Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor.
Division of Otolaryngology, Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin, Madison.
JAMA Otolaryngol Head Neck Surg. 2024 Oct 1;150(10):859-867. doi: 10.1001/jamaoto.2024.2554.
It is unknown whether adenotonsillectomy causes undesirable weight gain in children with mild obstructive sleep-disordered breathing (oSDB).
To compare changes in anthropometric measures in children with mild oSDB treated with adenotonsillectomy vs watchful waiting.
DESIGN, SETTING, AND PARTICIPANTS: This was an exploratory analysis of the Pediatric Adenotonsillectomy Trial for Snoring (PATS) randomized clinical trial of adenotonsillectomy vs watchful waiting for mild oSDB (snoring with obstructive apnea-hypopnea index of <3 events/hour) that took place at 7 pediatric tertiary care centers across the US and included 458 children aged 3.0 to 12.9 years with mild oSDB. Participants were recruited from June 29, 2016, to February 1, 2021. Anthropomorphic measures taken at baseline and 12 months after randomization were standardized for age and sex, including each participant's percentage of the 95th body mass index percentile (%BMIp95). Data analyses were performed from March 15, 2023, to April 1, 2024.
Early adenotonsillectomy (eAT) vs watchful waiting with supportive care (WWSC).
Twelve-month change in %BMIp95 from baseline and undesirable weight gain (defined as any weight gain in a child who already had overweight or obesity or an increase from baseline normal weight/underweight to overweight/obesity) at follow-up assessment.
The study analysis included 375 children (mean [SD] age, 6.1 [2.3] years; 188 [50.2%] females), of whom 143 (38%) had overweight or obesity at baseline. At 12 months, children in the eAT group experienced a 1.25-point increase in %BMIp95 compared with a 0.59-point increase in the WWSC group (mean difference, 0.93; 95% CI, -0.39 to 2.25). Undesirable weight gain was also similar between the eAT (n = 120; 32%) and WWSC (n = 101; 27%) groups (mean difference, 4%; 95% CI, 5% to 14%).
The findings of this exploratory analysis of the PATS trial indicate that adenotonsillectomy was not independently associated with an increased risk of undesirable weight gain in children with mild oSDB. However, one-third of the children gained undesirable weight during the study, which suggests that there is an opportunity to address healthy weight management during the evaluation and treatment of children with mild oSDB.
ClinicalTrials.gov Identifier: NCT02562040.
重要性：目前尚不清楚扁桃体腺样体切除术是否会导致患有轻度阻塞性睡眠呼吸障碍（OSDB）的儿童体重增加。
目的：比较轻度 OSDB 儿童接受腺样体切除术与观察等待治疗后，人体测量指标的变化。
设计、地点和参与者：这是美国 7 家儿科三级保健中心进行的小儿腺样体切除术治疗打鼾试验（PATS）的随机临床试验的探索性分析，该试验比较了腺样体切除术与观察等待治疗轻度 OSDB（打鼾，阻塞性呼吸暂停低通气指数<3 次/小时）的效果。该试验纳入了 458 名年龄在 3.0 至 12.9 岁之间的轻度 OSDB 儿童。参与者于 2016 年 6 月 29 日至 2021 年 2 月 1 日期间入组。基线和随机分组后 12 个月的人体测量指标进行了年龄和性别标准化，包括每个参与者的体重指数百分位数（%BMIp95）。数据分析于 2023 年 3 月 15 日至 2024 年 4 月 1 日进行。
干预措施：早期腺样体切除术（eAT）与支持性护理观察等待（WWSC）。
主要结局和测量指标：从基线到随访评估时，%BMIp95 的 12 个月变化和不良体重增加（定义为超重或肥胖的儿童体重增加，或从基线正常体重/体重不足增加到超重/肥胖）。
结果：研究分析纳入了 375 名儿童（平均[标准差]年龄，6.1[2.3]岁；188[50.2%]为女性），其中 143 名（38%）在基线时超重或肥胖。在 12 个月时，eAT 组的儿童%BMIp95 增加了 1.25 个点，而 WWSC 组增加了 0.59 个点（平均差异，0.93；95%CI，-0.39 至 2.25）。eAT 组（n=120；32%）和 WWSC 组（n=101；27%）的不良体重增加也相似（平均差异，4%；95%CI，5%至 14%）。
结论和相关性：本研究对 PATS 试验的探索性分析结果表明，在患有轻度 OSDB 的儿童中，腺样体切除术与不良体重增加的风险增加无关。然而，三分之一的儿童在研究期间体重增加不良，这表明在评估和治疗轻度 OSDB 儿童时，有机会解决健康体重管理问题。
试验注册：ClinicalTrials.gov 标识符：NCT02562040。
