OSAHS Growth Impairment and Resolution after Adenotonsillectomy in Children

Document Type : Original

Authors

1 Otolaryngology Unit, Department of Biomedicine and Advanced Diagnostic, University of Palermo, Palermo, Italy.

2 Otorhinolaryngology Unit, Villa Sofia-Cervello Hospital, Palermo, Italy.

3 Department of Biomedicine Neuroscience and Advanced Diagnostic-University of Palermo, Section of Human Anatomy, University of Palermo, Palermo, Italy.

4 Otolaryngology Unit, Department of Biomedicine and Advanced Diagnostic-University of Palermo, Palermo, Italy.

5 Clinica Pediatrica Università degli Studi di Palermo, Palermo, Italy.

6 Department of Biomedicine and Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy.

7 Otolaryngology Unit, Department of Biomedicine and Advanced Diagnostic - University of Palermo, Palermo, Italy.

Abstract

Introduction:
One of the most important complications of OSAHS in children is growth delay. The aim of this study was to investigate changes in clinical body growth, and laboratory growth in children with OSAHS after adeno-tonsillar surgery.
 
Materials and Methods:
In our study, among 102 children suffering from sleep-disordered breathing, 70 met the inclusion criteria because they were affected by OSAHS and adenotonsillar hypertrophy. In total, 96 children affected by adeno-tonsillar hypertrophy (55 males and 41 females) underwent nocturnal cardiorespiratory monitoring with Embletta MPR, monitoring for post-operative 24 hours. Patients underwent blood sampling to evaluate preoperative GH and IGF-1 serum levels, “placement” in Cacciari’s growth charts and adenotonsillectomy and saturation monitoring for post-operative 24 hours. According to auxological parameters, 82.86% of the patients were below the fiftieth percentile of BMI Cacciari’s growth charts and IGF-1 preoperative serum levels were below the normal range. All patients underwent adenotonsillectomy.
Results:
All 70 patients recovered from OSAHS according to the results of nocturnal cardiorespiratory monitoring after six months. IGF-1 serum levels significantly increased after three months and one year after. All the auxological parameters showed a significant increase after surgery. We calculated the average annual growth in height of the patients before and after adenotonsillectomy (AT): the growth rate was impaired by OSAHS (5.4±1.3 cm/year), while in the following year post-surgery we found a significant growth speed acceleration (9.9±1.7 cm/year, P=0.001).
Conclusions:
In conclusion, growth delay in children can be caused by OSAHS, and when it is due to adenotonsillar hypertrophy, adenotonsillectomy is to be considered as the therapy of choice.

Keywords

Main Subjects

References

  1. Standards and indications for cardiopulmonary sleep studies in children. American Thoracic Society. Am J Respir Crit Care Med. 1996;153(2):866-78.
  2. Modica DM, Marchese D, Lorusso F, Speciale R, Saraniti C, Gallina S. Functional Nasal Surgery and Use of CPAP in OSAS Patients: Our Experience. Indian J Otolaryngol Head Neck Surg. 2018;70(4):559-65.
  3. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130(3):e714-55.
  4. Shine NP, Coates HL, Lannigan FJ. Obstructive sleep apnea, morbid obesity, and adenotonsillar surgery: a review of the literature. Int J Pediatr Otorhinolaryngol. 2005;69(11):1475-82.
  5. Marcus CL, Katz ES, Lutz J, Black CA, Galster P, Carson KA. Upper airway dynamic responses in children with the obstructive sleep apnea syndrome. Pediatr Res. 2005;57(1):99-107.
  6. Lorusso F, Dispenza F, Modica DM, Gallina S. The Role of Modified Expansion Sphincter Pharyngoplasty in Multilevel Obstructive Sleep Apnea Syndrome Surgery. Int Arch Otorhinolaryngol. 2018;22(4):432-6.
  7. Francesco Lorusso FD, Gioacchino Matrinciglio, Aldo Messina, Alessia Battaglia, Salvatore Gallina. Postural changes in patients undergoing hyoid surgery for OSAS. EuroMediterranean Biomedical Journal (EMBJ) 2017;12(29):140-3.
  8. Cooper BG, White JE, Ashworth LA, Alberti KG, Gibson GJ. Hormonal and metabolic profiles in subjects with obstructive sleep apnea syndrome and the acute effects of nasal continuous positive airway pressure (CPAP) treatment. Sleep. 1995;18(3):
    172-9.
  9. Van Cauter E, Plat L, Copinschi G. Interrelations between sleep and the somatotropic axis. Sleep. 1998; 21(6):553-66.
  10. Ranke MB, Wit JM. Growth hormone - past, present and future. Nat Rev Endocrinol. 2018;14(5):285-300.
  11. Clayton PG, MS. Normal growth and its endocrine control. Clinical Pediatric Endocrinology. 1996; 44(1):95-114.
  12. Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am. 1989;36(6):          1551-69.
  13. Cassano P, Gelardi M, Cassano M, Fiorella ML, Fiorella R. Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic management. Int J Pediatr Otorhinolaryngol. 2003;67(12):1303-9.
  14. Cacciari E, Milani S, Balsamo A, Spada E, Bona G, Cavallo L, et al. Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr). J Endocrinol Invest. 2006;29(7):581-93.
  15. Todd CA, Bareiss AK, McCoul ED, Rodriguez KH. Adenotonsillectomy for Obstructive Sleep Apnea and Quality of Life: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2017;157(5):767-73.
  16. Garetz SL, Mitchell RB, Parker PD, Moore RH, Rosen CL, Giordani B, et al. Quality of life and obstructive sleep apnea symptoms after pediatric adenotonsillectomy. Pediatrics. 2015; 135(2): e477-86.
  17. Reckley LK, Fernandez-Salvador C, Camacho M. The effect of tonsillectomy on obstructive sleep apnea: an overview of systematic reviews. Nat Sci Sleep. 2018;10:105-10.
  18. Venekamp RP, Hearne BJ, Chandrasekharan D, Blackshaw H, Lim J, Schilder AG. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev. 2015(10):CD011165.
  19. Lorusso F, Gallina S, Modica DM, Di Salvo N, Riggio F. Bipolar Quantum Molecular Resonance versus Blunt Dissection tonsillectomy. B-ENT. 2015;11(2):101-8.
  20. Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. The New England journal of medicine. 2013; 368(25): 2366-76.
  21. Lorusso FM, F.; Mistretta, A.; Alagna, E.; Modica, DM.; Dspenza, F.;Gallina, S. Effects of adenotonsillectomy on neurocognitive and behavioural function in pediatric obstructive sleep apnea syndrome. B-ENT. 2018;14(2):113-8.
  22. Chervin RD, Ruzicka DL, Giordani BJ, Weatherly RA, Dillon JE, Hodges EK, et al. Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics. 2006;117(4):e769-78.
  23. Li H-Y, Huang Y-S, Chen N-H, Fang T-J, Lee L-A. Impact of Adenotonsillectomy on Behavior in Children With Sleep-Disordered Breathing. The Laryngoscope. 2006;116(7):1142-7.
  24. Stewart MG, Glaze DG, Friedman EM, Smith EOB, Bautista M. Quality of Life and Sleep Study Findings After Adenotonsillectomy in Children With Obstructive Sleep Apnea. Archives of Otolaryngology–Head & Neck Surgery. 2005; 131(4): 308-14.
  25. Montgomery-Downs HE, Crabtree VM, Gozal D. Cognition, sleep and respiration in at-risk children treated for obstructive sleep apnoea. European Respiratory Journal. 2005;25(2):336-42.
  26. Thomas NH, Xanthopoulos MS, Kim JY, Shults J, Escobar E, Giordani B, et al. Effects of Adenotonsillectomy on Parent-Reported Behavior in Children With Obstructive Sleep Apnea. Sleep. 2017; 40(4).
  27. Williams EF, 3rd, Woo P, Miller R, Kellman RM. The effects of adenotonsillectomy on growth in young children. Otolaryngol Head Neck Surg. 1991; 104(4):509-16.
  28. Nieminen P, Löppönen T, Tolonen U, Lanning P, Knip M, Löppönen H. Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea. Pediatrics. 2002; 109(4): e55.
  29. Bar A, Tarasiuk A, Segev Y, Phillip M, Tal A. The effect of adenotonsillectomy on serum insulin-like growth factor-I and growth in children with obstructive sleep apnea syndrome. J Pediatr. 1999; 135(1):76-80.
  30. Bonuck K, Parikh S, Bassila M. Growth failure and sleep disordered breathing: a review of the literature. Int J Pediatr Otorhinolaryngol. 2006; 70(5):769-78.
  31. Marcus CL, Carroll JL, Koerner CB, Hamer A, Lutz J, Loughlin GM. Determinants of growth in children with the obstructive sleep apnea syndrome. J Pediatr. 1994;125(4):556-62.
  32. Smith DF, Vikani AR, Benke JR, Boss EF, Ishman SL. Weight gain after adenotonsillectomy is more common in young children. Otolaryngol Head Neck Surg. 2013;148(3):488-93.
  33. Katz ES, Moore RH, Rosen CL, Mitchell RB, Amin R, Arens R, et al. Growth after adenotonsillectomy for obstructive sleep apnea: an RCT. Pediatrics. 2014;134(2):282-9.
  34. Lorusso F, Dispenza F, Saraniti C, Sireci F, Modica D, Gallina S. Sleep-disordered breathing: Evaluation of dynamic patterns of the upper airways in obese subjects. Otorinolaringologia. 2014;64:
    57-64.
  35. Zhang XM, Shi J, Meng GZ, Chen HS, Zhang LN, Wang ZY, et al. The effect of obstructive sleep apnea syndrome on growth and development in nonobese children: a parallel study of twins. J Pediatr. 2015;166(3):646-50 e1.

 

  1. Tahara S, Hara H, Yamashita H. Evaluation of body growth in prepubertal Japanese children with obstructive sleep apnea after adenotonsillectomy over a long postoperative period. Int J Pediatr Otorhinolaryngol. 2015;79(11):1806-9.
  2. Stradling JR, Thomas G, Warley AR, Williams P, Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. Lancet. 1990; 335 (8684): 249-53.
  3. Cassano M, Russo G, Granieri C, Ciavarella D. Modification of growth, immunologic and feeding parameters in children with OSAS after adenotonsillectomy. Acta Otorhinolaryngol Ital. 2018; 38(2):124-30.
Iranian Journal of Otorhinolaryngology
Volume 34, Issue 3
May and June 2022
Pages 145-153

Files

Share

How to cite

Statistics