Predicting Risk Factors in Children With Obstructive Sleep Apnea Undergoing Adenotonsillectomy Surgery
| Status: | Completed |
|---|---|
| Conditions: | Insomnia Sleep Studies, Obesity Weight Loss |
| Therapuetic Areas: | Endocrinology, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 2 - 12 |
| Updated: | 1/16/2019 |
| Start Date: | July 2015 |
| End Date: | September 7, 2018 |
Adenotonsillectomy (AT) is one of the most common pediatric surgeries performed, and is
estimated to comprise 530,000 procedures in children under 15 years of age. Historically, the
leading cause for these procedures was recurrent infections; however, more recently surgical
indications include sleep disordered breathing and obstructive sleep apnea (OSA).
Pre-operative polysomnography (PSG) is recommended for all children with suspected OSA prior
to undergoing AT, although it is unclear whether sleep disordered breathing characteristics
predict post-operative outcomes or complications.
Obesity has become an epidemic in our pediatric population. More recently, an increased
population of obese children are presenting for AT with upper airway obstruction with or
without tonsillar hypertrophy, which is similar to the adult etiology of OSA. Obesity is a
multisystem disease, causing fatty liver and cardiac disease, defects in glucose metabolism,
insulin resistance, leptin resistance, and creates a state of chronic inflammation. Markers
for inflammation, including TNF-α, CRP, leptin, IL-6 and IL-10, are abnormal in obese
patients and have also been linked to more severe OSA disease in children even after
controlling for BMI.
In pediatrics, medication dosing is based on an actual body-weight calculation, however,
recent reports suggest that this dosing method is over-dosing patients with obesity.
Therefore, increased respiratory complications after surgery may be related to inappropriate
intra-operative opioid dosing.
Specific Aim 1 (SA1): To compare analgesic-guided opioid dosing using actual body weight
(ABW) based dosing versus ideal body weight (IBW) dosing for adenotonsillectomy in children
with OSA (BMI >/=75%).
The investigators hypothesize that 1) weight-based opioid dosing compared to dosing based on
ideal body weight leads to increased respiratory complications defined by (a) upper airway
obstruction, (b) hypoventilation, and (c) oxygen desaturation without affecting pain scores
immediately after adenotonsillectomy. In addition, the investigators believe 2) that there
will be little statistically significant difference in pain scores between ABW and IBW for
these patients.
Specific Aim 2 (SA2): To determine whether biomarkers related to obesity, chronic
inflammation, and OSA predict post-operative respiratory compromise after AT. The
investigators hypothesize that inflammatory and obesity-related biomarkers are elevated in
overweight children with OSA, more so in obese children with OSA, compared to lean children
with OSA.
estimated to comprise 530,000 procedures in children under 15 years of age. Historically, the
leading cause for these procedures was recurrent infections; however, more recently surgical
indications include sleep disordered breathing and obstructive sleep apnea (OSA).
Pre-operative polysomnography (PSG) is recommended for all children with suspected OSA prior
to undergoing AT, although it is unclear whether sleep disordered breathing characteristics
predict post-operative outcomes or complications.
Obesity has become an epidemic in our pediatric population. More recently, an increased
population of obese children are presenting for AT with upper airway obstruction with or
without tonsillar hypertrophy, which is similar to the adult etiology of OSA. Obesity is a
multisystem disease, causing fatty liver and cardiac disease, defects in glucose metabolism,
insulin resistance, leptin resistance, and creates a state of chronic inflammation. Markers
for inflammation, including TNF-α, CRP, leptin, IL-6 and IL-10, are abnormal in obese
patients and have also been linked to more severe OSA disease in children even after
controlling for BMI.
In pediatrics, medication dosing is based on an actual body-weight calculation, however,
recent reports suggest that this dosing method is over-dosing patients with obesity.
Therefore, increased respiratory complications after surgery may be related to inappropriate
intra-operative opioid dosing.
Specific Aim 1 (SA1): To compare analgesic-guided opioid dosing using actual body weight
(ABW) based dosing versus ideal body weight (IBW) dosing for adenotonsillectomy in children
with OSA (BMI >/=75%).
The investigators hypothesize that 1) weight-based opioid dosing compared to dosing based on
ideal body weight leads to increased respiratory complications defined by (a) upper airway
obstruction, (b) hypoventilation, and (c) oxygen desaturation without affecting pain scores
immediately after adenotonsillectomy. In addition, the investigators believe 2) that there
will be little statistically significant difference in pain scores between ABW and IBW for
these patients.
Specific Aim 2 (SA2): To determine whether biomarkers related to obesity, chronic
inflammation, and OSA predict post-operative respiratory compromise after AT. The
investigators hypothesize that inflammatory and obesity-related biomarkers are elevated in
overweight children with OSA, more so in obese children with OSA, compared to lean children
with OSA.
Inclusion Criteria:
- Physician diagnosis of OSA presenting for adenotonsillectomy
- Age between 2 -12 years of age
- Pre-operative polysomnography study conducted prior to day of surgery
Exclusion Criteria:
- Emergency procedures involving AT, including tonsillar bleeding
- Procedures involving AT in addition to other surgeries at other anatomic locations
(except myringotomy)
- Patients with contra-indications for standardized anesthesia medications, such as
allergy or comorbidities (i.e. liver disease preventing Tylenol administration)
- Patients with co-morbidities that cause upper airway collapse (i.e: patients with
craniofacial syndromes, neuro-muscular disorders, genetic/metabolic syndromes, etc.)
- Patients with chronic inflammatory, rheumatologic, or other confounding co-morbid
diseases (i.e. Crohns disease, ulcerative colitis, sickle cell, Sjogren's, etc.)
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