An Exploratory Retrospective Study of Clinical Outcomes Following Adenotonsillectomy in Children With Obstructive Sleep Disordered Breathing Living With Severe Obesity

IF 1.5 4区医学 Q2 OTORHINOLARYNGOLOGY

Clinical Otolaryngology Pub Date : 2025-08-15 DOI:10.1111/coa.70022

Zoë A. Burton, Claire Nissenbaum, Manjeevan Singh, Camille Ball, Gurkirat Khokar, Eishaan K. Bhargava, Heather E. Elphick

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引用次数: 0

Abstract

Introduction

Adenotonsillectomy (AT) to improve obstructive sleep disordered breathing (oSDB) is a common paediatric surgical procedure. Children living with obesity have both an increased risk of oSDB and a higher perioperative risk.

Objectives

We aimed to establish whether AT in children with severe obesity improves clinical symptoms, and whether this correlates with quantifiable sleep studies. A secondary outcome was preoperative change in BMI z-score amongst children attending a specialist anaesthetic clinic.

Methods

A retrospective electronic notes review over a 2-year period identified children 2–16 years living with ‘severe’ obesity undergoing AT for oSDB. Demographic data, BMI and BMI z-score were collated preoperatively and at surgery. Pre- and postoperative quantifiable sleep study data and clinical episodes were examined. Postoperative AHI < 5/ODI4 < 4/h or clinical symptom resolution was considered ‘curative’.

Results

A total of 1007 tonsillectomies were performed for oSDB; 55 met inclusion criteria and 30 underwent preoperative sleep studies. Age ranged from 3 to 15 years (mean 8.7, SD 3.3) with a 2:1 ratio of males to females. Nine children (34.6%) underwent both pre- and postoperative studies with ODI4/AHI ranges of 0.5–121.2/h and 0–9.3/h, respectively. Overall ‘cure’ rate was 42.3%, with postoperative sleep studies confirming clinical findings. Preoperative mean BMI z-score was +3.83 (SD 1.19) with significant reduction at the time of surgery (−0.17, SD 0.29; p = 0.004) following lifestyle intervention (mean 6.0 months; SD 11.7 weeks).

Conclusion

Over half of severely obese children undergoing AT had residual postoperative oSDB symptoms. Sleep studies might identify those benefitting from further intervention. Findings support the effectiveness of preoperative lifestyle intervention, but the impact on symptoms and surgical timing should be further delineated.

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重度肥胖伴阻塞性睡眠呼吸障碍儿童腺扁桃体切除术后临床结果的探索性回顾性研究

腺扁桃体切除术（AT）改善阻塞性睡眠呼吸障碍（oSDB）是一种常见的儿科外科手术。肥胖儿童发生oSDB的风险增加，围手术期风险也较高。目的：我们旨在确定严重肥胖儿童的AT是否能改善临床症状，以及这是否与可量化的睡眠研究相关。次要结果是参加专科麻醉诊所的儿童术前BMI z评分的变化。方法：对2年的回顾性电子记录进行回顾，确定了2-16岁的“严重”肥胖儿童因oSDB接受AT治疗。术前、术中统计统计资料、BMI及BMI z-score。检查了术前和术后可量化的睡眠研究数据和临床发作。术后AHI结果：oSDB共行扁桃体切除术1007例；55人符合纳入标准，30人接受术前睡眠研究。年龄3 ~ 15岁（平均8.7岁，标准差3.3岁），男女比例为2:1。9名儿童（34.6%）接受了术前和术后研究，ODI4/AHI范围分别为0.5-121.2/h和0-9.3/h。总体治愈率为42.3%，术后睡眠研究证实了临床结果。术前平均BMI z-score为+3.83 (SD 1.19)，手术时显著降低(-0.17,SD 0.29；P = 0.004)，接受生活方式干预(平均6.0个月；SD 11.7周)。结论：超过一半的严重肥胖儿童接受AT手术后存在残留的oSDB症状。睡眠研究可能会确定那些从进一步干预中受益的人。研究结果支持术前生活方式干预的有效性，但对症状和手术时机的影响应进一步确定。

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来源期刊

Clinical Otolaryngology 医学-耳鼻喉科学

CiteScore

4.00

自引率

4.80%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with: current otorhinolaryngological practice audiology, otology, balance, rhinology, larynx, voice and paediatric ORL head and neck oncology head and neck plastic and reconstructive surgery continuing medical education and ORL training The emphasis is on high quality new work in the clinical field and on fresh, original research. Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject. • Negative/null results In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.