Risks of Child Sleep Apnea Treatment

Adenotonsillectomy in young children may lead to weight gain

(RxWiki News) Health risks can result from obstructive sleep apnea in both adults and in children. But some treatments in children may be tricky.

A recent study found that a surgery used to treat obstructive sleep apnea in children may contribute to greater weight gain.

That weight gain may actually further increase the risk of obstructive sleep apnea in those children.

Sleep apnea is a condition in which a person periodically stops breathing or breathes too shallowly while asleep.

"Discuss sleep apnea treatment options with your doctor."

The study, led by Eliot Katz, MD, of Division of Respiratory Diseases, Boston Children’s Hospital, looked at whether children gain weight after adenotonsillectomies.

An adenotonsillectomy is a procedure in which a child's tonsils and adenoids are removed, usually to treat obstructive sleep apnea.

The adenoids are patches of tissue at the back of the nasal cavity.

Obstructive sleep apnea usually results from the tonsils or adenoids partially getting in the way of the breathing passages.

The researchers randomly divided 464 children with obstructive sleep apnea, aged 5 to 9, into two groups.

The children in one group received adenotonsillectomies. The others were assigned "watchful waiting." That means their condition was watched to see if it worsened.

The children underwent sleep tests and were weighed and measured at the start of the study and seven months later.

Then the researchers compared the body mass index (BMI) of the children. BMI is a ratio of height and weight that can be used to determine if someone is overweight or obese.

At the follow-up, the BMI of children in both groups had increased, but it had increased more in those who had surgery.

In addition, 52 percent of children who were already overweight when the study began were obese at the 7-month follow-up, compared to only 21 percent of overweight children in the watchful waiting group.

This finding meant that overweight children had a greater risk of developing obesity with the surgery than without.

The researchers did not find any differences across race/ethnicity or sex.

"The increase in [fat] in overweight children places them at further risk for obstructive sleep apnea and the adverse consequences of obesity," the researchers wrote.

"Monitoring weight, nutritional counseling and encouragement of physical activity should be considered after early adenotonsillectomy for obstructive sleep apnea," they wrote.

This study reveals the importance of weighing risks and benefits, said William Kohler, MD, the medical director of the Florida Sleep Institute in Spring Hill, Florida.

"In general, when you consider any form of treatment, you need to balance the potential gain with the potential risk and adverse effects," he said.

"Overall, in most cases, the adenotonsillectomy for obstructive sleep apnea is thought to be indicated," Dr. Kohler said. "But one must keep in mind potential side effects, such as the weight gain."

How the possible weight gain affects children may vary based on their circumstances, he said.

"In some cases, the weight gain is a positive effect in that some of the children with severe sleep apnea have failure to thrive, so the weight gain is good," Dr. Kohler said. "Other children who are obese don't need the weight gain, and nutritional evaluation and treatment should be added to the treatment of adenotonsillectomy."

The study was published July 28 in the journal Pediatrics. The research was funded by that National Institutes of Health.

One author has consulted for Zansors and received research funding from Respironics/Phillips and Fisher-Paykel.

Review Date: 
July 26, 2014