{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T13:30:53Z","timestamp":1794490253889,"version":"4.9.1"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>It is unknown whether adenotonsillectomy causes undesirable weight gain in children with mild obstructive sleep-disordered breathing (oSDB).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare changes in anthropometric measures in children with mild oSDB treated with adenotonsillectomy vs watchful waiting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This was an exploratory analysis of the Pediatric Adenotonsillectomy Trial for Snoring (PATS) randomized clinical trial of adenotonsillectomy vs watchful waiting for mild oSDB (snoring with obstructive apnea-hypopnea index of &amp;amp;lt;3 events\/hour) that took place at 7 pediatric tertiary care centers across the US and included 458 children aged 3.0 to 12.9 years with mild oSDB. Participants were recruited from June 29, 2016, to February 1, 2021. Anthropomorphic measures taken at baseline and 12 months after randomization were standardized for age and sex, including each participant\u2019s percentage of the 95th body mass index percentile (%BMIp95). Data analyses were performed from March 15, 2023, to April 1, 2024.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>Early adenotonsillectomy (eAT) vs watchful waiting with supportive care (WWSC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Twelve-month change in %BMIp95 from baseline and undesirable weight gain (defined as any weight gain in a child who already had overweight or obesity or an increase from baseline normal weight\/underweight to overweight\/obesity) at follow-up assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study analysis included 375 children (mean [SD] age, 6.1 [2.3] years; 188 [50.2%] females), of whom 143 (38%) had overweight or obesity at baseline. At 12 months, children in the eAT group experienced a 1.25-point increase in %BMIp95 compared with a 0.59-point increase in the WWSC group (mean difference, 0.93; 95% CI, \u22120.39 to 2.25). Undesirable weight gain was also similar between the eAT (n\u2009=\u2009120; 32%) and WWSC (n\u2009=\u2009101; 27%) groups (mean difference, 4%; 95% CI, 5% to 14%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The findings of this exploratory analysis of the PATS trial indicate that adenotonsillectomy was not independently associated with an increased risk of undesirable weight gain in children with mild oSDB. However, one-third of the children gained undesirable weight during the study, which suggests that there is an opportunity to address healthy weight management during the evaluation and treatment of children with mild oSDB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT02562040\">NCT02562040<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2024.2554","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T17:35:15Z","timestamp":1724348115000},"page":"859","source":"Crossref","is-referenced-by-count":9,"title":["Weight Gain After Adenotonsillectomy in Children With Mild Obstructive Sleep-Disordered Breathing"],"prefix":"10.1001","volume":"150","author":[{"given":"Erin M.","family":"Kirkham","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Ishman","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology, Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina M.","family":"Baldassari","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eastern Virginia Medical School, Children\u2019s Hospital of The King\u2019s Daughters, Norfolk"},{"name":"Deputy Editor, JAMA Otolaryngology\u2013Head & Neck Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron B.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery and Neurology Sleep Disorders Center, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Kamal","family":"Naqvi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio E.","family":"Tapia","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Elden","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fauziya","family":"Hassan","sequence":"additional","affiliation":[{"name":"Sleep Disorders Center and Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospitals Rainbow Babies & Children\u2019s Hospital, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristie","family":"Ross","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospitals Rainbow Babies & Children\u2019s Hospital, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengqi","family":"Cen","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Redline","sequence":"additional","affiliation":[{"name":"Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald D.","family":"Chervin","sequence":"additional","affiliation":[{"name":"Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"ooi240054r1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0022-3476(82)80231-X","article-title":"Obstructive sleep apnea in infants and children.","volume":"100","author":"Brouillette","year":"1982","journal-title":"J Pediatr"},{"issue":"2","key":"ooi240054r2","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1002\/ppul.1950160208","article-title":"Polysomnography in obese children with a history of sleep-associated breathing disorders.","volume":"16","author":"Silvestri","year":"1993","journal-title":"Pediatr Pulmonol"},{"issue":"3","key":"ooi240054r3","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1002\/(SICI)1099-0496(199603)21:3<176::AID-PPUL5>3.0.CO;2-O","article-title":"Evaluation of pulmonary function and polysomnography in obese children and adolescents.","volume":"21","author":"Marcus","year":"1996","journal-title":"Pediatr Pulmonol"},{"issue":"5","key":"ooi240054r4","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.smrv.2007.11.002","article-title":"The prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents.","volume":"12","author":"Verhulst","year":"2008","journal-title":"Sleep Med Rev"},{"issue":"3","key":"ooi240054r5","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1007\/s00405-019-05290-2","article-title":"Obstructive sleep apnea in children and adolescents with and without obesity.","volume":"276","author":"Andersen","year":"2019","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"2","key":"ooi240054r6","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1177\/147323000303100204","article-title":"Does adenotonsillectomy improve growth in children with obstructive adenotonsillar hypertrophy?","volume":"31","author":"Selimoglu","year":"2003","journal-title":"J Int Med Res"},{"issue":"2","key":"ooi240054r7","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1542\/peds.2014-0591","article-title":"Growth after adenotonsillectomy for obstructive sleep apnea: an RCT.","volume":"134","author":"Katz","year":"2014","journal-title":"Pediatrics"},{"issue":"4","key":"ooi240054r8","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1177\/019459989110400415","article-title":"The effects of adenotonsillectomy on growth in young children.","volume":"104","author":"Williams","year":"1991","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"5","key":"ooi240054r9","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1111\/coa.13568","article-title":"Weight change before and after adenotonsillectomy in children: An analysis based upon pre-surgery body mass category.","volume":"45","author":"Beauchamp","year":"2020","journal-title":"Clin Otolaryngol"},{"issue":"4","key":"ooi240054r10","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/S0022-3476(94)70007-9","article-title":"Determinants of growth in children with the obstructive sleep apnea syndrome.","volume":"125","author":"Marcus","year":"1994","journal-title":"J Pediatr"},{"issue":"2","key":"ooi240054r11","doi-asserted-by":"crossref","first-page":"e200","DOI":"10.1542\/peds.2005-1007","article-title":"Increases in overweight after adenotonsillectomy in overweight children with obstructive sleep-disordered breathing are associated with decreases in motor activity and hyperactivity.","volume":"117","author":"Roemmich","year":"2006","journal-title":"Pediatrics"},{"issue":"2","key":"ooi240054r12","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1136\/adc.2008.141192","article-title":"Growth and growth biomarker changes after adenotonsillectomy: systematic review and meta-analysis.","volume":"94","author":"Bonuck","year":"2009","journal-title":"Arch Dis Child"},{"issue":"2","key":"ooi240054r13","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1177\/0194599810392328","article-title":"A systematic review of adenotonsillectomy as a risk factor for childhood obesity.","volume":"144","author":"Jeyakumar","year":"2011","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"25","key":"ooi240054r14","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.1056\/NEJMoa1215881","article-title":"A randomized trial of adenotonsillectomy for childhood sleep apnea.","volume":"368","author":"Marcus","year":"2013","journal-title":"N Engl J Med"},{"key":"ooi240054r15","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.sleep.2021.07.010","article-title":"Weight gain in children after adenotonsillectomy: undesirable weight gain or catch-up growth?","volume":"85","author":"Kirkham","year":"2021","journal-title":"Sleep Med"},{"issue":"6","key":"ooi240054r16","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1002\/lary.29863","article-title":"Growth after adenotonsillectomy for obstructive sleep apnea: revisited.","volume":"132","author":"Jensen","year":"2022","journal-title":"Laryngoscope"},{"issue":"3","key":"ooi240054r17","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-033889","article-title":"Pediatric Adenotonsillectomy Trial for Snoring (PATS): protocol for a randomised controlled trial to evaluate the effect of adenotonsillectomy in treating mild obstructive sleep-disordered breathing.","volume":"10","author":"Wang","year":"2020","journal-title":"BMJ Open"},{"issue":"21","key":"ooi240054r18","doi-asserted-by":"crossref","first-page":"2084","DOI":"10.1001\/jama.2023.22114","article-title":"Adenotonsillectomy for snoring and mild sleep apnea in children: a randomized clinical trial.","volume":"330","author":"Redline","year":"2023","journal-title":"JAMA"},{"issue":"9","key":"ooi240054r20","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.5664\/jcsm.10620","article-title":"Associations of actigraphy measures of sleep duration and continuity with executive function, vigilance, and fine motor control in children with snoring and mild sleep-disordered breathing.","volume":"19","author":"Robinson","year":"2023","journal-title":"J Clin Sleep Med"},{"issue":"8","key":"ooi240054r22","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1080\/03014460.2017.1388845","article-title":"Longitudinal changes in BMI z-scores among 45 414 2-4-year olds with severe obesity.","volume":"44","author":"Freedman","year":"2017","journal-title":"Ann Hum Biol"},{"key":"ooi240054r23","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.jpeds.2017.03.039","article-title":"The limitations of transforming very high body mass indexes into z-scores among 8.7 million 2- to 4-year-old children.","volume":"188","author":"Freedman","year":"2017","journal-title":"J Pediatr"},{"issue":"3","key":"ooi240054r24","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2017-1072","article-title":"Tracking of BMI z scores for severe obesity.","volume":"140","author":"Freedman","year":"2017","journal-title":"Pediatrics"},{"issue":"6","key":"ooi240054r25","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1164\/rccm.200710-1610OC","article-title":"Growth velocity predicts recurrence of sleep-disordered breathing 1 year after adenotonsillectomy.","volume":"177","author":"Amin","year":"2008","journal-title":"Am J Respir Crit Care Med"},{"issue":"4","key":"ooi240054r26","doi-asserted-by":"crossref","DOI":"10.1542\/peds.109.4.e55","article-title":"Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea.","volume":"109","author":"Nieminen","year":"2002","journal-title":"Pediatrics"},{"issue":"11","key":"ooi240054r27","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1016\/j.ijporl.2007.07.012","article-title":"The effect of recurrent tonsillitis and adenotonsillectomy on growth in childhood.","volume":"71","author":"Aydogan","year":"2007","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"1","key":"ooi240054r28","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1001\/archpedi.153.1.33","article-title":"Effect of treating obstructive sleep apnea by tonsillectomy and\/or adenoidectomy on obesity in children.","volume":"153","author":"Soultan","year":"1999","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"4","key":"ooi240054r29","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1542\/peds.2008-1502","article-title":"Adenotonsillectomy and the development of overweight.","volume":"123","author":"Wijga","year":"2009","journal-title":"Pediatrics"},{"issue":"7","key":"ooi240054r30","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1017\/S002221510010581X","article-title":"Weight gain in children following tonsillectomy.","volume":"102","author":"Barr","year":"1988","journal-title":"J Laryngol Otol"},{"issue":"1","key":"ooi240054r31","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/0165-5876(92)90066-X","article-title":"Body growth in relation to tonsillar enlargement and tonsillectomy.","volume":"24","author":"Ahlqvist-Rastad","year":"1992","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"1","key":"ooi240054r32","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S0165-5876(97)00105-5","article-title":"Tonsillitis, tonsillectomy and weight disturbance.","volume":"42","author":"Conlon","year":"1997","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"1","key":"ooi240054r33","doi-asserted-by":"crossref","DOI":"10.1111\/ijpo.12461","article-title":"Childhood obesity, weight loss and developmental trajectories predict the persistence and remission of childhood sleep-disordered breathing.","volume":"14","author":"Frye","year":"2019","journal-title":"Pediatr Obes"},{"issue":"1","key":"ooi240054r34","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jpeds.2010.01.033","article-title":"Incidence and remission of sleep-disordered breathing and related symptoms in 6- to 17-year old children: the Tucson Children\u2019s Assessment of Sleep Apnea Study.","volume":"157","author":"Goodwin","year":"2010","journal-title":"J Pediatr"},{"issue":"10","key":"ooi240054r35","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1164\/rccm.200711-1670OC","article-title":"Metabolic alterations and systemic inflammation in obstructive sleep apnea among nonobese and obese prepubertal children.","volume":"177","author":"Gozal","year":"2008","journal-title":"Am J Respir Crit Care Med"},{"key":"ooi240054r36","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.sleep.2020.01.011","article-title":"Association of visceral adiposity and systemic inflammation with sleep disordered breathing in normal weight, never obese adolescents.","volume":"69","author":"Danisi","year":"2020","journal-title":"Sleep Med"},{"issue":"1","key":"ooi240054r37","doi-asserted-by":"crossref","first-page":"55","DOI":"10.5664\/jcsm.10266","article-title":"Impact of adenotonsillectomy on growth trajectories in preschool children with mild-moderate obstructive sleep apnea.","volume":"19","author":"Kevat","year":"2023","journal-title":"J Clin Sleep Med"},{"issue":"22","key":"ooi240054r38","doi-asserted-by":"crossref","first-page":"12114","DOI":"10.3390\/ijerph182212114","article-title":"Degree of accuracy of the BMI z-score to determine excess fat mass using dxa in children and adolescents.","volume":"18","author":"Monasor-Ortol\u00e1","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"11","key":"ooi240054r39","first-page":"1","article-title":"Ambulatory surgery in the United States, 2006.","author":"Cullen","year":"2009","journal-title":"Natl Health Stat Report"},{"issue":"2","key":"ooi240054r40","article-title":"Executive summary: clinical practice guideline for the evaluation and treatment of children and adolescents with obesity.","volume":"151","author":"Hampl","year":"2023","journal-title":"Pediatrics"},{"issue":"14","key":"ooi240054r41","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1056\/NEJMoa1502821","article-title":"Cardiometabolic risks and severity of obesity in children and young adults.","volume":"373","author":"Skinner","year":"2015","journal-title":"N Engl J Med"},{"issue":"3","key":"ooi240054r42","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2017-3459","article-title":"Prevalence of obesity and severe obesity in US children, 1999-2016.","volume":"141","author":"Skinner","year":"2018","journal-title":"Pediatrics"},{"issue":"12","key":"ooi240054r43","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1001\/jama.2020.14590","article-title":"Trends in obesity prevalence by race and Hispanic origin-1999-2000 to 2017-2018.","volume":"324","author":"Ogden","year":"2020","journal-title":"JAMA"},{"issue":"1","key":"ooi240054r44","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.amepre.2017.01.041","article-title":"A systematic review of obesity disparities research.","volume":"53","author":"Pratt","year":"2017","journal-title":"Am J Prev Med"},{"issue":"1","key":"ooi240054r45","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1513\/AnnalsATS.201609-662OC","article-title":"Associations among neighborhood, race, and sleep apnea severity in children. a six-city analysis.","volume":"14","author":"Wang","year":"2017","journal-title":"Ann Am Thorac Soc"},{"key":"ooi240054r46","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.ssresearch.2016.01.008","article-title":"Neighborhood disadvantage and obesity across childhood and adolescence: evidence from the NLSY children and young adults cohort (1986-2010).","volume":"57","author":"Alvarado","year":"2016","journal-title":"Soc Sci Res"},{"issue":"3","key":"ooi240054r47","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2019-2077","article-title":"Providing care for children in immigrant families.","volume":"144","author":"Linton","year":"2019","journal-title":"Pediatrics"},{"key":"ooi240054r19","volume-title":"The International Classification of Sleep Disorders: Diagnostic & Coding Manual","author":"American Academy of Sleep Medicine","year":"2005","edition":"2nd ed"},{"key":"ooi240054r21","unstructured":"US Centers for Disease Control and Prevention. CDC growth charts: United States. Accessed July 19, 2024. https:\/\/www.cdc.gov\/growthcharts\/"}],"container-title":["JAMA Otolaryngology\u2013Head &amp; Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2822894\/jamaotolaryngology_kirkham_2024_oi_240054_1728498435.29723.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T15:09:33Z","timestamp":1728572973000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2822894"}},"subtitle":["Exploratory Analysis of the PATS Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2024,10,1]]},"references-count":47,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2024.2554","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2024,10,1]]}}}