19 IMPACT OF ADENOTONSILLECTOMY ON THE BODY MASS INDEX OF CHILDREN WITH OBSTRUCTIVE SLEEP APNEA. (1st January 2005) - Mitchell, R. B.
Abstract : Pediatric Obstructive Sleep Apnea syndrome (POSAS) can have many adverse effects on growth (including failure to thrive) in children. The "Gold Standard technique" for diagnosis of POSAS is polysomnography, and then followed by tonsillectomy for treatment. Previous studies have not followed Body Mass Index (BMI) percentiles as an indicator for growth after adenotonsillectomy. This study used calculated BMI percentiles to measure growth before and after adenotonsillectomy. Forty-seven children, diagnosed with PSOSAS by overnight polysomnography, from the University of New Mexico Pediatric Otolaryngology service (ages 2-18 years old) were followed up to 15 months post-adenotonsillectomy. Height and weight were measured at a preoperative visit, and then during two follow-up visits over the next 15 months. A BMI percentile was then calculated for each of these visits, and divided into categories of underweight (less than 5th percentile), normal range (5-95 percentile), and obese (greater than 95th percentile). When categorized, 8 (17%) were underweight, 23 (49%) were normal weight, and 16 (34%) were obese. Underweight children went from a BMI percentile of 0.8±1.1 to 12.2±7.2 (P≤0.008) at 1-6 months post-operatively, and to 21.8±17.6 (P≤0.02) at 7-15 months. Obese children changed from a preoperative BMI percentile of 99.2±1.0 to 97.0±4.7 (P≤0.0002) at 1-6 months post-operatively, and then to 96.5±5.4 (P≤0.008) at 7-15 months. Children with pre-operative BMI percentiles between the 5th and 95th percentile did not show a significant change in growth post-operatively. Our results demonstrate that treatment of OSAS with adenotonsillectomy can impact growth differently depending on pre-operative BMI. Children who were underweight pre-operatively (BMI ≤ 5th percentile) showed a post-operative increase in growth that was consistent with previous studies. In contrary, our results showed that children who were obese pre-operatively (BMI ≥95th percentile) actually had a post-operative decrease BMI percentile. This finding may suggest that it may be possible for POSAS to contribute to obesity.