title: Pediatric obstructive sleep apnea in obese and normal-weight children: impact of adenotonsillectomy on quality-of-life and behavior.
abstract: OBJECTIVE
  To evaluate the impact of adenotonsillectomy (T&A) on quality-of-life (QOL) and behavior in obese versus normal-weight children with Obstructive Sleep Apnea (OSA).
  
  
  METHODS
  Prospective, non-randomized, controlled study.
  
  
  METHODS
  Children with an apnea-hypopnea index (AHI) >or=2 were studied. Polysomnography was performed before and after T&A. An age- and gender-specific body mass index (BMI-for-age) percentile was determined preoperatively. Children who were obese (>95th percentile) were compared to normal-weight children (BMI-for-age > 5th-85th percentile). Caregivers completed the OSA-18 QOL survey and the Behavioral Assessment Survey for Children (BASC) before surgery and 3-6 months postoperatively. Pre- and postoperative scores were compared using paired t-tests, and the impact of covariants was analyzed using ANOVA.
  
  
  RESULTS
  The study population consisted of 89 children, 40 of whom were obese (45%). Postoperative scores for AHI, OSA-18 total and domain scores, and BASC scales and composites were significantly lower (improved) compared to pre-operative values in all children (p < .001). All mean OSA-18 and BASC scores were higher (indicating worse quality-of-life and behavior) pre- and postoperatively in obese than in normal-weight children. Postoperatively, the majority of OSA-18 total scores and domain scores were significantly higher in obese children. A comparison of the total OSA-18 scores between children with a postoperative AHI < 2 and AHI >or= 2 in obese children and a similar comparison in normal-weight children was not statistically significant. There was no significant difference for BASC scores pre- and postoperatively between obese and normal-weight children. The pre- and postoperative scores for the AHI had a poor correlation with the pre- and postoperative Behavioral Symptoms Index (BSI) and total OSA-18 scores (r = .09), respectively.
  
  
  CONCLUSIONS
  Following T&A all children have improvements in AHI, QOL, and behavior. Obese children are more likely to have persistent OSA and poor QOL scores after T&A. Behavior improves postoperatively to a similar extent in all children regardless of obesity.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Ron B
authors.initials: RB
authors.lastname: Mitchell
authors.forename: Emily F
authors.initials: EF
authors.lastname: Boss
mesh_terms: D000233:Adenoidectomy / Q000379:methods; D000704:Analysis of Variance; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002652:Child Behavior / Q000523:psychology*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000523:psychology*; D017286:Polysomnography / Q000379:methods; D011184:Postoperative Period; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D011795:Surveys and Questionnaires; D014068:Tonsillectomy / Q000379:methods; D016896:Treatment Outcome