2026/07/01 by Ronald D. Chervin, Ronald D Chervin, Seyni Gueye-Ndiaye +14
Medicine · Neuroscience · Psychology · #Neuroscience of respiration and sleep #Obstructive Sleep Apnea Research #Sleep and related disorders
paper · doi:10.1093/sleep/zsag169
openalex publication_date 2026/07/01 · openalex created_date 2026/07/10 · openalex updated_date 2026/07/30
Abstract Study Objectives To examine clinically meaningful benefit that may be achieved by early adenotonsillectomy (eAT) vs. watchful waiting with supportive care (WWSC) in children with mild sleep-disordered breathing (MSDB, snoring but little or no obstructive sleep apnea), and to identify baseline demographic, symptom, physical exam, historical, or polysomnographic features that may predict such benefit. Materials and Methods Secondary analysis of participants (aged 3.0–12.9 years) in the 12-month multi-center randomized clinical trial of eAT vs. WWSC for MSDB, the Pediatric Adenotonsillectomy Trial for Snoring (PATS). Meaningful benefit was defined as a composite outcome of clinically-significant change in at least two of four domains—behavior, quality of life, subjective sleepiness, and blood pressure—each of which had shown greater improvement 12 months after AT versus WWSC in PATS. Results Among 363 participants, the mean age was 6.6 (SD 2.3) years, 199 (55%) were >5 years old at enrollment, and 185 (51%) were male. A total of 115 (65%) vs. 73 (39%) in the eAT vs. WWSC arms, respectively, experienced clinically-meaningful improvement on ≥2 domains (p < .01). Among variables explored for effect modification—including demographics, health factors, symptoms and signs, and polysomnographic data—only a high Mallampati score of III or IV vs. I or II showed predictive value (OR 4.16, 95% CI [1.22, 15.6], p = .027). Conclusions Clinically meaningful positive outcomes occur more often after eAT vs. WWSC for children with MSDB. However, many clinical features accessible prior to AT, with the intriguing exception of a high Mallampati score, may not help to identify which children stand to benefit. Clinical Trial Pediatric Adenotonsillectomy for Snoring (PATS); https://clinicaltrials.gov/study/NCT02562040; Registration number: NCT02562040. Statement of Significance This study provides important insights into the management of mild sleep-disordered breathing (MSDB) in children. Results demonstrate that adenotonsillectomy (AT) leads to clinically meaningful improvements at 12 months reassessment, in that a greater proportion of children treated with AT as opposed to WWSC benefitted in at least two of four domains, including behavior, quality of life, sleepiness, and blood pressure. Most routinely available clinical features and findings before surgery did not predict which children would benefit most from AT, though a high Mallampati score may serve as a useful indicator. These data may help clinicians and families to understand the potential benefit of AT and decide on treatment strategies for pediatric MSDB.