Pilot Study to Assess the Effectiveness of Tonsil and Adenoidectomy (T+A) in Overweight Children and Adolescents
Condition: Obesity; Obstructive Sleep Apnea Syndrome
MeSH terms: Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Overweight
Study type: Observational

Summary: 
      Obesity has reached epidemic proportions in the United States with roughly 20% of American
      children being overweight and has serious consequences such as sleep apnea.Additionally,
      obesity is known to result in the earlier onset of puberty . Thus, it can be expected that
      obese children take-on adult characteristics at an earlier chronologic age than their
      non-obese counterparts. Current guidelines recommend adenotonsillectomy (T+A) as primary and
      effective therapy for sleep apnea resulting in polysomnographic resolution in 75-100% of
      patients. Small studies have shown that T+A relieves symptoms in obese children but surgical
      intervention has been less efficacious in adults. We hypothesize that T+A may be less
      efficacious in obese adolescents because of earlier onset of puberty imparting more adult
      characteristics. We further hypothesize that the efficacy of T+A will correlate more closely
      with Tanner staging than with chronologic age because of the earlier onset of sexual
      maturation associated with obesity.
    

Detailed description: 
      Obesity has reached epidemic proportions in the United States with roughly 20% of American
      children being overweight . Obesity has serious health consequences increasing the risk of
      hypertension , type II diabetes and obstructive sleep apnea . Additionally, obesity is known
      to result in the earlier onset of puberty . Thus, it can be expected that obese children
      take-on adult characteristics at an earlier chronologic age than their non-obese
      counterparts.

      Similarly, sleep apnea is a common problem with wide reaching consequences including
      increased risk for hypertension , insulin resistance and neurocognitive dysfunction leading
      to poor academic performance . Furthermore, sleep fragmentation produced by repetitive
      episodes of nocturnal apnea may lead to daytime somnolence and increased food intake as a
      behavioral attempt to overcome sleepiness and thereby further contribute to obesity .

      Current guidelines recommend adenotonsillectomy (T+A) as primary and effective therapy for
      sleep apnea resulting in polysomnographic resolution in 75-100% of patients. Small studies
      have shown that T+A relieves symptoms in obese children but surgical intervention has been
      less efficacious in adults . Although nocturnal polysomnogrpahy (NPSG) is considered the gold
      standard by which to diagnose obstructive sleep apnea (OSAS), published studies assessing the
      efficacy of treatment in obese children using polysomngraphy to objectively quantify the
      degree of sleep apnea before and after T+A do not exist.

      Surgical intervention may not be indicated in children without adenotonsillar hypertrophy.
      Similarly, children who are at high risk for surgical or anesthetic related complications may
      be deemed poor surgical candidates. For these children as well as those who fail T+A,
      non-invasive, continuous positive airway pressure (CPAP) applied via a nasal mask is
      effective in treating sleep disordered breathing. However, CPAP is effective only when in use
      and multiple studies demonstrate low rates of long-term compliance in adults . No studies
      assessing children's adherence with CPAP exist. Certainly, it is expected that compliance in
      the adolescent population would be similar, if not worse than adults. Thus, CPAP is not
      recommended as first-line therapy when surgical intervention is viable.

      We hypothesize that T+A may be less efficacious in obese adolescents because of earlier onset
      of puberty imparting more adult characteristics. We further hypothesize that the efficacy of
      T+A will correlate more closely with Tanner staging than with chronologic age because of the
      earlier onset of sexual maturation associated with obesity. Thus, we propose to study the
      efficacy of T+A in the treatment of sleep apnea in obese adolescents using polysomnography to
      quantify the severity of OSAS before and after T+A. It is anticipated that results from this
      preliminary study will be used to form the basis for studies comparing efficacy of
      adenotonsillectomy against the use of CPAP in this population.
    

Time perspective: Prospective
Keywords: Obesity; Obstructive Sleep Apnea Syndrome; Children; Adolescents; Adenotonsillectomy