The authors present the results of their literature review and meta-analysis of studies examining adenotonsillectomy, uvulopalatopharyngoplasty (UPPP), supraglottoplasty, tongue base surgery or a combination in obese children with obstructive sleep apnoea (OSA). The one study investigating effects of UPPP was a retrospective chart review of 143 children with severe obesity who underwent various surgical procedures to treat OSA. The median age was 12 and median body mass index (BMI) z score was 2.8. Defining resolution of OSA as an apnoea-hypopnoea index (AHI) of less than 1.5/hour, resolution rates were 13% for UPPP alone, 18% for UPPP with adenoidectomy and 18% for UPPP with adenotonsillectomy. One study investigated 24 children who underwent supraglottoplasty for OSA secondary to laryngomalacia. Seven of these children were overweight (BMI above 85th centile) and had more severe OSA. These patients had persistent OSA despite previous adenotonsillectomy. Normal weight children experienced a decrease in apnoeas (from 18 to 0.6/hour), whereas overweight children experienced an increase (from 3 to 6/hour). One study looked at 68 children who underwent lingual tonsillectomy for persistent OSA after adenotonsillectomy. Of these, 24 were overweight (BMI above 85th centile). They showed improvement postoperatively but overweight children had significantly higher AHIs compared to normal-weight counterparts preoperatively (15/hour versus 10/hour) and postoperatively (9/hour versus 4/hour).

One study looked at 13 children with trisomy 21 who underwent midline posterior glossectomy with lingual tonsillectomy. In this study, none of the children who were obese preoperatively (seven children) improved, compared to the non-obese (six children) who all did.

A review and meta-analysis of isolated tongue base surgery showed that the percentage improvement decreased as BMI increased. Eleven studies examining the effects of adenotonsillectomy in obese children were identified with a total of 408 children. Six of the 11 studies (235 children) provided polysomnographic data with pre and postoperative AHI. Analysis of these studies showed that AHI improved significantly following surgery from 25/hour to 10/hr (p<0.001). The mean oxygen saturation (SaO2) improved significantly from 78% to 87% following surgery (p<0.001). The percentage of resolution of OSA varied depending on the definition used: studies defining resolution as an AHI less than 1/hr had a pooled success rate of 34%; AHI less than 2/hour was 49%; AHI less than 5/hour was 44%; and respiratory disturbance index (RDI) less than 5 was 44%. The authors conclude that adenotonsillectomy for OSA in obese children is as effective at reducing polysomnographic parameters as in normal weight children, but not at resolving OSA.

Surgery for Obstructive Sleep Apnea in Obese Children: Literature Review and Meta-analysis.
Scheffler P, Wolter NE, Narang I, et al.
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Richard (Wei Chern) Gan

Hull University Teaching Hospitals NHS Trust, UK.

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