title: Adenotonsillectomy in obese children with obstructive sleep apnea syndrome: magnetic resonance imaging findings and considerations.
abstract: OBJECTIVE
  The reasons why adenotonsillectomy (AT) is less effective treating obese children with obstructive sleep apnea syndrome (OSAS) are not understood. Thus, the aim of the study was to evaluate how anatomical factors contributing to airway obstruction are affected by AT in these children.
  
  
  METHODS
  Twenty-seven obese children with OSAS (age 13.0 ± 2.3 y, body mass index Z-score 2.5 ± 0.3) underwent polysomnography and magnetic resonance imaging of the head during wakefulness before and after AT. Volumetric analysis of the upper airway and surrounding tissues was performed using commercial software (AMIRA®).
  
  
  RESULTS
  Patients were followed for 6.1 ± 3.6 mo after AT. AT improved mean obstructive apnea-hypopnea index (AHI) from 23.7 ± 21.4 to 5.6 ± 8.7 (P < 0.001). Resolution of OSAS was noted in 44% (12 of 27), but only in 22% (4 of 18) of those with severe OSAS (AHI > 10). AT increased the volume of the nasopharynx and oropharynx (2.9 ± 1.3 versus 4.4 ± 0.9 cm(3), P < 0.001, and 3.2 ± 1.2 versus 4.3 ± 2.0 cm(3), P < 0.01, respectively), reduced tonsils (11.3 ± 4.3 versus 1.3 ± 1.4 cm(3), P < 0.001), but had no effect on the adenoid, lingual tonsil, or retropharyngeal nodes. A small significant increase in the volume of the soft palate and tongue was also noted (7.3 ± 2.5 versus 8.0 ± 1.9 cm(3), P = 0.02, and 88.2 ± 18.3 versus 89.3 ± 24.4 cm(3), P = 0.005, respectively).
  
  
  CONCLUSIONS
  This is the first report to quantify volumetric changes in the upper airway in obese children with OSAS after adenotonsillectomy showing significant residual adenoid tissue and an increase in the volume of the tongue and soft palate. These findings could explain the low success rate of AT reported in obese children with OSAS and are important considerations for clinicians treating these children.
authors.affiliation: Division of Respiratory and Sleep Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
authors.forename: Kiran
authors.initials: K
authors.lastname: Nandalike
authors.forename: Keivan
authors.initials: K
authors.lastname: Shifteh
authors.forename: Sanghun
authors.initials: S
authors.lastname: Sin
authors.forename: Temima
authors.initials: T
authors.lastname: Strauss
authors.forename: Allison
authors.initials: A
authors.lastname: Stakofsky
authors.forename: Nathan
authors.initials: N
authors.lastname: Gonik
authors.forename: John
authors.initials: J
authors.lastname: Bent
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Parikh
authors.forename: Maha
authors.initials: M
authors.lastname: Bassila
authors.forename: Margarita
authors.initials: M
authors.lastname: Nikova
authors.forename: Hiren
authors.initials: H
authors.lastname: Muzumdar
authors.forename: Raanan
authors.initials: R
authors.lastname: Arens
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009305:Nasopharynx / Q000473:pathology; D009765:Obesity / Q000150:complications* / Q000473:pathology; D009960:Oropharynx / Q000473:pathology; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000473:pathology / Q000601:surgery*; D014068:Tonsillectomy
keywords: Obesity; adenotonsillectomy; obstructive sleep apnea syndrome