed in both obese and non-obese children indicates that SDB is a chronic condition," said Raouf Amin, M.D., director of pulmonary medicine at Cincinnati Children's Hospital Medical Center.
In the study, the researchers recruited 40 healthy children between seven and 13 whose parents and otolaryngologists had jointly agreed upon adenotonsillectomy surgery to treat nightly snoring.
The investigators also recruited 30 sex- and age-matched children who were not undergoing adenotonsillectomy as a control group.
They performed polysomnographies on each child at time of recruitment, and again at six weeks, six months, and a year following surgery. Children in the control group had polysomnographies at the same intervals.
While the majority of children with SDB showed significant improvement in their AHI scores six weeks after surgery, the rate of relapse one year later had no correlation with the six-week score. Children who relapsed were more likely to be more obese, have worse SDB at baseline, and have an accelerated body mass index (BMI) gain.
"Most post-adenotonsillectomy outcome studies have focused on the assessment of SDB six to 16 weeks after surgery. Resolution of SDB during this window was usually interpreted as a cure for the disorder," noted Dr. Amin.
Half of the non-obese children, and two-thirds of the obese children had an AHI score of greater than 3 prior to surgery. A year later, 27 percent of the non-obese children and 79 percent of obese children had AHI score of greater than 3, indicating that the surgery was significantly more effective at a year in non-obese children.
While children who were obese at the baseline were more likely to relapse than their no-obese peers, accelerated BMI gain was also an independent risk factor for relapse.
"These results highlight the differential disease mechanisms between those due to obesity and those due to the rapid change in body composition associated with accelerated BMI gain," explained Dr. Amin.
The study is published in the American Journal of Respiratory and Critical Care Medicine.