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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, London E1 1FR, UK E-mail: Nilesh.vakharia@nhs.net
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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

Information

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

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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.

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