Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-05-23T05:42:23.827Z Has data issue: false hasContentIssue false
  • English
  • Français

Adenotonsillectomy for the treatment of obstructive sleep apnoea in extreme paediatric obesity

Published online by Cambridge University Press:  01 October 2021

N Vakharia Open the ORCID record for N Vakharia [Opens in a new window] ,
C Murkin ,
A Hall  and
Y Bajaj
N Vakharia*
Affiliation:
Department of ENT Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
C Murkin
Affiliation:
Department of ENT Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
A Hall
Affiliation:
Department of ENT Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
Y Bajaj
Affiliation:
Department of ENT Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
*
Author for correspondence: Dr N Vakharia, Department of ENT Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, LondonE1 1FR, UK E-mail: Nilesh.vakharia@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Adenotonsillectomy is a recognised treatment for paediatric obstructive sleep apnoea. Recent literature highlights the need to assess outcomes in the extremely obese subpopulation. This study reviewed the efficacy of adenotonsillectomy performed in patients with extreme obesity.

Method

A retrospective analysis of attendees at a tertiary paediatric obesity clinic was performed, identifying patients with a body mass index z-score equal to or more than three who had undergone adenotonsillectomy for obstructive sleep apnoea. Electronic patient records, including respiratory polygraphy, were analysed.

Results

Nine patients met the study criteria. All required nocturnal non-invasive ventilation pre-operatively. Mean age at referral was 6.9 years, and average age of non-invasive ventilation commencement was 7.8 years. Post-operatively, 8 patients (89 per cent) required non-invasive ventilation with evidence of post-operative obstructive sleep apnoea.

Conclusion

In extreme obesity, adenotonsillectomy does not prevent the need for non-invasive ventilation. Management of this patient group requires treatment of obesity alongside potential surgical intervention. Poor efficacy in treating obstructive sleep apnoea may influence the decision to proceed with adenotonsillectomy.

Keywords

Sleep Apnea, ObstructivePediatric ObesityAdenoidectomyTonsillectomy
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 11 , November 2022 , pp. 1071 - 1076
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr N Vakharia takes responsibility for the integrity of the content of the paper

Presented at the British Association for Paediatric Otolaryngology, 23–24 September 2021, Birmingham, UK.

References

Bentham, J, Di Cesare, M, Bilano, V, Bixby, H, Zhou, B, Stevens, GA et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128⋅9 million children, adolescents, and adults. Lancet 2017;390:2627–42Google Scholar
Arens, R, Muzumdar, H. Childhood obesity and obstructive sleep apnea syndrome. J Appl Physiol 2010;108:436–44CrossRefGoogle ScholarPubMed
Kelly, AS, Barlow, SE, Rao, G, Inge, TH, Hayman, LL, Steinberger, J et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation 2013;128:1689–712CrossRefGoogle ScholarPubMed
Flegal, KM, Wei, R, Ogden, CL, Freedman, DS, Johnson, CL, Curtin, LR. Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts. Am J Clin Nutr 2009 Nov;90:1314–20CrossRefGoogle ScholarPubMed
Koebnick, C, Smith, N, Coleman, KJ, Getahun, D, Reynolds, K, Quinn, VP et al. Prevalence of extreme obesity in a multiethnic cohort of children and adolescents. J Pediatr 2010;157:26–31.e2CrossRefGoogle Scholar
Barlow, SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120(suppl):164–92CrossRefGoogle ScholarPubMed
Shine, NP, Coates, HL, Lannigan, FJ. Obstructive sleep apnea, morbid obesity, and adenotonsillar surgery: a review of the literature. Int J Pediatr Otorhinolaryngol 2005;69:1475–82CrossRefGoogle ScholarPubMed
Shelton, KE, Woodson, H, Gay, S, Suratt, PM. Pharyngeal fat in obstructive sleep apnea. Am Rev Respir Dis 1993;148:462–6CrossRefGoogle ScholarPubMed
Mitchell, RB, Kelly, J. Behavioral changes in children with mild sleep-disordered breathing or obstructive sleep apnea after adenotonsillectomy. Laryngoscope 2007;117:1685–8CrossRefGoogle ScholarPubMed
Capdevila, OS, Kheirandish-Gozal, L, Dayyat, E, Gozal, D. Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc 2008;5:274–82CrossRefGoogle Scholar
Martinot, JB, Le-Dong, NN, Denison, S, Guénard, HJP, Borel, JC, Silkoff, PE et al. Persistent respiratory effort after adenotonsillectomy in children with sleep-disordered breathing. Laryngoscope 2018;128:1230–7CrossRefGoogle ScholarPubMed
Costa, DJ, Mitchell, R. Adenotonsillectomy for obstructive sleep apnea in obese children: a meta-analysis. Otolaryngol Head Neck Surg 2009;140:455–60CrossRefGoogle ScholarPubMed
Venekamp, RP, Hearne, BJ, Chandrasekharan, D, Blackshaw, H, Lim, J, Schilder, AG. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev 2015;(10):CD011165Google Scholar
Lee, CH, Kang, KT, Chiu, SN, Chang, IS, Weng, WC, Lee, PL et al. Association of adenotonsillectomy with blood pressure among hypertensive and nonhypertensive children with obstructive sleep apnea. JAMA Otolaryngol Head Neck Surg 2018;144:300–7CrossRefGoogle ScholarPubMed
Scheffler, P, Wolter, NE, Narang, I, Amin, R, Holler, T, Ishman, SL et al. Surgery for obstructive sleep apnea in obese children: literature review and meta-analysis. Otolaryngol Head Neck Surg 2019;160:985–92CrossRefGoogle ScholarPubMed
Lennon, CJ, Wang, RY, Wallace, A, Chinnadurai, S. Risk of failure of adenotonsillectomy for obstructive sleep apnea in obese pediatric patients. Int J Pediatr Otorhinolaryngol 2017;92:7–10CrossRefGoogle ScholarPubMed
Barlow, SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120:s164–92CrossRefGoogle ScholarPubMed
Tsai, CM, Kang, CH, Su, MC, Lin, HC, Huang, EY, Chen, CC et al. Usefulness of desaturation index for the assessment of obstructive sleep apnea syndrome in children. Int J Pediatr Otorhinolaryngol 2013;77:1286–90CrossRefGoogle ScholarPubMed
Kaditis, A, Kheirandish-Gozal, L, Gozal, D. Pediatric OSAS: oximetry can provide answers when polysomnography is not available. Sleep Med Rev 2015;27:96–105CrossRefGoogle Scholar
Powell, S, Kubba, H, O'Brien, C, Tremlett, M. Paediatric obstructive sleep apnoea. BMJ 2010;340:1018–23CrossRefGoogle ScholarPubMed
Brouillette, RT, Morielli, A, Leimanis, A, Waters, KA, Luciano, R, Ducharme, FM. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatrics 2000;105:405–12CrossRefGoogle ScholarPubMed
Rosen, CL, D'andrea, L, Haddad, GG. Adult criteria for obstructive sleep apnea do not identify children with serious obstruction. Am Rev Respir Dis 1992;146:1231–4CrossRefGoogle Scholar
Nixon, GM, Brouillette, RT. Sleep⋅8: paediatric obstructive sleep apnoea. Thorax 2005;60:511–6CrossRefGoogle Scholar
Working Party on Sleep Physiology and Respiratory Control Disorders in Childhood. Standards for Services for Children with Disorders of Sleep Physiology 2009. In: https://www.rcpch.ac.uk/Research/ce/Guidelines-frontpage/Guideline-Appraisals-by-Organisation/RCPCH-Working-Party [19 May 2022]Google Scholar
Dehlink, E, Tan, H-L. Update on paediatric obstructive sleep apnoea. J Thorac Dis 2016;8:224–35Google ScholarPubMed
Mitchell, RB, Kelly, J. Adenotonsillectomy for obstructive sleep apnea in obese children. Otolaryngol Head Neck Surg 2004;131:104–8CrossRefGoogle ScholarPubMed
Shine, NP, Lannigan, FJ, Coates, HL, Wilson, A. Adenotonsillectomy for obstructive sleep apnea in obese children. Arch Otolaryngol Neck Surg 2006;132:1123CrossRefGoogle ScholarPubMed
Brietzke, SE, Gallagher, D. The effectiveness of tonsillectomy and adenoidectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a meta-analysis. Otolaryngol Head Neck Surg 2006;134:979–84CrossRefGoogle ScholarPubMed
Andersen, IG, Holm, J-C, Homøe, P. Impact of weight-loss management on children and adolescents with obesity and obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2019;123:57–62CrossRefGoogle ScholarPubMed
Verhulst, SL, Franckx, H, Van Gaal, L, De Backer, W, Desager, K. The effect of weight loss on sleep-disordered breathing in obese teenagers. Obesity 2009;17:1178–83CrossRefGoogle ScholarPubMed
Nafiu, OO, Green, GE, Walton, S, Morris, M, Reddy, S, Tremper, KK. Obesity and risk of peri-operative complications in children presenting for adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2009;73:89–95CrossRefGoogle ScholarPubMed
Lavin, JM, Smith, C, Harris, ZL, Thompson, DM. Critical care resources utilized in high-risk adenotonsillectomy patients. Laryngoscope 2019;129:1229–34CrossRefGoogle ScholarPubMed
Croft, CB, Pringle, M. Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol 1991;16:504–9CrossRefGoogle ScholarPubMed
Boudewyns, A, Verhulst, S, Maris, M, Saldien, V, Van de Heyning, P. Drug-induced sedation endoscopy in pediatric obstructive sleep apnea syndrome. Sleep Med 2014;15:1526–31CrossRefGoogle ScholarPubMed
Maris, M, Verhulst, S, Saldien, V, Van de Heyning, P, Wojciechowski, M, Boudewyns, A. Drug-induced sedation endoscopy in surgically naive children with Down syndrome and obstructive sleep apnea. Sleep Med 2016;24:63–70CrossRefGoogle ScholarPubMed
Gazzaz, MJ, Isaac, A, Anderson, S, Alsufyani, N, Alrajhi, Y, El-Hakim, H. Does drug-induced sleep endoscopy change the surgical decision in surgically naïve non-syndromic children with snoring/sleep disordered breathing from the standard adenotonsillectomy? A retrospective cohort study. J Otolaryngol Head Neck Surg 2017;46:12CrossRefGoogle ScholarPubMed
Van de Perck, E, Van Hoorenbeeck, K, Verhulst, S, Saldien, V, Vanderveken, OM, Boudewyns, A. Effect of body weight on upper airway findings and treatment outcome in children with obstructive sleep apnea. Sleep Med 2021;79:19–28CrossRefGoogle ScholarPubMed
Kotecha, BT, Hall, AC. Role of surgery in adult obstructive sleep apnoea. Sleep Med Rev 2014;18:405–13CrossRefGoogle ScholarPubMed
Rashid, NHA, Zaghi, S, Scapuccin, M, Camacho, M, Certal, V, Capasso, R. The value of oxygen desaturation index for diagnosing obstructive sleep apnea: a systematic review. Laryngoscope 2020;131:440–7CrossRefGoogle ScholarPubMed
Terrill, PI. A review of approaches for analysing obstructive sleep apnoea-related patterns in pulse oximetry data. Respirology 2020;25:475–85CrossRefGoogle ScholarPubMed
Dos Santos, C, Samuels, M, Laverty, A, Raywood, E. Comparison of oxygen desaturation index and apnoea-hypopnoea index for categorising OSA in children. Eur Respir J 2018;52:PA549Google Scholar
Liu, JF, Tsai, CM, Su, MC, Lin, MC, Lin, HC, Lee, WJ et al. Application of desaturation index in post-surgery follow-up in children with obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 2017;274:375–82CrossRefGoogle ScholarPubMed
de Onis, M, Onyango, AW, Borghi, E, Siyam, A, Nishida, C, Siekmann, J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007;85:660–7CrossRefGoogle ScholarPubMed