The trial—the Childhood Adenotonsillectomy Trial (CHAT)—enrolled children ages 5 to 9.9 years and spanned seven sites across the country. It randomized 464 children with sleep apnea to either early adenotonsillectomy or watchful waiting with supportive care, evaluating a wide variety of outcomes such as cognition, behavior, blood pressure and improvement in nighttime breathing.
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November 2012The results of the trial are not yet published but are likely to shed light on the efficacy of adenotonsillectomy for sleep-disordered breathing in children, said Dr. Mitchell, a principal investigator for this trial at Saint Louis University-affiliated SSM Cardinal Glennon Children’s Hospital.
Another CHAT principal investigator, Susan Redline, MD, MPH, Peter C. Farrell professor of sleep medicine at Harvard Medical School in Boston, added, “There have been wide fluctuations in the use of tonsillectomy over the last several decades. In part, this reflects the lack of high-level research to properly inform decision making.” She also noted that the increase in the procedure’s usage is likely attributable to a combination of factors: increased awareness of adverse health and behavioral outcomes associated with sleep apnea and an increase in childhood obesity.
The Larger Picture
Dr. Rosenfeld further advised keeping the rise in tonsillectomies in perspective. “You have to take the big picture of where we were a half-century ago (for tonsillectomy rates) and also how the indications have changed and our knowledge of the effects of sleep-disordered breathing,” he said. “When you look at it that way, we’re probably doing just the right number of tonsillectomies. It may continue to evolve and change, but we’re getting closer to the right number.”
Post-Surgery Weight Gain
Several studies have found that children who undergo tonsillectomy are at increased risk for becoming overweight following surgery, and many point to an underlying diagnosis of sleep apnea as the cause in cases of weight gain. A new study out of Johns Hopkins University School of Medicine in Baltimore may have shed some light on this issue.
The study looked at 115 children who had received tonsillectomies, and found that weight gain after the procedure happened at the same rate in children who had the surgery for obstructive sleep apnea as in those who had it due to recurring episodes of tonsil inflammation. Only age mattered, researchers say, after discounting gender and height. They found that weight gains occurred mainly in children under the age of 6, and not in older children.
“Our study results show that parents’ current concerns about weight gain are serious, but only underweight or normal weight children between the ages of 2 and 6 are most likely to gain even more weight, not older children,” said Stacey Ishman, MD, MPH, an assistant professor in the of otolaryngology at the Johns Hopkins University School of Medicine and the study’s senior investigator. “Parents with overweight adolescent children need not fear tonsillectomy, and those with younger, normal weight and overweight children just really need to closely watch their child’s diet following surgery, and make caloric adjustments,” she said.