Growth velocity predicts recurrence of sleep-disordered breathing 1 year after adenotonsillectomy

Am J Respir Crit Care Med. 2008 Mar 15;177(6):654-9. doi: 10.1164/rccm.200710-1610OC. Epub 2008 Jan 3.

Abstract

Rationale: Adenotonsillectomy, the first line of treatment of sleep-disordered breathing (SDB), is the most commonly performed pediatric surgery. Predictors of the recurrence of SDB after adenotonsillectomy and its impact on cardiovascular risk factors have not been identified.

Objectives: Demonstrate that gain velocity in body mass index (BMI) defined as unit increase in BMI/year confers an independent risk for the recurrence of SDB 1 year after adenotonsillectomy.

Methods: Children with SDB and hypertrophy of the tonsils and a comparison group of healthy children were followed prospectively for 1 year.

Measurements and main results: Serial polysomnographies, BMI, and blood pressure were obtained before adenotonsillectomy and 6 weeks, 6 months, and 1 year postoperatively. Gain velocity in BMI, BMI and being African American (odds ratios, 4-6/unit change/yr; 1.4/unit and 15, respectively) provided equal amounts of predictive power to the risk of recurrence of SDB. In the group that experienced recurrence, systolic blood pressure at 1 year was higher than at baseline and higher than in children who did not experience recurrence.

Conclusions: Three clinical parameters confer independent increased risk for high recurrence of SDB after adenotonsillectomy: gain velocity in BMI, obesity, and being African American. A long-term follow-up of children with SDB and monitoring of gain velocity in BMI are essential to identifying children at risk for recurrence of SDB and in turn at risk for hypertension.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenoidectomy*
  • Adolescent
  • African Americans*
  • Body Mass Index*
  • Cardiovascular Diseases / epidemiology
  • Case-Control Studies
  • Child
  • European Continental Ancestry Group
  • Female
  • Humans
  • Male
  • Obesity*
  • Polysomnography
  • Predictive Value of Tests
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Sleep Apnea Syndromes / surgery*
  • Tonsillectomy*