Surgery only effective for few kids with sleep apnea: Study

Surgery may provide only short-term relief for some children with sleep-disordered breathing, say researchers at Cincinnati Children's Hospital Medical Center.

One of the most common surgeries performed on children, Adenotonsillectomy surgery is the first line of treatment for sleep-disordered breathing (SDB) in children.

Children who gain weight rapidly after having their tonsils or adenoids removed to treat SDB may improve in the short-term, but may relapse or even worsen over the long-term, the researchers found.

"The high rate of recurrence we observed in both obese and non-obese children indicates that SDB is a chronic condition," said Dr. Raouf Amin, director of pulmonary medicine at Cincinnati Children's Hospital Medical Center.

For the study the researchers examined 40 children, aged 7-13, who had adenotonsillectomy surgery to treat nightly snoring. Most of the children showed improved sleep scores six weeks after surgery, but the rate of relapse at one year had no correlation with the six-week score, the researchers found.

Moreover, relapse was more likely to occur among children who were obese, had worse SDB at baseline, had high blood pressure, had an accelerated body-mass index (BMI) gain, or were black.

"Most post-adenotonsillectomy outcome studies have focused on the assessment of SDB 6 to 16 weeks after surgery. Resolution of SDB during this window was usually interpreted as a cure for the disorder," Amin said.

Prior to surgery, half the non-obese and two-thirds of the obese children in the study had an AHI (apnea/hypopnea index — a measure of the severity of SDB) score of 3. A year after surgery, 27 percent of non-obese children and 79 percent of obese children had an AHI score of greater than 3, thus suggesting that the surgery was significantly more effective after one year for non-obese children.

The study is the first to identify the importance of weight gain and race on the recurrence of the condition. The study appears in the second issue for March of the American Journal of Respiratory and Critical Care Medicine.