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Study Shows that Tonsillectomy for Kids’ Sleep Apnea Risks Weight Gain

Though most people imagine older males who are overweight, perhaps even obese when the subject of obstructive sleep apnea is raised, the truth is that sleep apnea can occur in either males or females, young people or old, slim or obese. In fact, sleep apnea is commonly seen in children. But one of the biggest differences between sleep apnea in kids and sleep apnea in adults is that where the adult version of this serious condition generally arises from health issues that can raise a variety of concerns, in children obstructive sleep apnea is often the result of swollen tonsils and adenoids.

Sleep apnea is a condition in which the airway becomes blocked when the patient is sound asleep. In adults the airway closes off because of an overabundance of tissue in the throat area, or because the body has lost muscle tone or been impacted by other exacerbating circumstances such as smoking or cardiovascular problems. In children, the problem is often caused by swelling in the infection-fighting tissues of the tonsils and the adenoids which are located at the back of the throat and sinuses. Though the conditions have different causes, they both have the same impact – the block the airway and stop oxygen from reaching the brain. In response, the brain panics and gasps for air. This process puts intense pressure on several bodily systems. It also causes sleep deprivation. Adult sleep apnea is generally detected by sleep partners or as a result of extreme daytime drowsiness. In children the symptoms are drowsiness and the instances of gasping are generally reported by parents or siblings.

Though adult obstructive sleep apnea is generally treated with the use of continuous positive airway pressure (CPAP devices) that place a mask over the face of the patient as they sleep, delivering a constant flow of oxygen into the airway in order to keep it open, children are usually treated surgically. Ear, nose and throat physicians surgically remove the adenoids and tonsils and create a free path for the oxygen to flow. The surgery is generally successful, but a recent study has shown that tonsillectomies in children can also lead to a rapid weight gain – especially if the child was overweight before the operation took place.

This is of particular concern because obesity in and of itself is a risk factor for apnea, as well as for several other health conditions. Though doctors still believe that the surgery is the best answer for childhood apnea patients, they also feel strongly that doctors and parents need to be aware of the risk and take measures to prevent the weight loss from happening post-surgery.

Dr. Eliot Katz of the Boston Children’s Hospital is a respiratory disease specialist. He says, “You can’t just treat the sleep apnea. You have to have nutrition and lifestyle counseling too.” His thoughts are echoed by Dr. Sangeeta Chakravorty, codirector of the pediatric sleep evaluation center at Children’s Hospital of Pittsburg. Dr. Chakravorty says, “Nutrition and exercise are just as important as treating the sleep apnea with a single procedure.”

It has long been known that increased weight gain accompanies tonsillectomy for obstructive sleep apnea, though there are different theories for why that is the case. Dr. Katz’ team believes that children with sleep apnea are working hard to breathe while they are asleep, and that once that effort is no longer necessary, they bun fewer calories at night. Others believe that the sleep apnea causes daytime hyperactivity that burns high numbers of calories, and that once the problem is cured the children become less active during the day, thus burning fewer calories.

Whatever the reason, the study results achieved by Katz’ team, and published in the journal Pediatrics, has proven that it is the surgery itself that causes the weight gain. This was shown by separating the children in the study into two groups – those that had the tonsillectomy surgery and those that were put into a “watchful waiting” group. The waiting group delayed surgery and were assigned to alternative therapies such as allergy and asthma medications to treat their symptoms. With over 400 children between the ages of 5 and 9 involved in the study and split evenly between the two groups, the researchers found that the group that had tonsillectomy surgery gained weight more quickly than those in the other group.  And though the difference was incremental, it was of great concern for those children that were overweight before they had the surgery.

Where normal weight children simply gained a little weight, overweight children easily crossed into the category of obesity. Fifty two percent of those children were classified as obese after seven months, where only 21 percent of the overweight children who were in the weight group became obese.

Katz points out that sleep apnea has an impact on some of children’s growth hormones that are released at night, and posits that correcting the obstruction may leave overweight children with a metabolism that is struggling to correct itself. And where historically children who suffered from sleep apnea were underweight, the change in society’s weight and propensity towards obesity has changed that.  Many children diagnosed with sleep apnea are obese or overweight to begin with, putting them at additional risk for being diagnosed again following the surgery, but the second time around the cause is their weight rather than the excess tissue of their tonsils or adenoids.  Overweight children who have undergone the surgery and who have gained additional weight rapidly have been found to redevelop apnea within six months to a year.

According to Katz, the concern is very real. “After surgery, parents are often very satisfied. Their kids are sleeping better and they may be better behaved and doing better in school. But there’s this insidious issue of weight gain.” The answer, says Chakravorty, is to control diet and encourage exercise, no matter whether the child has had surgery or not.


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