Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. e200-e208 (doi:10.1542/peds.2005-1007)
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Increases in Overweight After Adenotonsillectomy in Overweight Children With Obstructive Sleep-Disordered Breathing Are Associated With Decreases in Motor Activity and Hyperactivity

James N. Roemmich, PhDa,b, Jacob E. Barkley, MSa,b, Lynn D'Andrea, MDc, Margarita Nikova, MDd, Alan D. Rogol, MDc, Mary A. Carskadon, PhDe and Paul M. Suratt, MDd

a Department of Pediatrics, School of Medicine and Biomedical Sciences University at Buffalo, Buffalo, New York
b Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
c Department of Pediatrics University of Virginia School of Medicine, Charlottesville, Virginia
d Department of Internal Medicine, Pulmonary and Critical Care Division, Sleep Disorders Center, University of Virginia School of Medicine, Charlottesville, Virginia
e Departments of Psychiatry and Human Behavior, Brown Medical School, Brown University, Providence, Rhode Island

Objective. To examine the effect of adenotonsillectomy (T&A) in children with obstructive sleep-disordered breathing on growth, hyperactivity, and sleep and waking motor activity.

Methods. We studied 54 children who were aged 6 to 12 years and had adenotonsillar hypertrophy and an obstructive apnea-hypopnea index of ≥1 before and 12 months after they all received adenotonsillectomy (T&A). We measured their height, weight, percentage overweight (patient BMI – BMI at 50th percentile)/BMI at 50th percentile * 100) and obtained a hyperactivity score from parent report on a standardized behavior questionnaire scale. A subset of 21 of these children were also studied for motor activity by wrist actigraphy for 7 consecutive days and nights before and 12 months after T&A.

Results. After T&A, mean obstructive apnea-hypopnea index decreased from 7.6 to 0.6. Height percentile did not change, but weight percentile increased; as a consequence, percentage overweight increased from 32.0% to 36.3%. Hyperactivity scores and total daily motor activity were reduced after T&A. From linear regression, the reduction in hyperactivity scores predicted an increase in percentage overweight. Reduced motor activity was correlated with increased percentage overweight.

Conclusions. An increase in percentage overweight after T&A in children with obstructive sleep-disordered breathing is correlated to decreased child hyperactivity scores and to decreased measured motor activity in the subset studied. These associations suggest that the increase in overweight may be attributable to reductions in physical activity and fidgeting energy expenditure.

Key Words: sleep apnea • growth • height • weight • obesity • physical activity • hyperactivity • nonexercise activity thermogenesis

Abbreviations: OSDB—obstructive sleep-disordered breathing • T&A—adenotonsillectomy • OAHI—obstructive apnea-hypopnea index

Accepted Aug 5, 2005.




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