Growth velocity predicts recurrence of sleep-disordered breathing 1 year after adenotonsillectomy.
BACKGROUND
Adenotonsillectomy, the first line of treatment of sleep-disordered breathing (SDB), is the most commonly performed pediatric surgery. Predictors of the recurrence of SDB after adenotonsillectomy and its impact on cardiovascular risk factors have not been identified.


OBJECTIVE
Demonstrate that gain velocity in body mass index (BMI) defined as unit increase in BMI/year confers an independent risk for the recurrence of SDB 1 year after adenotonsillectomy.


METHODS
Children with SDB and hypertrophy of the tonsils and a comparison group of healthy children were followed prospectively for 1 year.


RESULTS
Serial polysomnographies, BMI, and blood pressure were obtained before adenotonsillectomy and 6 weeks, 6 months, and 1 year postoperatively. Gain velocity in BMI, BMI and being African American (odds ratios, 4-6/unit change/yr; 1.4/unit and 15, respectively) provided equal amounts of predictive power to the risk of recurrence of SDB. In the group that experienced recurrence, systolic blood pressure at 1 year was higher than at baseline and higher than in children who did not experience recurrence.


CONCLUSIONS
Three clinical parameters confer independent increased risk for high recurrence of SDB after adenotonsillectomy: gain velocity in BMI, obesity, and being African American. A long-term follow-up of children with SDB and monitoring of gain velocity in BMI are essential to identifying children at risk for recurrence of SDB and in turn at risk for hypertension.
Amin
Raouf
R
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. raouf.amin@cchmc.org
Anthony
Leonard
L
Somers
Virend
V
Fenchel
Matthew
M
McConnell
Keith
K
Jefferies
Jenny
J
Willging
Paul
P
Kalra
Maninder
M
Daniels
Stephen
S
D000233:Adenoidectomy; D000293:Adolescent; D001741:Black or African American; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity; D017286:Polysomnography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000601:surgery*; D014068:Tonsillectomy; D044465:White People