Adenotonsillectomy in obese children with obstructive sleep apnea syndrome: Magnetic resonance imaging findings and considerations

Kiran Nandalike, Keivan Shifteh, Sanghun Sin, Temima Strauss, Allison Stakofsky, Nathan Gonik, John Bent, Sanjay R. Parikh, Maha Bassila, Margarita Nikova, Hiren Muzumdar, Raanan Arens

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objective: The reasons why adenotonsillectomy (AT) is less effective treating obese children with obstructive sleep apnea syndrome (OSAS) are not understood. Thus, the aim of the study was to evaluate how anatomical factors contributing to airway obstruction are affected by AT in these children. Methods: Twenty-seven obese children with OSAS (age 13.0 ± 2.3 y, body mass index Z-score 2.5 ± 0.3) underwent polysomnography and magnetic resonance imaging of the head during wakefulness before and after AT. Volumetric analysis of the upper airway and surrounding tissues was performed using commercial software (AMIRA®). Results: Patients were followed for 6.1 ± 3.6 mo after AT. AT improved mean obstructive apnea-hypopnea index (AHI) from 23.7 ± 21.4 to 5.6 ± 8.7 (P < 0.001). Resolution of OSAS was noted in 44% (12 of 27), but only in 22% (4 of 18) of those with severe OSAS (AHI > 10). AT increased the volume of the nasopharynx and oropharynx (2.9 ± 1.3 versus 4.4 ± 0.9 cm3, P < 0.001, and 3.2 ± 1.2 versus 4.3 ± 2.0 cm3, P < 0.01, respectively), reduced tonsils (11.3 ± 4.3 versus 1.3 ± 1.4 cm3, P < 0.001), but had no effect on the adenoid, lingual tonsil, or retropharyngeal nodes. A small significant increase in the volume of the soft palate and tongue was also noted (7.3 ± 2.5 versus 8.0 ± 1.9 cm3, P = 0.02, and 88.2 ± 18.3 versus 89.3 ± 24.4 cm3, P = 0.005, respectively). Conclusions: This is the first report to quantify volumetric changes in the upper airway in obese children with OSAS after adenotonsillectomy showing significant residual adenoid tissue and an increase in the volume of the tongue and soft palate. These findings could explain the low success rate of AT reported in obese children with OSAS and are important considerations for clinicians treating these children.

Original languageEnglish (US)
Pages (from-to)841-847
Number of pages7
JournalSleep
Volume36
Issue number6
DOIs
StatePublished - Jun 1 2013
Externally publishedYes

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Obstructive Sleep Apnea
Magnetic Resonance Imaging
Tongue
Adenoids
Soft Palate
Palatine Tonsil
Oropharynx
Nasopharynx
Polysomnography
Wakefulness
Apnea
Airway Obstruction
Body Mass Index
Software
Head

Keywords

  • Adenotonsillectomy
  • Obesity
  • Obstructive sleep apnea syndrome

ASJC Scopus subject areas

  • Physiology (medical)
  • Clinical Neurology

Cite this

Adenotonsillectomy in obese children with obstructive sleep apnea syndrome : Magnetic resonance imaging findings and considerations. / Nandalike, Kiran; Shifteh, Keivan; Sin, Sanghun; Strauss, Temima; Stakofsky, Allison; Gonik, Nathan; Bent, John; Parikh, Sanjay R.; Bassila, Maha; Nikova, Margarita; Muzumdar, Hiren; Arens, Raanan.

In: Sleep, Vol. 36, No. 6, 01.06.2013, p. 841-847.

Research output: Contribution to journalArticle

Nandalike, K, Shifteh, K, Sin, S, Strauss, T, Stakofsky, A, Gonik, N, Bent, J, Parikh, SR, Bassila, M, Nikova, M, Muzumdar, H & Arens, R 2013, 'Adenotonsillectomy in obese children with obstructive sleep apnea syndrome: Magnetic resonance imaging findings and considerations', Sleep, vol. 36, no. 6, pp. 841-847. https://doi.org/10.5665/sleep.2708
Nandalike, Kiran ; Shifteh, Keivan ; Sin, Sanghun ; Strauss, Temima ; Stakofsky, Allison ; Gonik, Nathan ; Bent, John ; Parikh, Sanjay R. ; Bassila, Maha ; Nikova, Margarita ; Muzumdar, Hiren ; Arens, Raanan. / Adenotonsillectomy in obese children with obstructive sleep apnea syndrome : Magnetic resonance imaging findings and considerations. In: Sleep. 2013 ; Vol. 36, No. 6. pp. 841-847.
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abstract = "Objective: The reasons why adenotonsillectomy (AT) is less effective treating obese children with obstructive sleep apnea syndrome (OSAS) are not understood. Thus, the aim of the study was to evaluate how anatomical factors contributing to airway obstruction are affected by AT in these children. Methods: Twenty-seven obese children with OSAS (age 13.0 ± 2.3 y, body mass index Z-score 2.5 ± 0.3) underwent polysomnography and magnetic resonance imaging of the head during wakefulness before and after AT. Volumetric analysis of the upper airway and surrounding tissues was performed using commercial software (AMIRA{\circledR}). Results: Patients were followed for 6.1 ± 3.6 mo after AT. AT improved mean obstructive apnea-hypopnea index (AHI) from 23.7 ± 21.4 to 5.6 ± 8.7 (P < 0.001). Resolution of OSAS was noted in 44{\%} (12 of 27), but only in 22{\%} (4 of 18) of those with severe OSAS (AHI > 10). AT increased the volume of the nasopharynx and oropharynx (2.9 ± 1.3 versus 4.4 ± 0.9 cm3, P < 0.001, and 3.2 ± 1.2 versus 4.3 ± 2.0 cm3, P < 0.01, respectively), reduced tonsils (11.3 ± 4.3 versus 1.3 ± 1.4 cm3, P < 0.001), but had no effect on the adenoid, lingual tonsil, or retropharyngeal nodes. A small significant increase in the volume of the soft palate and tongue was also noted (7.3 ± 2.5 versus 8.0 ± 1.9 cm3, P = 0.02, and 88.2 ± 18.3 versus 89.3 ± 24.4 cm3, P = 0.005, respectively). Conclusions: This is the first report to quantify volumetric changes in the upper airway in obese children with OSAS after adenotonsillectomy showing significant residual adenoid tissue and an increase in the volume of the tongue and soft palate. These findings could explain the low success rate of AT reported in obese children with OSAS and are important considerations for clinicians treating these children.",
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T1 - Adenotonsillectomy in obese children with obstructive sleep apnea syndrome

T2 - Magnetic resonance imaging findings and considerations

AU - Nandalike, Kiran

AU - Shifteh, Keivan

AU - Sin, Sanghun

AU - Strauss, Temima

AU - Stakofsky, Allison

AU - Gonik, Nathan

AU - Bent, John

AU - Parikh, Sanjay R.

AU - Bassila, Maha

AU - Nikova, Margarita

AU - Muzumdar, Hiren

AU - Arens, Raanan

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N2 - Objective: The reasons why adenotonsillectomy (AT) is less effective treating obese children with obstructive sleep apnea syndrome (OSAS) are not understood. Thus, the aim of the study was to evaluate how anatomical factors contributing to airway obstruction are affected by AT in these children. Methods: Twenty-seven obese children with OSAS (age 13.0 ± 2.3 y, body mass index Z-score 2.5 ± 0.3) underwent polysomnography and magnetic resonance imaging of the head during wakefulness before and after AT. Volumetric analysis of the upper airway and surrounding tissues was performed using commercial software (AMIRA®). Results: Patients were followed for 6.1 ± 3.6 mo after AT. AT improved mean obstructive apnea-hypopnea index (AHI) from 23.7 ± 21.4 to 5.6 ± 8.7 (P < 0.001). Resolution of OSAS was noted in 44% (12 of 27), but only in 22% (4 of 18) of those with severe OSAS (AHI > 10). AT increased the volume of the nasopharynx and oropharynx (2.9 ± 1.3 versus 4.4 ± 0.9 cm3, P < 0.001, and 3.2 ± 1.2 versus 4.3 ± 2.0 cm3, P < 0.01, respectively), reduced tonsils (11.3 ± 4.3 versus 1.3 ± 1.4 cm3, P < 0.001), but had no effect on the adenoid, lingual tonsil, or retropharyngeal nodes. A small significant increase in the volume of the soft palate and tongue was also noted (7.3 ± 2.5 versus 8.0 ± 1.9 cm3, P = 0.02, and 88.2 ± 18.3 versus 89.3 ± 24.4 cm3, P = 0.005, respectively). Conclusions: This is the first report to quantify volumetric changes in the upper airway in obese children with OSAS after adenotonsillectomy showing significant residual adenoid tissue and an increase in the volume of the tongue and soft palate. These findings could explain the low success rate of AT reported in obese children with OSAS and are important considerations for clinicians treating these children.

AB - Objective: The reasons why adenotonsillectomy (AT) is less effective treating obese children with obstructive sleep apnea syndrome (OSAS) are not understood. Thus, the aim of the study was to evaluate how anatomical factors contributing to airway obstruction are affected by AT in these children. Methods: Twenty-seven obese children with OSAS (age 13.0 ± 2.3 y, body mass index Z-score 2.5 ± 0.3) underwent polysomnography and magnetic resonance imaging of the head during wakefulness before and after AT. Volumetric analysis of the upper airway and surrounding tissues was performed using commercial software (AMIRA®). Results: Patients were followed for 6.1 ± 3.6 mo after AT. AT improved mean obstructive apnea-hypopnea index (AHI) from 23.7 ± 21.4 to 5.6 ± 8.7 (P < 0.001). Resolution of OSAS was noted in 44% (12 of 27), but only in 22% (4 of 18) of those with severe OSAS (AHI > 10). AT increased the volume of the nasopharynx and oropharynx (2.9 ± 1.3 versus 4.4 ± 0.9 cm3, P < 0.001, and 3.2 ± 1.2 versus 4.3 ± 2.0 cm3, P < 0.01, respectively), reduced tonsils (11.3 ± 4.3 versus 1.3 ± 1.4 cm3, P < 0.001), but had no effect on the adenoid, lingual tonsil, or retropharyngeal nodes. A small significant increase in the volume of the soft palate and tongue was also noted (7.3 ± 2.5 versus 8.0 ± 1.9 cm3, P = 0.02, and 88.2 ± 18.3 versus 89.3 ± 24.4 cm3, P = 0.005, respectively). Conclusions: This is the first report to quantify volumetric changes in the upper airway in obese children with OSAS after adenotonsillectomy showing significant residual adenoid tissue and an increase in the volume of the tongue and soft palate. These findings could explain the low success rate of AT reported in obese children with OSAS and are important considerations for clinicians treating these children.

KW - Adenotonsillectomy

KW - Obesity

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