Does Tonsillectomy Increase Obesity Risk in Children with Down Syndrome?

Abstract

Objectives: To examine weight changes relative to surgical success in children with Down syndrome and obstructive sleep apnea (OSA).

Study design: Retrospective chart review of children with Down syndrome undergoing tonsillectomy from 2005 to 2016 for OSA at a tertiary care children's hospital. Only patients with pre-and postoperative polysomnogram within 6 months of tonsillectomy were included. Demographics, weight, height, and polysomnogram data were collected. Body mass index (BMI), expressed as a percentage of the 95th percentile (%BMI_p95), was calculated for 24 months prior to and following surgery. Pre-and postoperative OSA severity were also recorded. The postoperative obstructive/hypopnea index identified subjects with resolution of obstruction (obstructive/hypopnea index <2 events/hour) or persistent mild/moderate/severe obstructive apnea. Regression analyses were used to compare %BMI_p95 pre- and post-tonsillectomy with %BMI_p95 by OSA status following tonsillectomy.

Results: A total of 78 patients with Down syndrome whose mean age was 5.29 years at time of tonsillectomy were identified. There was no difference between best-fit curves of %BMI _p95 pre-and post-tonsillectomy. There was no difference between best-fit curves of %BMI _p95 in patients who saw resolution of OSA after tonsillectomy vs patients with residual OSA.

Conclusions: Tonsillectomy neither alters the BMI trajectory of children with Down syndrome, nor changes differentially the risk for obesity in children whose OSA did or did not resolve after surgery.

Keywords: BMI; obstructive sleep apnea; polysomnogram; weight gain.