title: Characteristics and surgical and clinical outcomes of severely obese children with obstructive sleep apnea.
abstract: OBJECTIVE
  To describe characteristics and surgical and clinical outcomes of obese children with obstructive sleep apnea (OSA).
  
  
  METHODS
  At our institution from 2000 to 2010, 143 obese children with an overnight polysomnography (OPSG) diagnosis of OSA, excluding children with comorbidities, were identified. Relationships between demographics, clinical findings, and the severity of OSA were assessed. Presurgery and postsurgery OPSG indices were compared. We defined cure as an apneahypopnea index (AHI) < 1.5/h on the postsurgery OPSG, and we compared the cure rates of different surgeries.
  
  
  RESULTS
  A total of 143 children, median age 12.4 y (interquartile range [IQR] 9.6-14.9) and BMI z-scores 2.8 (IQR 2.6-2.9), were included. Seventy-eight (55%) (Median age 12 y [IQR 9-15]) underwent surgery: 1 had tonsillectomy; 1 tonsillectomy + uvulopharyngopalatoplasty (UPPP); 23 adenotonsillectomy (AT); 27 AT + UPPP; 11 adenoidectomy + UPPP; 8 UPPP; and 7 AT + turbinate trim ± tongue base suspension. Overall, surgery cured 19 children (26%), but AHI improved in the majority of children (p = 0.001). Similarly, the arousal index, PETCO2, and SpO2 nadir improved significantly (p < 0.002, p = 0.019, p < 0.001, respectively). AHI improved significantly in children with mild-to-moderate OSA in comparison to severe OSA (p < 0.001). Children with enlarged tonsils and no history of prior surgery benefitted more often from surgery (p < 0.004 and p = 0.002, respectively). AT was the only surgery reducing the AHI significantly (p = 0.008). Children did not lose weight despite intervention. Adherence with PAP was poor.
  
  
  CONCLUSIONS
  Surgery improved OPSG indices in the majority of obese children with OSA.
authors: Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, University of Arkansas Medical Sciences, Little Rock, AR.
authors: Gulnur
authors: G
authors: Com
authors: Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, University of Arkansas Medical Sciences, Little Rock, AR.
authors: John L
authors: JL
authors: Carroll
authors: Department of Pediatrics, Biostatistics Program, University of Arkansas Medical Sciences, Little Rock, AR.
authors: Xinyu
authors: X
authors: Tang
authors: Department of Pediatrics, Biostatistics Program, University of Arkansas Medical Sciences, Little Rock, AR.
authors: Maria S
authors: MS
authors: Melguizo
authors: Department of Otolaryngology, University of Arkansas Medical Sciences, Little Rock, AR.
authors: Charles
authors: C
authors: Bower
authors: Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, University of Arkansas Medical Sciences, Little Rock, AR.
authors: Supriya
authors: S
authors: Jambhekar
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications*; D010159:Palate / Q000601:surgery; D010614:Pharynx / Q000601:surgery; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000601:surgery*; D014068:Tonsillectomy; D016896:Treatment Outcome; D014609:Uvula / Q000601:surgery
keywords: adenotonsillectomy; children; obesity; positive airway pressure treatment; sleep apnea; uvulopharyngopalatoplasty