Zoë A. Burton, Claire Nissenbaum, Manjeevan Singh, Camille Ball, Gurkirat Khokar, Eishaan K. Bhargava, Heather E. Elphick
{"title":"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","authors":"Zoë A. Burton, Claire Nissenbaum, Manjeevan Singh, Camille Ball, Gurkirat Khokar, Eishaan K. Bhargava, Heather E. Elphick","doi":"10.1111/coa.70022","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>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 <i>z</i>-score amongst children attending a specialist anaesthetic clinic.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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 <i>z</i>-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’.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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 <i>z</i>-score was +3.83 (SD 1.19) with significant reduction at the time of surgery (−0.17, SD 0.29; <i>p</i> = 0.004) following lifestyle intervention (mean 6.0 months; SD 11.7 weeks).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":"50 6","pages":"1088-1095"},"PeriodicalIF":1.5000,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"An Exploratory Retrospective Study of Clinical Outcomes Following Adenotonsillectomy in Children With Obstructive Sleep Disordered Breathing Living With Severe Obesity\",\"authors\":\"Zoë A. Burton, Claire Nissenbaum, Manjeevan Singh, Camille Ball, Gurkirat Khokar, Eishaan K. Bhargava, Heather E. Elphick\",\"doi\":\"10.1111/coa.70022\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>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 <i>z</i>-score amongst children attending a specialist anaesthetic clinic.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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 <i>z</i>-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’.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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. 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An Exploratory Retrospective Study of Clinical Outcomes Following Adenotonsillectomy in Children With Obstructive Sleep Disordered Breathing Living With Severe Obesity
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.
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.
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