Surgery Only Works for Some Kids with Sleep Apnea
FRIDAY March 14, 2008 -- Surgery may provide only short-term relief for some children with sleep-disordered breathing, say researchers at Cincinnati Children's Hospital Medical Center.
Adenotonsillectomy surgery is the first line of treatment for sleep-disordered breathing (SDB) in children. It is the most common surgery performed upon children, the researchers noted.
This study found that children who gain weight rapidly after having their tonsils or adenoids removed to treat SDB may improve in the short-term, but may relapse or even worsen over the long-term. Black children also tend to relapse.
"The high rate of recurrence we observed in both obese and non-obese children indicates that SDB is a chronic condition," Dr. Raouf Amin, director of pulmonary medicine at Cincinnati Children's, said in a prepared statement.
The study included 40 children, aged 7-13, who had adenotonsillectomy surgery to treat nightly snoring. Most of the children showed improved sleep scores six weeks after surgery, but the rate of relapse at one year had no correlation with the six-week score, the researchers found. Relapse was more likely to occur among children who were obese, had worse SDB at baseline, had an accelerated body-mass index (BMI) gain, had high blood pressure, or were black.
"Most post-adenotonsillectomy outcome studies have focused on the assessment of SDB six to 16 weeks after surgery. Resolution of SDB during this window was usually interpreted as a cure for the disorder," Amin said. He said the study is the first to identify the importance of weight gain and race on the recurrence of the condition.
Prior to surgery, half the non-obese and two-thirds of the obese children in the study had an AHI (apnea/hypopnea index -- a measure of the severity of SDB) score of 3. A year after surgery, 27 percent of non-obese children and 79 percent of obese children had an AHI score of greater than 3, which suggests the surgery was significantly more effective after one year for non-obese children.
"SDB appears to be a chronic disorder that is clearly linked to other medical problems. Given the rate of relapse, we advocate long-term follow-up of children with SDB, monitoring of BMI [weight] gain, and reevaluation of children who demonstrate rapid BMI gain, especially those who are African-Americans," the researchers concluded.
The study appears in the second issue for March of the American Journal of Respiratory and Critical Care Medicine.
The Nemours Foundation has information about sleep apnea in children.
Posted: March 2008
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