Surgery in kids with mild sleep-disordered breathing tied to fewer doctor visits, meds

Surgical removal of enlarged tonsils and adenoids in children with mild sleep-disordered breathing (SDB) appears to significantly reduce the frequency of medical office visits and prescription medicine use in this group, according to a clinical study supported by the National Institutes of Health (NIH). The findings, published in JAMA Pediatrics, show that the surgery, called adenotonsillectomy, was tied to a 32% reduction in medical visits and a 48% reduction in prescription use among children with a mild form of the condition.

SDB refers to breathing disturbances during sleep that can range from loud snoring to occasional breathing pauses. About 6 to 17% of children in the United States have it, and for those with moderate to severe cases, adenotonsillectomy is a standard treatment commonly used. It can help reduce breathing problems, minimize behavioral issues, and also lower the risk of high blood pressure, full-blown sleep apnea, and other problems that may occur if the condition is left untreated. A recent NIH-supported clinical trial showed that for children with mild SDB, the surgery helped lower blood pressure and improve sleep and quality of life.

In the new study, researchers sought to determine whether adenotonsillectomy in comparison to watchful waiting (non-intervention) with supportive care is associated with fewer health care encounters and prescriptions. To find out, the researchers analyzed data from a randomized clinical trial that involved 459 children and adolescents with mild SDB who were recruited between 2016 and 2021 and followed for one year. The participants were ages 3 to 12 and were studied at seven academic sleep centers in the U.S.

During the trial, half the participants received an adenotonsillectomy, and the other half received supportive care without surgery, which included standardized education on healthy sleep and lifestyle and referral for untreated allergies or asthma. An analysis after the 12-month study period found 32% fewer health care encounters and 48% fewer prescriptions used among participants who underwent adenotonsillectomy, compared to those who did not undergo the surgery. For every 100 children, this equates to 125 fewer health care encounters and 253 fewer prescriptions-including for pain, skin, and respiratory medications — administered during the first year following surgery.

The reduced health care encounters included fewer office visits and outpatient procedures, particularly for sleep- and respiratory-related problems, but the mechanisms linking SDB treatment to health care outcomes are not clear.

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