Early Surgery Benefits Kids with Sleep-Disordered Breathing: JAMA
A recent study has revealed that children with mild sleep-disordered breathing who underwent early surgical removal of their adenoids and tonsils experienced notable health improvements. These children had fewer health care visits and required fewer prescriptions compared to those who were monitored without surgery. The procedure also appeared to reduce the incidence of skin and pain-related conditions, likely due to decreased inflammation.
The literature indicates that health care utilization (HCU) of children with untreated moderate-to-severe obstructive sleep apnea is greater than that of matched controls before diagnosis, and treatment is associated with a decline in HCU not observed in those who remain untreated.
Research on this topic has been limited to retrospective analyses and observational cohort studies; little is known about HCU among the many children with snoring and mild sleep-disordered breathing (SDB).
A study was done to determine whether adenotonsillectomy in comparison with watchful waiting with supportive care is associated with fewer health care encounters and prescriptions. This randomized clinical trial, Pediatric Adenotonsillectomy Trial for Snoring (PATS), was a 12-month, parallel-arm trial conducted from 2016 to 2022 in tertiary care centers in the United States. Participants were recruited from otolaryngology, sleep, pulmonary, or general pediatric clinics; aged 3 to 13 years; diagnosed with mild SDB; had a tonsillar hypertrophy grade of 2 or more; and had a body mass index z score less than 3. Children referred from a clinician outside of the local electronic medical record system were excluded. Data analysis was conducted from June 2022 to April 2024. Evaluation of HCU was a prespecified secondary aim of PATS. Total encounters and total prescriptions over the 12 months after randomization were analyzed. Results Among 459 children who were randomized, the analytic sample included 381 children, after excluding those referred from outside the local electronic medical record system.
The median (IQR) age was 6 (4-8) years; 192 participants (50%) were female and 189 (50%) male. Adenotonsillectomy was associated with a 32% reduction in total health care encounters (mean difference, −1.25 per participant per year; 95% CI, −1.96 to −0.53) and a 48% reduction in prescriptions (mean difference, −2.53 per participant per year; 95% CI, −4.12 to −0.94). The difference in encounters was primarily driven by fewer office visits and outpatient procedures rather than by reduced hospitalizations or urgent care visits.
This study found that adenotonsillectomy was associated with reduced all-cause HCU in children with mild SDB, supporting early intervention for children with mild SDB. Future research focused on the cost effectiveness of adenotonsillectomy for pediatric SDB is warranted.
Reference:
Bakker JP, Zhang F, Amin R, et al. Adenotonsillectomy and Health Care Utilization in Children With Snoring and Mild Sleep Apnea: A Randomized Clinical Trial. JAMA Pediatr. Published online March 17, 2025. doi:10.1001/jamapediatrics.2025.0023
