Study Reveals Adenotonsillectomy Not Superior to Watchful Waiting for Mild OSA in Young Children

A recent study published in JAMA Otolaryngology-Head and Neck Surgery suggests that for young children diagnosed with mild obstructive sleep apnea (OSA) and possessing small tonsils, the surgical procedure known as adenotonsillectomy (ATE) may not provide significant advantages over a strategy of watchful waiting (WW).

The research, led by a team from Uppsala University in Sweden, involved a randomized clinical trial focusing on young children between the ages of 2 and 4 who exhibited mild to moderate OSA. Participants were assigned either to undergo adenotonsillectomy or to be monitored without immediate intervention. The study tracked these children over a period of three years, assessing their health outcomes based on their Obstructive Apnea-Hypopnea Index (OAHI) scores.

A total of 60 children participated, with 29 undergoing ATE and 31 placed in the WW group. Following the study, 48 children completed the trial, and the analysis revealed that the differences in OAHI scores between the two groups were minimal. However, there was a noted improvement in the total OSA-18 questionnaire score for those who underwent the surgical procedure.

Interestingly, a significant number of children in the watchful waiting cohort--13 out of 31--eventually opted for surgery after showing persistent signs of obstructive sleep apnea. Of these, follow-up polysomnography indicated that OAHI scores normalized in nine children following surgery. The crossover group, which transitioned from watchful waiting to surgery, demonstrated more severe OSA symptoms and larger tonsils compared to those who remained in the nonsurgical group.

The authors of the study concluded that their findings suggest adenotonsillectomy does not significantly outperform the watchful waiting approach for children with mild obstructive sleep apnea. They noted that nearly half of the children initially assigned to watchful waiting eventually required surgical intervention due to ongoing symptoms.

This research adds to the ongoing discussion about the management of mild obstructive sleep apnea in young children, highlighting the importance of individualized patient assessment and the potential for conservative management strategies.