Chronic Snoring remains after Surgery for Obese and African-American Children

A new study from Cincinnati Children's Hospital Medical Center reports that surgery to remove children's tonsils and adenoids to treat sleep-disordered breathing (SDB) may be successful in the short term. However, children who gain weight rapidly and African-American children tend to relapse or even worsen. The study is published in the American Journal of Respiratory and Critical Care Medicine.

Adenotonsillectomy - or removal of the tonsils and adenoids - is a surgery that is frequently performed on children. About 19 per 10,000 children in Canada, 50 per 10,000 in the U.S, and 115 per 10,000 in the Netherlands receive the surgery. Although it is often the first treatment option for SDB in children, many patients are only provided with short-term relief from SDB.

Author Raouf Amin, M.D., who directs pulmonary medicine at the hospital, writes, "The high rate of recurrence we observed in both obese and non-obese children indicates that SDB is a chronic condition."

Amin and colleagues used a sample of 40 healthy children, ages 7 to 13, whose parents and otolaryngologists agreed to treat chronic snoring with adenotonsillectomy. Thirty sex- and age-matched children who were not having the surgery were recruited as a control group. At the time of recruitment, each child received a polysomnography (PSG) - a multi-parametric test used to study sleep. PSGs were again performed at six weeks, six months, and a year after the surgery for both the treatment and control groups.

Six weeks after surgery, most of the children with SDB improved their apnea-hypopnea index (AHI) scores. However, the rate of relapse after one year had no correlation with the six-week score. Traits such as obesity, worse SDB at baseline, rapid body mass index (BMI) gain, and being African-American were associated with children who relapse.

"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." Dr. Amin notes that, "We report[ed] for the first time the longitudinal outcome of adenotonsillectomy in healthy children, the important influence of BMI gain velocity and African-American race on recurrence of SDB."

Before surgery, about 50% of the non-obese children and 67% of the obese children had an AHI score of greater than 3. A year after surgery, 27% and 79%, respectively, had AHI score of greater than 3. These changes indicate that the surgery was significantly more effective in non-obese children after on year. Children who were obese at the baseline and, independently, children who had rapid BMI gain were more likely to relapse than those who lacked these characteristics.

Amin clarifies, "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." Additionally, relapse was significantly associated with children who had higher blood pressure.

"SDB appears to be a chronic disorder that is clearly linked to other medical problems. Given the rate of relapse, we advocate long-term follow up of children with SDB, monitoring of BMI gain, and reevaluation of children who demonstrate rapid BMI gain, especially those who are African-American," conclude the researchers.

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