The effect of adenotonsillectomy on serum insulin-like growth factor-I and growth in children with obstructive sleep apnea syndrome

doi:10.1016/S0022-3476(99)70331-8

The Journal of Pediatrics

Volume 135, Issue 1, July 1999, Pages 76-80

https://doi.org/10.1016/S0022-3476(99)70331-8 Get rights and content

Abstract

Objective: Obstructive sleep apnea syndrome (OSAS) in children is frequently associated with growth interruption. The objective of this study was to evaluate the effect of OSAS and adenotonsillectomy on the insulin-like growth factor-I (IGF-I) axis in children. Study design: Thirteen prepubertal children (mean age, 6.0 ± 2.8 years) were studied before and after adenotonsillectomy (T&A). Weight, height, overnight polysomnography, and IGF-I and IGF-binding protein-3 levels were evaluated before and 3 to 12 months after T&A. The children’s weights and heights were monitored for 18 months. Results: The respiratory disturbance index improved from 7.8 ± 9.1 events/h to 1.0 ± 2.1 events/h after T&A (P < .02). Slow-wave sleep increased from 29.1% ± 7.2% to 34.6% ± 9.8% after T&A (P < .02). The weight standard deviation score increased from 0.86 ± 1 to 1.24 ± 0.9, 18 months after T&A (P < .01). Serum IGF-I levels increased from 146.3 ± 76.2 ng/mL before T&A to 210.3 ± 112.5 ng/mL after surgery (P < .01), but IGF–binding protein-3 levels did not change significantly. Conclusion: The respiratory improvement after T&A in children with OSAS is associated with a significant increase in serum IGF-I levels and weight. We conclude that the IGF-I axis is affected in children with OSAS. (J Pediatr 1999;135:76-80)

Section snippets

Study Population

Prepubertal children aged 1 to 11 years were recruited. They were referred to the Sleep-Wake Disorders Unit because of signs and symptoms consistent with OSAS. The parents of 51 children (of 85 who were approached) gave informed consent for their children to participate in the study. Thirty-three of these 51 children were diagnosed with OSAS and referred for T&A. The diagnosis of OSAS was based on a detailed clinical history obtained by using a standard questionnaire,¹⁸ physical examination,

Patients

Thirteen prepubertal children, 11 boys and 2 girls, participated in this study. The mean age at surgery (T&A) was 6.0 ± 2.8 years (range, 1.6 to 10.8 years). In 10 children, a PSG study was performed, whereas in the other 3, overnight oximetry was performed. The mean time from the pre-T&A sleep study to surgery was 3.0 ± 2.6 months (range, 0.3 to 10 months), and the mean time between the pre-T&A and the post-T&A sleep studies was 5.0 ± 3.0 months (range, 3 to 10 months).

SLEEP CHARACTERISTICS (TABLE I)

. Sleep characteristics

DISCUSSION

Improvement in growth after the resolution of OSAS in children is accompanied by a significant increase in serum IGF-I levels. The children’s weight increased after surgery, consistent with previous studies reporting catch-up growth after T&A.4, 5, 6, 7, 8, 9, 10, 11 Although there was no statistically significant increase in the mean height, in 7 of the 13 children the SDS of height increased by at least 0.2.

The physiologic secretion of GH is episodic and closely associated with the sleep-wake

References (32)

J Ahlqvist-Rastad et al.
Body growth in relation to tonsillar enlargement and tonsillectomy
Int J Pediatr Otorhinolaryngol
(1992)
RT Brouillette et al.
Obstructive sleep apnea in infants and children
J Pediatr
(1982)
JR Stradling et al.
Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children
Lancet
(1990)
CL Marcus et al.
Determinants of growth in children with obstructive sleep apnea syndrome
J Pediatr
(1994)
DB Jarrett et al.
A reexamination of the relationship between growth hormone and slow wave sleep using delta analysis
Biol Psychiatry
(1990)
J Born et al.
The significance of sleep onset and slow wave sleep for release of growth hormone (GH) and cortisol
Psychoneuroendocrinol
(1988)
KA Waters et al.
The use of nasal CPAP in children
Pediatr Pulmonol
(1995)
SH Sheldon et al.
Sleep-disordered respiration in childhood
CL Marcus et al.
Normal polysomnographic values in children and adolescents
Am Rev Respir Dis
(1992)
TW Bate et al.
Short stature caused by obstructive apnoea during sleep
Arch Dis Child
(1984)

EF Williams et al.

The effects of adenotonsillectomy on growth in young children

Otolaryngol Head Neck Surg

(1991)

C Guilleminaullt et al.

A review of 50 children with obstructive sleep apnea syndrome

Lung

(1981)

JS Suen et al.

Adenotonsillectomy for treatment of obstructive sleep apnea in children

Arch Otolaryngol Head Neck Surg

(1995)

AD Everett et al.

Failure to thrive due to obstructive sleep apnea

Clin Pediatr

(1987)

RR Grunstein et al.

Neuroendocrine dysfunction in sleep apnoea: reversal by continuous positive airways pressure therapy

J Clin Endocrinol Metab

(1989)

SJ Goldstein et al.

Reversibility of deficient sleep entrained growth hormone secretion in a boy with achondroplasia and obstructive sleep apnea

Acta Endocrinol Copenh

(1987)

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Le syndrome d’apnéesdu sommeil (SAS) est un problème de santé publique. C’est une pathologie sous diagnostiquée en Afrique. L’objectif est d’évaluer les connaissances, attitudes et pratiques des médecins sur le SAS à Niamey.
Il s’agissait d’une étude transversale descriptive de 6 mois, menée du 1^er décembre 2018 au 31 mai 2019, ayant concernée 307 médecins travaillant dans les formations sanitaires de Niamey.
Deux cent soixante-douze médecins ont répondu, soit 88,59 %, dont 51,47 % (n = 140) médecins en spécialisation, 32,35 % (n = 88) médecins généralistes et 16,18 % (n = 44) médecins spécialistes. Le niveau de connaissance était insuffisant et passable dans respectivement 77,94 % (n = 212) et 16,91 % (n = 46) des cas. La principale source d’information était l’enseignement reçu au cours du cursus universitaire dans 61,03 % (n = 166) des cas. Les types de SAS les plus cités étaient obstructif et central dans 66,18 % (n = 180) et 30,15 % (n = 82) des cas. Chez l’adulte, le principal facteur de risque de SAS était l’obésité dans 79,41 % (n= 216) des cas et chez l’enfant, l’hypertrophie des amygdales dans 68,75 % (n = 187). Les interrogés ne connaissaient pas l’échelle d’évaluation du degré de somnolence diurne et l’examen de référence du diagnostic de SAS dans 87,13 % (n = 237) et 75,40 % (n = 205) des cas Plus des trois quarts (n= 221 soit 81,25 %) des médecins n’ont jamais évoqué le SAS chez leurs patients et respectivement 63,24 % (n = 172) et 50,74 % (n = 138) des médecins orienteront vers un ORL et un pneumologue un cas suspect de SAS. Presque la totalité des médecins (n = 258 soit 94,85 %) désiraient recevoir une formation sur le SAS.
Le niveau de connaissance était majoritairement insuffisant. Une formation des médecins sur le SAS s’avère nécessaire.
Sleep apnea syndrome (SAS) is a public health problem. In African countries, it is an underdiagnosed pathology. Our objective was to assess SAS knowledge, attitudes and practices among doctors in Niamey, Niger.
A 6-month descriptive cross-sectional study was conducted from December 1, 2018 to May 31, 2019, involving 307 doctors working in health facilities in Niamey.
Two hundred and seventy-two doctors (88.59%) responded, of whom 51.47% (n = 140) were medical specialists, 32.35% (n = 88) general practitioners and 16.18% (n = 44) specialist doctors. Their level of knowledge was insufficient or fair in 77.94% (n = 212) and 16.91% (n = 46) of cases respectively. Their main source of information was the education they had received during university courses (61.03% [n = 166]). The most commonly cited types of SAS were obstructive in 66.18% (n = 180) of their responses and central in 30.15% (n = 82). For adults, the main perceived risk factor for SAS was obesity (79.41% [n = 216]) and among children, enlarged tonsils (68.75% [n = 187]). For the most part, they were not familiar with the scale for assessing degree of daytime sleepiness (87.13% [n = 237]) or with the baseline diagnostic examination for SAS (75.40% [n = 205]). More than ¾ (n = 221 or 81.25%) of the doctors never mentioned SAS to their patients and 59.93% (n = 163) and 56.99% (n = 155) of them referred a suspected case of SAS to an ENT specialist or a pulmonologist, respectively. Almost all of the doctors (94.85% [n = 258]) wished to receive training on SAS.
In a majority of cases, level of relevant knowledge was insufficient. Doctors need training on sleep apnea syndrome.
Changes in childhood growth after adenotonsillectomy: a population-based cohort study
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Citation Excerpt :
Increasing evidence suggests that growth spurts are observed after tonsillectomy; studies including a meta-analysis have reported significant increases in height and weight following adenotonsillectomy. Unfortunately, large-sized investigations with adequate controls are rare, and the available studies have failed to assess either height or weight [9–13]. Moreover, earlier studies focused on children over 5 years of age [14,15], and there is insufficient information on younger children.
This study aimed to investigate the association between adenotonsillectomy (T&A) and serial changes in growth in children through a population-based nationwide study as well as the national health insurance service (NHIS) database.
Propensity score (PS) matched children with and without T&A were selected in NHIS database, which includes all individuals born in Korea in 2008–2009. Serial changes of BMI and height were compared in children with and without T&A, and growth changes depending on the time of operation were also considered. The outcomes were differences in age-/sex-standardized BMI (BMI-z) and height (height-z) between the groups. Changes in BMI-z and height-z were further analyzed according to the timing of operation.
Of 919,707 individuals born in Korea in 2008–2009, 3172 children were included in the operation group and 31,663 PS-matched children were included in the control group. T&A was related to increased weight and height in the operation group than in the control group. At 66–71 months of age, BMI-z and height-z were 0.41 (0.02) and 0.42 (0.02), respectively, in the operation group and 0.18 (0.01) and 0.35 (0.01), respectively, in the control group. On adjustment with preoperative BMI-z, more weight gain was noted in the operation group (p < 0.001). Shortly after T&A, BMI-z increased significantly in the operation group; a significant increase in height-z was observed more than 1 year after T&A.
Children who underwent T&A tended to experience a growth spurt; when surgical intervention such as T&A is required, care should be taken to minimize or reverse the anticipated weight gain.
Sleep and puberty
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In 1976, Boyar et al made the seminal observation that during the early stages of puberty, there is a sleep-specific augmentation of pulsatile luteinizing hormone secretion. Building on this tantalizing association between sleep and the reawakening of the neuro-reproductive axis, a number of investigators have since mapped the dynamic relationship between sleep and reproductive hormones across the pubertal transition. In this review, we focus on the complex, reciprocal relationship between sleep and reproductive hormones during adolescence, as well as on the potential effects of melatonin and orexin on gonadotropin-releasing hormone activity in children with chronic insomnia and narcolepsy, respectively. Given the important interaction between the reproductive and somatotropic axes during puberty, we end with a discussion of sleep and growth hormone secretion in children.
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Developmental and growth retardation is a condition that is often encountered among children with adenotonsillar hypertrophy (ATH). Leptin, ghrelin and IGF-1 are important factors in growth and development for children. The aim of the study was to investigate serum leptin, ghrelin and IGF-1 levels in children with ATH compare with healthy controls.
82 children between ages 6–12 were included in this study, divided into two groups. The first group being the study-group consisted of 42 children with obstructive adenotonsillar hypertrophy and the second group being the control-group consisted of 40 healthy children. At 08:30 a.m., peripheral blood samples were extracted from children from both groups to examine the serum levels, and kept in −40 °C until the Elisa test.
Leptin serum level of the control-group was found to be statistically significantly higher than the serum leptin level of the ATH group (p = 0,049; p < 0.05). Body mass indexes of the children with ATH were found to be statistically significantly lower than the body mass index (BMI) of the control group (p = 0,001; p < 0.05). In contrast, there was no statistically significant difference between ghrelin and IGF-1 levels between the ATH and control group (p = 0.193, p > 0.05 and p = 0.478, p > 0.05, respectively).
Upper airway infections are common in children with ATH. Increased airway infections and obstructive enlarged adenotonsillar lymphoid tissue which are caused swallowing difficulties can lead to reduced oral intake and fat tissue. It has led us to think that, ghrelin levels may be increasing secondary to these problems in children with ATH. Furthermore, BMI and leptin would be lower in children with ATH, considering adipose tissue was lesser and leptin was being synthesized and oscillated out of the fat cells of the tissue in these children.
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^☆: Supported by grant no. 89914101 from the Israeli Chief Scientist.

^☆☆: Reprints requests: Asher Tal, MD, Department of Pediatrics, Soroka Medical Center, PO Box 151, Beer-Sheva, 84101, Israel.

^★: 0022-3476/99/$8.00 + 0 9/21/98790

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The effect of adenotonsillectomy on serum insulin-like growth factor-I and growth in children with obstructive sleep apnea syndrome☆,☆☆,★

Abstract

Section snippets

Study Population

Patients

SLEEP CHARACTERISTICS (TABLE I)

DISCUSSION

Int J Pediatr Otorhinolaryngol

J Pediatr

Lancet

J Pediatr

Biol Psychiatry

Psychoneuroendocrinol

The use of nasal CPAP in children

Pediatr Pulmonol

Sleep-disordered respiration in childhood

Normal polysomnographic values in children and adolescents

Am Rev Respir Dis

Short stature caused by obstructive apnoea during sleep

Arch Dis Child