Differential effects of adenotonsillectomy on growth and asthma control in children with obstructive sleep apnea and varying body mass index: A prospective cohort study.

backgroundAdenotonsillectomy (AT) is the primary treatment for pediatric obstructive sleep apnea (OSAS). However, its effectiveness on somatic growth and comorbid conditions like asthma may vary depending on the child's body mass index (BMI). The interplay between OSAS, obesity, and asthma is complex, and prospective data guiding expectations after AT is needed.

objectiveTo investigate the differential effects of AT on growth parameters and asthma control over 12 months in children with OSAS, stratified by baseline BMI categories.

methodsWe conducted a prospective cohort study between March 2022 and March 2023 at a tertiary pediatric hospital. Children aged 4–10 years with moderate-to-severe OSAS (obstructive apnea–hypopnea index [oAHI] ≥ 5 events/hour) undergoing AT were enrolled and stratified into three groups based on BMI-for-age percentiles: Normal Weight (NW; 5th to < 85th percentile), Overweight (OW; 85th to < 95th percentile), and Obese (OB; ≥ 95th percentile). Primary outcomes were the 12-month change in BMI Z-score and height-for-age Z-score. Secondary outcomes included changes in oAHI and, in a subgroup with comorbid asthma, the Asthma Control Test (ACT) score. Data were analyzed using linear mixed-effects models.

resultsA total of 265 children were analyzed (121 NW, 78 OW, 66 OB). At baseline, the OB group had a significantly higher median oAHI (15.5 vs. 9.8 in NW; P < 0.001) and lower mean ACT scores (17.2 vs. 19.5 in NW; P = 0.01). At 12 months post-AT, all groups showed significant oAHI reduction, but residual OSAS (oAHI ≥ 2) was more common in the OB group (45.5% vs. 19.8% in NW; P < 0.001). The NW group demonstrated a significant increase in height-for-age Z-score (mean change, + 0.21; P < 0.001), indicative of catch-up growth, whereas the OW and OB groups showed no significant change. The mean BMI Z-score decreased significantly in the OW group (-0.15; P = 0.02) and non-significantly in the OB group (-0.08; P = 0.11), while remaining stable in the NW group. Among children with asthma (n = 95), the improvement in ACT score was greatest in the NW group (+ 4.1 points), moderate in the OW group (+ 2.8 points), and smallest in the OB group (+ 1.5 points), with a significant difference in change between groups (P = 0.005).

conclusionAT effectively treats OSAS across all BMI categories but is associated with differential benefits for growth and asthma control. Children with normal weight showed significant catch-up growth and the most substantial improvement in asthma control. While children with overweight or obesity benefit, they exhibit higher rates of residual OSAS, blunted improvements in asthma, and do not experience catch-up growth, highlighting the need for multidisciplinary, long-term weight management in this high-risk population.