睡眠事件对早发性腺样体扁桃体切除术治疗儿童阻塞性睡眠呼吸暂停后体重增加的影响与支持性护理的比较。

The impact of sleep events on weight gain following early adenotonsillectomy compared to supportive care for pediatric OSA.

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.

Department of Otorhinolaryngology, Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.

出版信息

Int J Pediatr Otorhinolaryngol. 2022 Mar;154:111049. doi: 10.1016/j.ijporl.2022.111049. Epub 2022 Jan 19.

DOI:10.1016/j.ijporl.2022.111049

PMID:35085874

Abstract

OBJECTIVES

Children with obstructive sleep apnea (OSA) who undergo adenotonsillectomy (AT) often experience post-operative weight gain, although the mechanism remains unclear. Our aim is to understand how changes in sleep events impact changes in weight in children with OSA following adenotonsillectomy compared to watchful waiting with supportive care.

METHODS

We performed a secondary analysis of the Childhood adenotonsillectomy trial (CHAT) dataset in which children with OSA were randomized to undergo early adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC). The primary outcome measures included changes in body mass index (BMI) percentile, apnea-hypopnea index (AHI) and arousal index (AI) during rapid eye movement (REM) sleep. The change in BMI percentile attributable to changes in AHI and AI during REM sleep was determined using causal mediation analysis.

RESULTS

Of the 453 children with OSA randomized to eAT or WWSC, 397 children were included in the analysis. Children in the eAT arm experienced a greater increase in their weight as measured by BMI percentile, compared to children who received WWSC (WWSC 4.12 (2.70, 5.55) vs. eAT 6.62 (4.87, 8.38), Cohen's d = 0.22 (0.02, 0.42), p = 0.02). A significant proportion of the weight gain was attributable to decreases in apneic events (proportion mediated 19% (2-97%), p = 0.03) and arousals (proportion mediated 20% (5-78%), p = 0.01) during REM sleep.

CONCLUSION

A significant proportion of post-adenotonsillectomy weight gain in children with OSA is attributable to polysomnographic changes during REM sleep, potentially due to the mitigation of REM-related sleep fragmentation and subsequent reduction in metabolic expenditure.

摘要

目的

接受腺样体扁桃体切除术（AT）的阻塞性睡眠呼吸暂停（OSA）儿童常经历术后体重增加，尽管其机制尚不清楚。我们的目的是了解与观察等待和支持性护理相比，腺样体扁桃体切除术（AT）后 OSA 儿童的睡眠事件变化如何影响体重变化。

方法

我们对儿童腺样体扁桃体切除术试验（CHAT）数据集进行了二次分析，其中 OSA 儿童被随机分为早期 AT 组（eAT）或观察等待和支持性护理组（WWSC）。主要结局指标包括 REM 睡眠期间体重指数（BMI）百分位数、呼吸暂停低通气指数（AHI）和觉醒指数（AI）的变化。使用因果中介分析确定 REM 睡眠期间 AHI 和 AI 变化导致的 BMI 百分位数变化。

结果

在随机分为 eAT 或 WWSC 的 453 例 OSA 儿童中，有 397 例儿童纳入分析。与接受 WWSC 的儿童相比，eAT 组的儿童体重增加更多，表现为 BMI 百分位数增加（WWSC 4.12（2.70，5.55）vs. eAT 6.62（4.87，8.38），Cohen's d=0.22（0.02，0.42），p=0.02）。体重增加的很大一部分归因于呼吸暂停事件（中介比例 19%（2-97%），p=0.03）和觉醒（中介比例 20%（5-78%），p=0.01）在 REM 睡眠期间减少。