Adenotonsillectomy Shows No Significant Advantage Over Watchful Waiting in Children with Mild Sleep Apnea

Recent research published in JAMA Otolaryngology–Head & Neck Surgery indicates that adenotonsillectomy (ATE) may not provide greater benefits than a conservative approach of watchful waiting (WW) for young children diagnosed with mild obstructive sleep apnea (OSA) and small tonsils. The study, conducted by Dr. Isabella Sjölander and colleagues from Uppsala University in Sweden, involved a randomized clinical trial with children aged 2 to 4 years who had an Obstructive Apnea-Hypopnea Index (OAHI) between 2 and less than 10.

The trial assigned 60 children randomly to either undergo ATE or be monitored with WW, with follow-up over three years. Out of the initial participants, 48 completed the study, with 23 in the surgical group and 16 in the watchful waiting group after accounting for crossovers. During the study, researchers observed that changes in OAHI levels did not significantly differ between the two groups. However, there was a medium effect size favoring ATE when looking at the overall results of the OSA-18 questionnaire, which assesses quality of life related to sleep issues.

Interestingly, nearly half of the children in the WW group (42%) eventually crossed over to surgery due to persistent symptoms. Follow-up polysomnography revealed that OAHI normalized in nine children after ATE. The children who crossed over to surgery typically had more severe OSA, larger tonsils, and worse scores on sleep-related quality of life assessments compared to those who remained in the WW group.

The findings suggest that for this specific patient population—young children with mild OSA and small tonsils—immediate surgery may not be more effective than observation. The authors highlight that almost half of the children managed without surgery continued to show signs of OSA, prompting some to undergo surgical intervention later. This study underscores the importance of individualized treatment plans and indicates that watchful waiting can be a valid initial approach in selected cases.

For further details, the full study is available at source.