Impact of Adenotonsillectomy On Insulin Resistance And Lipoprotein Profile In Nonobese And Obese Children.

Koren D, Gozal D, Bhattacharjee R, Philby M, Kheirandish-Gozal L. Chest. 2015 Oct 8.

Background: Obstructive sleep apnea (OSA) associates with insulin resistance (IR), hyperglycemia and dyslipidemia consistently in adults but inconsistently in children. We set out to quantify the impact of OSA treatment upon obesity and metabolic outcomes and thus assess causality.
Methods: 69 children with OSA, mean age 5.9 years (range 3-16), 55% male, 68% non-obese (NOB) underwent baseline overnight polysomnography (PSG), anthropometric and metabolic measurements, adenotonsillectomy (T&A), and follow-up testing a mean 7.9 months (range 2-20) later.
Results: 53 children (77% of study cohort; 91% of obese children) had residual OSA (apnea-hypopnea index or AHI>1 event/hr) post-T&A. Fasting plasma insulin (FPI, 14.4±9.4→12.6±9.7 microIU/mL, p=0.008) and homeostasis model assessment-IR (HOMA-IR 3.05±2.13→2.62±2.22, p=0.005), and high-density lipoprotein (HDL) (51.0±12.9→56.5±14.4 mg/dL, p=0.007) improved despite increased body mass index Z-score (BMI-Z: 1.43±0.78→1.52±0.62, p=0.001); changes did not differ significantly between sexes or NOB and obese participants; however, post-T&A BMI Z-score rather than AHI was the main predictor of levels of follow-up FPI, HDL and other metabolic parameters. Higher baseline FPI and BMI-Z predicted likelihood of residual OSA; conversely, on regression analysis, follow-up IR, HDL and triglycerides were predicted by BMI-Z, not residual OSA.
Conclusions: T&A improved IR and HDL, and residual OSA is predicted by baseline FPI and BMI Z-score, indicating a causal relationship; however, following T&A, residual metabolic dysfunction related to underlying adiposity rather than remaining sleep-disordered breathing. Finally, T&A cured OSA in <25% of all children and only 10% of obese children; post-T&A PSG is indicated to assess which children still require treatment.

Ventana Científica. Diciembre 2015. Artículo 112
Impact of Adenotonsillectomy On Insulin Resistance And Lipoprotein Profile In Nonobese And Obese Children.