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Growth Velocity Predicts Recurrence of Sleep-disordered Breathing 1 Year after Adenotonsillectomy

¹ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; ² Institute for the Study of Health, University of Cincinnati Academic Medical Center, Cincinnati, Ohio; ³ Mayo Clinic, Rochester, Minnesota; and ⁴ Denver Children's Hospital, Denver, Colorado

Correspondence and requests for reprints should be addressed to Raouf Amin, M.D., 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail: raouf.amin{at}cchmc.org

Rationale: Adenotonsillectomy, the first line of treatment of sleep-disordered breathing (SDB), is the most commonly performed pediatric surgery. Predictors of the recurrence of SDB after adenotonsillectomy and its impact on cardiovascular risk factors have not been identified.

Objectives: Demonstrate that gain velocity in body mass index (BMI) defined as unit increase in BMI/year confers an independent risk for the recurrence of SDB 1 year after adenotonsillectomy.

Methods: Children with SDB and hypertrophy of the tonsils and a comparison group of healthy children were followed prospectively for 1 year.

Measurements and Main Results: Serial polysomnographies, BMI, and blood pressure were obtained before adenotonsillectomy and 6 weeks, 6 months, and 1 year postoperatively. Gain velocity in BMI, BMI and being African American (odds ratios, 4–6/unit change/yr; 1.4/unit and 15, respectively) provided equal amounts of predictive power to the risk of recurrence of SDB. In the group that experienced recurrence, systolic blood pressure at 1 year was higher than at baseline and higher than in children who did not experience recurrence.

Conclusions: Three clinical parameters confer independent increased risk for high recurrence of SDB after adenotonsillectomy: gain velocity in BMI, obesity, and being African American. A long-term follow-up of children with SDB and monitoring of gain velocity in BMI are essential to identifying children at risk for recurrence of SDB and in turn at risk for hypertension.

Key Words: growth velocity • adenotonsillectomy • sleep-disordered breathing

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject The current practice is to treat children with sleep-disordered breathing (SDB) by adenotonsillectomy without clear guidelines for postoperative follow-up to assess recurrence. What This Study Adds to the Field Three clinical parameters confer independent increased risk for high recurrence of SDB after adenotonsillectomy: gain velocity in BMI, obesity, and being African American. Rapid body mass index gain is an independent risk for recurrence after adenotonsillectomy. Recurrence is associated with an increase in blood pressure that is independent of body mass index.

 

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