Pediatric Obstructive Sleep Apnea in Obese and Normal-Weight Children: Impact of Adenotonsillectomy on Quality-of-Life and Behavior

Objectives: To evaluate the impact of adenotonsillectomy (T&A) on quality-of-life (QOL) and behavior in obese versus normal-weight children with Obstructive Sleep Apnea (OSA). Design: Prospective, non-randomized, controlled study. Methods: Children with an apnea-hypopnea index (AHI) >= 2 were studied. Polysomnography was performed before and after T&A. An age- and gender-specific body mass index (BMI-for-age) percentile was determined preoperatively. Children who were obese (> 95th percentile) were compared to normal-weight children (BMI-for-age > 5th-85th percentile). Caregivers completed the OSA-18 QOL survey and the Behavioral Assessment Survey for Children (BASC) before surgery and 3-6 months postoperatively. Pre- and postoperative scores were compared using paired t-tests, and the impact of covariants was analyzed using ANOVA. Results: The study population consisted of 89 children, 40 of whom were obese (45%). Postoperative scores for AHI, OSA-18 total and domain scores, and BASC scales and composites were significantly lower (improved) compared to pre-operative values in all children (p < .001). All mean OSA-18 and BASC scores were higher (indicating worse quality-of-life and behavior) pre- and postoperatively in obese than in normal-weight children. Postoperatively, the majority of OSA-18 total scores and domain scores were significantly higher in obese children. A comparison of the total OSA-18 scores between children with a postoperative AHI < 2 and AHI >= 2 in obese children and a similar comparison in normal-weight children was not statistically significant. There was no significant difference for BASC scores pre- and postoperatively between obese and normal-weight children. The pre- and postoperative scores for the AHI had a poor correlation with the pre- and postoperative Behavioral Symptoms Index (BSI) and total OSA-18 scores (r = .09), respectively. Conclusions: Following T&A all children have improvements in AHI, QOL, and behavior. Obese children are more likely to have persistent OSA and poor QOL scores after T&A. Behavior improves postoperatively to a similar extent in all children regardless of obesity.