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Literature Review: A Roundup of Important Recent Studies

Adenotonsillectomy in Obese Children Improves AHI but Not Inflammation

Does adenotonsillectomy in obese children improve OSA and systemic inflammation, as measured by TNF-α and IL-6?

Background: Obese children with obstructive sleep apnea (OSA) are more likely to have excessive daytime sleepiness (EDS) with resultant reduction in learning and growth. Elevated TNF-α and IL-6 levels seen in OSA may augment EDS. It is unknown if these markers decrease with treatment in obese children, however, as persistent OSA is highly likely.

Study design: Prospective evaluation of 90 obese children with OSA before and six months after adenotonsillectomy, by polysomnography and lab analysis over a total of eight months.

Setting: Academic medical center (Children’s Hospital of Chongqing Medical University, China).

Synopsis: Ninety obese children with a mean age 6.6±4.1 years had a mean apnea-hypopnea index (AHI) that decreased from 22.3±9.1 to 8.9±5.9 events/hour and an improvement in oxygen saturation nadir from 74.3±7.5 percent to 86.4±5.6 percent. There was no significant change in body mass index (BMI) after surgery (preoperative mean = 41 kg/m2). Resolution of OSA (AHI <5) occurred in 38.9 percent. TNF-α and IL-6 did not change significantly after surgery, regardless of final OSA status. BMI, but not AHI, correlated with TNF-α (r2 = 0.235, p <0.001) and IL-6 (r2 = 0.663, p <0.001) levels. Children with diabetes, craniofacial disease, neuromuscular disease, excessive daytime sleepiness and inflammation were excluded. Limitations include the fact that excluding children with excessive daytime sleepiness may have removed those children most likely to benefit from adenotonsillectomy with reduction in inflammatory markers. The reduction in AHI and level of persistent pediatric OSA is in keeping with previous studies.

Bottom line: OSA is likely to significantly improve in obese children without EDS, although persistent disease occurs in up to 61.1 percent, and inflammatory markers did not improve after adenotonsillectomy, even in those with resolution of OSA.

Reference: Chu L, Li Q. The evaluation of adenotonsillectomy on TNF-α and IL-6 levels in obese children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2013;77:690-694.