Assessment of Growth in Children Following Adenoidectomy and or Tonsillectomy for Obstructive Sleep Disordered Breathing at Kenyatta National Hospitaldr.

Abstract

Background Obstructive Sleep disordered breathing (oSDB) is a spectrum of disease that varies from simple snoring to obstructive sleep apnoea. It has many harmful effects in the paediatric age group including growth disturbances. The most common cause of oSDB in this group is adenotonsillar hypertrophy. Studies have shown increase in weight after adenoidectomy and or tonsillectomy for oSDB however clinicians routinely do not screen for growth disturbances in oSDB. Broad objective To assess the rate of growth in children with obstructive Sleep disordered breathing after adenoidectomy and or tonsillectomy. Research question Does adenoidectomy and or tonsillectomy in children with SDB lead to growth rate changes? Study design and population Prospective case controlled study, 62 cases (40 males and 22 females) and 63 controls (34 males and 29 females) from the age of 2 to 5 years. Study site Kenyatta National Hospital Ear Nose Throat (ENT) Clinic, ENT ward and well-baby clinic. Study time and duration Eight months, starting April 2018. Methodology Patients with obstructive sleep disordered breathing scheduled for adenoidectomy and or tonsillectomy and controls from the well-baby clinic were recruited using convenience sampling. After parental consent to participate in the study, they were subjected to the Sleep related breathing disordered paediatric subscale questionnaire (SRBD-PSQ). The children met the criteria for oSDB proceeded to have their heights in centimetres and weights in kilograms measured before adenoidectomy and or tonsillectomy. For the control group, those without oSDB proceeded to have their heights and weights measured. The heights and weight measurements were taken 3 months later for both groups. The data was analysed using SPSS version 21. Descriptive statistics was used to summarize age, weight and height measurements. Frequencies and percentages were used to summarize categorical data. Anthropometric indices were calculated using the WHO anthro software. The student’s T-test was used to assess the difference in the means of weight for age, height for age and BMI for age Z scores between the study group and controls. The growth rate was then determined by

calculating a gradient representing the rate of change in anthropometric indices for each of the two groups of children. These gradients were used to determine the growth rate changes in children in the study group versus the controls. Results Data from the study population and controls was analysed. Children with oSDB had statistically lower weight height and BMI Z scores when compared to controls (WAZ- 0.76 vs 0.14p value<0.001, HAZ -0.54 vs-0.08 p value 0.04, BMI z score -0.67 vs 0.25, p value 0.001). Three months after surgery, there was no statistical difference in the WAZ, HAZ and BMI Z scores of the study group and the controls. When divided into 18month age groups, the children in the younger age group had significantly larger changes in their Z scores. There was no significant difference in growth between the males and females. There was also no association between the quantity change in SRBD-PSQ score and the quantity change in WAZ, HAZ, and BMI Z score. Conclusion Obstructive sleep disordered breathing had a negative impact on growth of affected children. Adenoidectomy and or tonsillectomy led to improvement in growth parameters as early as three months postoperatively