Study author, year, country | No. with pre and post data | Age, pre-T&A | Growth failure reported at baseline† | Source of sample | SDB in sample? | Follow-up, post-T&A | Change in height and weight before and after T&A (reference group) | Change in IGF-1 and IGFBP-3 before and after T&A | ||||||||
Ahlqvist, 1992, Sweden63 | 85 | 1.8–15.8 years, median 6.6 years | No | ENT clinic | Some: snoring and apnoea among inclusion criteria | Within 12 months for 75% | Ht: excess gain vs expected | – | ||||||||
Wt: excess gain vs expected (Swedish growth charts) | ||||||||||||||||
Aydogan, 2007, Turkey64 | 38 | 4–10 years, mean 6.7 years | No | ENT clinic | Some: 30/38 snored; 16/38 disturbed sleep by questionnaire | 12–18 months | Ht: z score = −0.03 | IGF-1 z score = 0.06 | ||||||||
Wt: z score = 0.44 | IGFBP-3 z score = 0.58 | |||||||||||||||
(Turkish growth charts) | (used SDSs normed for age) | |||||||||||||||
Bar, 1999, Israel65 | 13 | 1.6–10.8 years, mean 6.0 years | No | Sleep centre | All: OSAS by history, exam and sleep monitoring | 18 months (wt and ht), 5 months (IGF data) | Ht: insufficient data‡ | IGF-1 SMD = 0.85 ng/ml | ||||||||
Wt: z score = 0.85 | IGF-BP3, no increase stated | |||||||||||||||
(US growth charts) | ||||||||||||||||
Brouillette, 1982, USA66 | 22 | Mean 14 months, | Yes: 6/22 (weight) | Sleep centre | All: OSAS by history, exam, ECG and chest/ upper airway radiography | Surgery for OSAS: 11 T&A/10 other surgery; unspecified follow-up period | Ht: not assessed | – | ||||||||
SD 12 months | Wt: underweight resolved in 6/22 | |||||||||||||||
(US growth charts) | ||||||||||||||||
Barr, 1988, Scotland67 | 82 | 3.1–15.1 years | No | ENT clinic | Not specified | 12 months | Ht: not assessed | – | ||||||||
Wt: 20% increased over expected | ||||||||||||||||
(unspecified reference group) | ||||||||||||||||
Camilleri, | 112 | 2.9–10.8 years, | No | ENT clinic | Not specified | 12 months | Ht: no %ile | – | ||||||||
1995, | mean 6.1 years | increase | ||||||||||||||
Scotland68 | Wt: increased velocity (Tanner and Whitehouse velocity) | |||||||||||||||
Conlon, 1997, Ireland69 | 55 | 2–14 years, mean 7 years | No | ENT clinic | Not specified | 18 months (mean) | Ht: not assessed | – | ||||||||
Wt: increase 12% vs expected (Irish growth charts) | ||||||||||||||||
Ersoy, 2005, Turkey70 | 28 | 3–10 years, mean 6.2 years | No | ENT clinic | All: snoring, apnoea and/or difficulty breathing by exam and questionnaire | 12 months | Ht: z score = 0.41 Wt: z score = 0.62 (Turkish growth charts) | IGF-1 SMD = 0.86 ng/ml IGFBP-3 SMD = 0.38 ng/ml | ||||||||
Lind, 1982, Sweden71 | 14 | 2.8–7.6 years, mean 4.8 years | Yes: Wt z score<0 Ht z score<0 | ENT clinic | All: OSAS by exam and day+night capnography | 10–42 months | Ht: z score = 1.41 Wt: z score = 1.59 (Swedish growth charts) | – | ||||||||
Marcus, 1994, USA72 | 14 | 2–6 years, mean 4 years | Yes: Wt z score<0 | Sleep centre | All: OSAS by polysomnography | 10 weeks (mean) | Ht: not assessed Wt: z score = 0.90 (US growth charts as reference) | – | ||||||||
– | ||||||||||||||||
Nieminen, 2002, Finland73 | 19 | 4.5–6.6 years, mean 5.6 years | No | ENT clinic | All: OSAS per polysomnography | 6 months | Ht: z score = 0.38 Wt: insufficient data‡ (Finnish growth charts) | IGF-1 SMD = 0.83 nmol/l IGFBP-3 SMD = 0.90 ng/l | ||||||||
Nuyens,† 1999, Switzerland74 | 65 | – | – | ENT clinic | Some: obstructive symptoms (snoring, apnoeas ↓90% after T&A) | 6–12 months | Ht-for-age: 8 increased %ile | – | ||||||||
Wt-for-ht: 25 increased %iles | ||||||||||||||||
(reference data NA) | ||||||||||||||||
Roemmich, 2006, USA75 | 54 | 6–12 years, | No | Study of SDB and AH | All: OSAS per polysomnography and report of snoring frequency | 6−27.4 months | Ht: z score = −0.01§ | – | ||||||||
mean 7.8 years | Wt: z score = 0.36§ | |||||||||||||||
(US growth charts as reference) | ||||||||||||||||
Selimoglu, 2003, Turkey76 | 29 | 4–12 years, mean 7.3 years | Yes: for 3/29, wt z score<−0.2 | ENT clinic | All: by obstructive adenotonsillar hypertrophy on Brodsky scale | 6 months | Ht: z score = 0.68 Wt: z score = 0.68 (Turkish growth charts) | IGF-1 = 0.68 ng/ml IGFBP-3, reported as not increased | ||||||||
ht z score <−0.2 | ||||||||||||||||
Shatz, 2004, Israel77 | 24 | 5–12 months, | Yes: for 19/24, wt and ht <3rd %ile | ENT clinic | All: SDB symptoms, hypertrophy and OSAS by polysomnography | 4–18 months | “Failure to thrive” resolved in 10/24 | – | ||||||||
mean 10 months | ||||||||||||||||
Soultan, 1999, USA78 | 45 | 1.4–10.3 years, mean 4.9 years | Yes: for 3/45, wt <5th %ile | ENT clinic | All: OSAS by clinical diagnosis+tonsillar hypertrophy | 6 months−3 years | Ht: z score = 0.53 | |||||||||
Wt: z score = 0.53 (US growth charts) | ||||||||||||||||
Stradling, 1990, UK79 | 61 | 2–14 years, mean 4.7 years | No | ENT clinic | All: by report of snoring | 6 months | Ht: z score = 0.29§ Wt: z score = 0.45§ (Tanner and Whitehouse) | – | ||||||||
– | ||||||||||||||||
Vontetsianos, 2005, Greece80 | 57 | Mean 5 years | No | ENT clinic | Not specified | 6–13 months | Ht: z score = 0.53 | IGF-1 SMD = 0.41 IU/l (for 18/57) | ||||||||
IGFBP-3, no data given | ||||||||||||||||
Williams, 1991, USA81 | 18 ht, 37 wt (41 at baseline) | 6–36 months | Yes: wt 19/41 <5th %ile; ht 15/34 <5th %ile | ENT inpatients | All: obstructive symptoms by record review for 37/41 total | 11.6 months (mean) | Ht: z score = 0.39§ | – | ||||||||
Wt: z score = 0.97§ (Ross curves, age and sex adjusted) | – | |||||||||||||||
Yilmaz, 2002, Turkey82 | 32 | 4–8 years | No | ENT clinic | All: obstructive symptoms+tonsillar hypertrophy | 5.8 months (mean) | Ht: not assessed Wt: not assessed | IGF-1 SMD = 0.64 ng/ml IGFBP-3 SMD = 0.64 ng/ml | ||||||||
*Greater than expected proportion of children identified with growth failure, generally <5th %ile in age and sex-adjusted weight or height before surgery.
†Data obtained from abstract of foreign language publication; complete publication not reviewed.
‡For Bar, although height SDS data were presented, no p value was given, thus the SD of the difference could not be determined. For Nieminen, weight-for-height percentage values were presented which exceeded 100% and are thus implausible.
§z Scores computed from standardised percentiles. For Williams, percentiles obtained from raw data in figures.
Studies shown here for which a z score was not given or could not be calculated were not included in meta-analyses. AH, adenotonsillar hypertrophy; ENT, ear nose and throat; ht, height; IGF-1, insulin-like growth factor-1; IGFBP-3, IGF-binding protein 3; NA, not available; OSAS, obstructive sleep apnea syndrome; SDS, standard deviation score; T&A, adenotonsillectomy; – indicates not assessed; wt, weight.