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Adenotonsillectomy outcomes in obese adolescents with obstructive sleep apnea.

STUDY OBJECTIVES
(1) To assess adenotonsillectomy (AT) outcomes in obese adolescents with obstructive sleep apnea (OSA); (2) To identify clinical factors predicting OSA in adolescents following AT.


METHODS
Obese adolescents 12 to 18 years old that underwent AT for OSA were included. Subjects had pre- and post-AT polysomnogram. Non-obese adolescents with OSA that underwent AT were included as a comparison.


RESULTS
Seventy obese adolescents with a mean age of 14.2 years and a mean BMI of 38.0 were included. Patients in the non-obese group (n=32) were similar demographically to the obese group with the exception of BMI. The majority of obese adolescents (74%) had severe OSA (AHI ≥ 10) with a mean baseline AHI of 33.9 (SD 28.5). The obese and control groups experienced clinically meaningful improvements in AHI following AT with median change scores of 18.3 (95% CI -29.2, -11.2, p<0.001) and 14.6 (95% CI -25.5, -8.5, p<0.001) respectively. 48% of obese adolescents had an AHI < 5 on post-operative PSG. However, obese adolescents were 7 times more likely (OR=7.1, 95% CI (2.24, 22.48), p=0.001) to have moderate or severe persistent OSA (AHI>5) after AT compared with non-obese patients. The need for post-AT positive airway pressure (PAP) therapy was significantly higher in obese adolescents, with 37.1% of subjects requiring this therapy (OR=8.3, 95% CI 1.8, 37.6, p<0.001).


CONCLUSIONS
AT results in improvement in PSG parameters in obese adolescents with OSA. However, obese patients are at high risk for persistent OSA. Future research should include prospective trials to compare outcomes between AT and PAP therapy for obese adolescents.