Pilot Study to Assess the Effectiveness of Tonsil and Adenoidectomy (T+A) in Overweight Children and Adolescents
Pilot Study to Assess the Effectiveness of Tonsil and Adenoidectomy (T+A) in Overweight Children and Adolescents
Obesity has reached epidemic proportions in the United States with roughly 20% of American
 children being overweight and has serious consequences such as sleep apnea.Additionally,
 obesity is known to result in the earlier onset of puberty . Thus, it can be expected that
 obese children take-on adult characteristics at an earlier chronologic age than their
 non-obese counterparts. Current guidelines recommend adenotonsillectomy (T+A) as primary and
 effective therapy for sleep apnea resulting in polysomnographic resolution in 75-100% of
 patients. Small studies have shown that T+A relieves symptoms in obese children but surgical
 intervention has been less efficacious in adults. We hypothesize that T+A may be less
 efficacious in obese adolescents because of earlier onset of puberty imparting more adult
 characteristics. We further hypothesize that the efficacy of T+A will correlate more closely
 with Tanner staging than with chronologic age because of the earlier onset of sexual
 maturation associated with obesity.
Obesity has reached epidemic proportions in the United States with roughly 20% of American
 children being overweight . Obesity has serious health consequences increasing the risk of
 hypertension , type II diabetes and obstructive sleep apnea . Additionally, obesity is known
 to result in the earlier onset of puberty . Thus, it can be expected that obese children
 take-on adult characteristics at an earlier chronologic age than their non-obese
 counterparts.

 Similarly, sleep apnea is a common problem with wide reaching consequences including
 increased risk for hypertension , insulin resistance and neurocognitive dysfunction leading
 to poor academic performance . Furthermore, sleep fragmentation produced by repetitive
 episodes of nocturnal apnea may lead to daytime somnolence and increased food intake as a
 behavioral attempt to overcome sleepiness and thereby further contribute to obesity .

 Current guidelines recommend adenotonsillectomy (T+A) as primary and effective therapy for
 sleep apnea resulting in polysomnographic resolution in 75-100% of patients. Small studies
 have shown that T+A relieves symptoms in obese children but surgical intervention has been
 less efficacious in adults . Although nocturnal polysomnogrpahy (NPSG) is considered the gold
 standard by which to diagnose obstructive sleep apnea (OSAS), published studies assessing the
 efficacy of treatment in obese children using polysomngraphy to objectively quantify the
 degree of sleep apnea before and after T+A do not exist.

 Surgical intervention may not be indicated in children without adenotonsillar hypertrophy.
 Similarly, children who are at high risk for surgical or anesthetic related complications may
 be deemed poor surgical candidates. For these children as well as those who fail T+A,
 non-invasive, continuous positive airway pressure (CPAP) applied via a nasal mask is
 effective in treating sleep disordered breathing. However, CPAP is effective only when in use
 and multiple studies demonstrate low rates of long-term compliance in adults . No studies
 assessing children's adherence with CPAP exist. Certainly, it is expected that compliance in
 the adolescent population would be similar, if not worse than adults. Thus, CPAP is not
 recommended as first-line therapy when surgical intervention is viable.

 We hypothesize that T+A may be less efficacious in obese adolescents because of earlier onset
 of puberty imparting more adult characteristics. We further hypothesize that the efficacy of
 T+A will correlate more closely with Tanner staging than with chronologic age because of the
 earlier onset of sexual maturation associated with obesity. Thus, we propose to study the
 efficacy of T+A in the treatment of sleep apnea in obese adolescents using polysomnography to
 quantify the severity of OSAS before and after T+A. It is anticipated that results from this
 preliminary study will be used to form the basis for studies comparing efficacy of
 adenotonsillectomy against the use of CPAP in this population.
Inclusion Criteria:

 -  Children aged 8-18 who are overweight or at risk for overweight (defined as BMI
 >85%ile for age and gender referred for evaluation and treatment of sleep apnea.

 Exclusion Criteria:

 -  Children with underlying craniofacial anomalies, chromosomal abnormalities,
 neuromuscular disorders and metabolic disorders except diabetes will be excluded.
 Children and parents who do not speak or write English will be excluded. Children with
 neuropsychiatric disabilities severe enough to preclude sufficient cooperation with
 overnight polysomnography will also be excluded.