Beyond the growth delay in children with sleep-related breathing disorders: a systematic review

Panminerva Med. 2020 Sep;62(3):164-175. doi: 10.23736/S0031-0808.20.03904-X. Epub 2020 Apr 23.


Introduction: The availability of high-quality studies on the association between sleep-disordered breathing in children and delayed growth associated with the hormonal profile recorded before surgery and at follow-up is limited.

Evidence acquisition: Medline PubMed, Scopus and WebOfScience databases were searched for relevant publications published between January 2008 to January 2020 and a total of 261 potentially eligible studies were identified.

Evidence synthesis: Following review 19 papers were eligible for inclusion: seven reported a significant postsurgical increase in growth regardless of initial weight status, type of surgery, type of study design, and length of follow-up period. The only high-quality study was a randomized controlled trial that found an increased risk of obstructive sleep apnea syndrome relapse in overweight children. Twelve studies reported the significant increase in growth parameters showing that IGF-1, IGFBP-3, and ghrelin may boost growth after surgery.

Conclusions: The current systematic review demonstrates a scarcity of high-quality studies on growth delay in children with sleep-disordered breathing. Significant catch-up growth after surgery in the short term and changes in IGF-1, IGFBP-3, ghrelin, and leptin levels has been reported in most published studies.

Publication types

  • Systematic Review

MeSH terms

  • Adenoidectomy* / adverse effects
  • Adolescent
  • Adolescent Development*
  • Age Factors
  • Biomarkers / blood
  • Child
  • Child Development*
  • Child, Preschool
  • Ghrelin / blood
  • Growth Disorders / blood
  • Growth Disorders / etiology
  • Growth Disorders / physiopathology*
  • Humans
  • Infant
  • Insulin-Like Growth Factor Binding Protein 3 / blood
  • Insulin-Like Growth Factor I / metabolism
  • Leptin / blood
  • Risk Assessment
  • Risk Factors
  • Sleep Apnea Syndromes / blood
  • Sleep Apnea Syndromes / complications
  • Sleep Apnea Syndromes / physiopathology
  • Sleep Apnea Syndromes / surgery*
  • Tonsillectomy* / adverse effects
  • Treatment Outcome


  • Biomarkers
  • GHRL protein, human
  • Ghrelin
  • IGF1 protein, human
  • IGFBP3 protein, human
  • Insulin-Like Growth Factor Binding Protein 3
  • LEP protein, human
  • Leptin
  • Insulin-Like Growth Factor I