Chronic Snoring Remains After Surgery for Obese Children

Surgery to remove children's tonsils and adenoids to treat sleep-disordered breathing (SDB) may be successful in the short term, but children who gain weight rapidly tend to relapse or even worsen, according to a new study.

Researchers from the Cincinnati Children's Hospital Medical Center (OH, USA) used a sample of 40 healthy children, aged 7-13, who were treated for chronic snoring by adenotonsillectomy; a control group included 30 sex- and age-matched children who were not having the surgery. Each child underwent a polysomnography (PSG), a multi-parametric test used to study sleep, and apnea-hypopnea index (AHI) scores were measured. Before surgery, about 50% of the non-obese children and 67% of the obese children had an AHI score of greater than three. PSGs and AHIs were again performed at six weeks, six months, and a year after the surgery for both the treatment and control groups.

The researchers found that at six weeks after surgery, most of the children with SDB improved their scores. However, the rate of relapse after one year had no correlation with the six-week score. A year after surgery, 27% of the non-obese, and 79% of the obese children had AHI score of greater than three. The researchers concluded that these changes indicate that the surgery was significantly more effective in non-obese children after one year. Children who were obese at the baseline and, independently, children who had rapid BMI gain were more likely to relapse than those who lacked these characteristics; African-American origin was also associated with children who relapsed, as was high blood pressure. The study was published in the March 15, 2008, issue of the American Journal of Respiratory and Critical Care Medicine.

"These results highlight the differential disease mechanisms between those due to obesity and those due to the rapid change in body composition associated with accelerated BMI gain,” said lead author Raouf Amin, M.D. "The high rate of recurrence we observed in both obese and non-obese children indicates that SDB is a chronic condition.”


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Cincinnati Children's Hospital Medical Center