title: Growth after adenotonsillectomy for obstructive sleep apnea: an RCT.
abstract: OBJECTIVE
  Adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) may lead to weight gain, which can have deleterious health effects when leading to obesity. However, previous data have been from nonrandomized uncontrolled studies, limiting inferences. This study examined the anthropometric changes over a 7-month interval in a randomized controlled trial of adenotonsillectomy for OSAS, the Childhood Adenotonsillectomy Trial.
  
  
  METHODS
  A total of 464 children who had OSAS (average apnea/hypopnea index [AHI] 5.1/hour), aged 5 to 9.9 years, were randomized to Early Adenotonsillectomy (eAT) or Watchful Waiting and Supportive Care (WWSC). Polysomnography and anthropometry were performed at baseline and 7-month follow-up. Multivariable regression modeling was used to predict the change in weight and growth indices.
  
  
  RESULTS
  Interval increases in the BMI z score (0.13 vs. 0.31) was observed in both the WWSC and eAT intervention arms, respectively, but were greater with eAT (P < .0001). Statistical modeling showed that BMI z score increased significantly more in association with eAT after considering the influences of baseline weight and AHI. A greater proportion of overweight children randomized to eAT compared with WWSC developed obesity over the 7-month interval (52% vs. 21%; P < .05). Race, gender, and follow-up AHI were not significantly associated with BMI z score change.
  
  
  CONCLUSIONS
  eAT for OSAS in children results in clinically significant greater than expected weight gain, even in children overweight at baseline. The increase in adiposity in overweight children places them at further risk for OSAS and the adverse consequences of obesity. Monitoring weight, nutritional counseling, and encouragement of physical activity should be considered after eAT for OSAS.
authors: Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts; eliot.katz@childrens.harvard.edu.
authors: Eliot S
authors: ES
authors: Katz
authors: Department of Statistics, North Carolina State University, Raleigh, North Carolina;
authors: Renee H
authors: RH
authors: Moore
authors: Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio;
authors: Carol L
authors: CL
authors: Rosen
authors: Departments of Otolaryngology and Pediatrics, Utah Southwestern Medical Center, Dallas, Texas;
authors: Ron B
authors: RB
authors: Mitchell
authors: Departments of Pediatrics, and.
authors: Raouf
authors: R
authors: Amin
authors: Department of Pediatrics, Children's Hospital at Montefiore and Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York;
authors: Raanan
authors: R
authors: Arens
authors: Department of Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan;
authors: Hiren
authors: H
authors: Muzumdar
authors: Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, Pennsylvania;
authors: Ronald D
authors: RD
authors: Chervin
authors: Department of Statistics, North Carolina State University, Raleigh, North Carolina;
authors: Carole L
authors: CL
authors: Marcus
authors: Department of Pediatrics, Cardinal Glennon Children's Medical Center, Saint Louis University, St Louis, Missouri; and.
authors: Shalini
authors: S
authors: Paruthi
authors: Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors: Paul
authors: P
authors: Willging
authors: Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors: Susan
authors: S
authors: Redline
mesh_terms: D000233:Adenoidectomy; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010149:Postoperative Pain; D017286:Polysomnography; D011184:Postoperative Period; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy; D015430:Weight Gain
keywords: BMI; height; weight