Pediatric obstructive sleep apnea in obese and normal-weight children: Impact of adenotonsillectomy on quality-of-life and behavior

Ron B. Mitchell, Emily F. Boss

Research output: Contribution to journalArticlepeer-review

77 Scopus citations


Objectives: To evaluate the impact of adenotonsillectomy (TA) 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 TA. 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 TA all children have improvements in AHI, QOL, and behavior. Obese children are more likely to have persistent OSA and poor QOL scores after TA. Behavior improves postoperatively to a similar extent in all children regardless of obesity.

Original languageEnglish (US)
Pages (from-to)650-661
Number of pages12
JournalDevelopmental Neuropsychology
Issue number5
StatePublished - Sep 1 2009

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Developmental and Educational Psychology


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