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Laparoscopic sleeve gastrectomy in children and adolescents with Prader-Willi syndrome: a matched control study
Surgery for Obesity and Related Diseases ] (2016) 00–00
Letter to the editor
Laparoscopic sleeve gastrectomy in children and adolescents with Prader-Willi syndrome: a matched control study To the Editor: We reviewed with great interest the recently published article by Alqahtani et al. reporting outcomes o1 to 5 years after sleeve gastrectomy in 24 children and adolescents (mean age 10.6 yr) with Prader-Willi syndrome (PWS) compared with children without PWS matched for age, sex, and body mass index (BMI) [1]. Preoperative BMI Z-score for the PWS patients was 3.05 ⫾ .43, with co-morbidities that included obstructive sleep apnea (OSA), diabetes, dyslipidemia, and hypertension. Treatment response was determined by observed remission and improvement in co-morbidities. Criteria for resolution and improvement of OSA were assessed by the investigators as previously reported through the pediatric sleep questionnaire by Chervin et al. [2] and polysomnography and defined as resolution of all symptoms [3]. The authors report that all children with PWS had OSA at baseline diagnosed by pediatric sleep questionnaire scores and polysomnography (mean apnea/hypopnea index of 10.5 ⫾ 3.7) with remission or resolution of OSA in 21 of 24 children (87.5%) with PWS at longitudinal assessment (o1 year to 5 years postoperatively). As rates of OSA among children with PWS range from 44% to 100% - far higher than rates in children in the general population [4–6], we reviewed data from an existing investigational review board–approved retrospective study of polysomnography performed among children and adolescents with genetically confirmed diagnosis of PWS and compared prevalence data using Fisher exact test (GraphPad Prism version 6.05, GraphPad Software, San Diego, California). Sleep study data were available for 30 patients with PWS (mean age 14.4 ⫾ 4 yr; mean BMI Z-score 2.07 ⫾ .8) similar in mean age (15.3 ⫾ 4.5 yr) and BMI Z-score (1.99 ⫾ .66) to the 15 patients with PWS who had undergone laparoscopic sleeve gastrectomy (LSG) 3 or more years earlier. Thirteen of 30 patients had moderate to severe OSA as determined by polysomnography in our population, compared with 1 of 15 in the LSG group (P = .016). Seven of 30 patients with PWS that we studied had no evidence of OSA, compared with 12 of 15 among the LSG group (P = .004).
Although some factors that increase the risk of OSA in individuals with PWS, such as airway narrowing from fatty deposition in the neck, may be ameliorated through LSG, other contributing factors such as scoliosis and reduced airway response to hypoxia or hypercapnia [4] found in PWS are unrelated to obesity severity. Consequently, we would suggest cautious interpretation of the OSA results. Ann O. Scheimann, M.D., M.B.A. Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland Department of Pediatrics, Baylor College of Medicine Houston, Texas Jennifer Miller, M.D. Department of Pediatrics, University of Florida School of Medicine, Gainesville, Florida Daniel G. Glaze, M.D. Department of Pediatrics, Baylor College of Medicine Houston, Texas References [1] Alqahtani AR, Elahmedi MO, Al Qahtani AR, Lee J, Butler MG. Laparoscopic sleeve gastrectomy in children and adolescents with Prader-Willi syndrome: a matched control study. Surg Obes Relat Dis 2016;12(1):100–12. [2] Chervin RA, Hedger K, Dillon JE, Pittuch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleepdisordered breathing, snoring, sleepiness and behavioral problems. Sleep Medicine 2000;1(1):21–32. [3] Alqahtani AR, Elahmedi MO, Al Qahtani AR. Co-morbidity resolution in morbidly obese children and adolescents undergoing sleeve gastrectomy. Surg Obes Relat Dis 2014;10(5):542–50. [4] Sedky K, Bennett DS, Pumariega A. Prader-Willi syndrome and obstructive sleep apnea: co-occurrence in the pediatric population. J Clin Sleep Med 2014;10(4):403–9. [5] Miller J, Silverstein J, Shuster J, Driscoll DJ, Wagner M. Short-term effects of growth hormone on sleep abnormalities in Prader-Willi syndrome. J Clin Endocrinol Metab 2006;91(2):413–7. [6] Williams K, Scheimann A, Sutton V, Hayslett E, Glaze DG. Sleepiness and sleep disordered breathing in Prader-Willi syndrome: relation to genotype, growth hormone therapy and body composition. J Clin Sleep Med 2008;4(2):111–8.
http://dx.doi.org/10.1016/j.soard.2016.08.013
http://dx.doi.org/10.1016/j.soard.2016.08.013 1550-7289/r 2016 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.
Letter to the editor
Laparoscopic sleeve gastrectomy in children and adolescents with Prader-Willi syndrome: a matched control study To the Editor: We reviewed with great interest the recently published article by Alqahtani et al. reporting outcomes o1 to 5 years after sleeve gastrectomy in 24 children and adolescents (mean age 10.6 yr) with Prader-Willi syndrome (PWS) compared with children without PWS matched for age, sex, and body mass index (BMI) [1]. Preoperative BMI Z-score for the PWS patients was 3.05 ⫾ .43, with co-morbidities that included obstructive sleep apnea (OSA), diabetes, dyslipidemia, and hypertension. Treatment response was determined by observed remission and improvement in co-morbidities. Criteria for resolution and improvement of OSA were assessed by the investigators as previously reported through the pediatric sleep questionnaire by Chervin et al. [2] and polysomnography and defined as resolution of all symptoms [3]. The authors report that all children with PWS had OSA at baseline diagnosed by pediatric sleep questionnaire scores and polysomnography (mean apnea/hypopnea index of 10.5 ⫾ 3.7) with remission or resolution of OSA in 21 of 24 children (87.5%) with PWS at longitudinal assessment (o1 year to 5 years postoperatively). As rates of OSA among children with PWS range from 44% to 100% - far higher than rates in children in the general population [4–6], we reviewed data from an existing investigational review board–approved retrospective study of polysomnography performed among children and adolescents with genetically confirmed diagnosis of PWS and compared prevalence data using Fisher exact test (GraphPad Prism version 6.05, GraphPad Software, San Diego, California). Sleep study data were available for 30 patients with PWS (mean age 14.4 ⫾ 4 yr; mean BMI Z-score 2.07 ⫾ .8) similar in mean age (15.3 ⫾ 4.5 yr) and BMI Z-score (1.99 ⫾ .66) to the 15 patients with PWS who had undergone laparoscopic sleeve gastrectomy (LSG) 3 or more years earlier. Thirteen of 30 patients had moderate to severe OSA as determined by polysomnography in our population, compared with 1 of 15 in the LSG group (P = .016). Seven of 30 patients with PWS that we studied had no evidence of OSA, compared with 12 of 15 among the LSG group (P = .004).
Although some factors that increase the risk of OSA in individuals with PWS, such as airway narrowing from fatty deposition in the neck, may be ameliorated through LSG, other contributing factors such as scoliosis and reduced airway response to hypoxia or hypercapnia [4] found in PWS are unrelated to obesity severity. Consequently, we would suggest cautious interpretation of the OSA results. Ann O. Scheimann, M.D., M.B.A. Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland Department of Pediatrics, Baylor College of Medicine Houston, Texas Jennifer Miller, M.D. Department of Pediatrics, University of Florida School of Medicine, Gainesville, Florida Daniel G. Glaze, M.D. Department of Pediatrics, Baylor College of Medicine Houston, Texas References [1] Alqahtani AR, Elahmedi MO, Al Qahtani AR, Lee J, Butler MG. Laparoscopic sleeve gastrectomy in children and adolescents with Prader-Willi syndrome: a matched control study. Surg Obes Relat Dis 2016;12(1):100–12. [2] Chervin RA, Hedger K, Dillon JE, Pittuch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleepdisordered breathing, snoring, sleepiness and behavioral problems. Sleep Medicine 2000;1(1):21–32. [3] Alqahtani AR, Elahmedi MO, Al Qahtani AR. Co-morbidity resolution in morbidly obese children and adolescents undergoing sleeve gastrectomy. Surg Obes Relat Dis 2014;10(5):542–50. [4] Sedky K, Bennett DS, Pumariega A. Prader-Willi syndrome and obstructive sleep apnea: co-occurrence in the pediatric population. J Clin Sleep Med 2014;10(4):403–9. [5] Miller J, Silverstein J, Shuster J, Driscoll DJ, Wagner M. Short-term effects of growth hormone on sleep abnormalities in Prader-Willi syndrome. J Clin Endocrinol Metab 2006;91(2):413–7. [6] Williams K, Scheimann A, Sutton V, Hayslett E, Glaze DG. Sleepiness and sleep disordered breathing in Prader-Willi syndrome: relation to genotype, growth hormone therapy and body composition. J Clin Sleep Med 2008;4(2):111–8.
http://dx.doi.org/10.1016/j.soard.2016.08.013
http://dx.doi.org/10.1016/j.soard.2016.08.013 1550-7289/r 2016 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.