For young children with mild obstructive sleep apnea (OSA) and small tonsils, adenotonsillectomy (ATE) seems to be no more effective than watchful waiting (WW), according to a study published online Sept. 18 in JAMA Otolaryngology-Head and Neck Surgery.
Isabella Sjölander, M.D., Ph.D., from Uppsala University in Sweden, and colleagues conducted a randomized clinical trial (RCT) of young children with mild-to-moderate OSA to examine the benefit of ATE compared to WW after three years. Children aged 2 to 4 years with an Obstructive Apnea-Hypopnea Index (OAHI) score of 2 or greater and less than 10 were randomly assigned to ATE or WW (29 and 31 children, respectively).
Forty-eight children completed the study (23 ATE, 16 WW, and nine crossovers), and 39 were analyzed per protocol. The researchers found that changes in OAHI did not differ between groups, but there was a difference of medium effect size when comparing change in the total OSA-18 questionnaire score, in favor of ATE.
Of the children in the WW group, 13 (42%) crossed over to surgery; OAHI normalized after ATE on follow-up polysomnography in nine children. Compared with the nonsurgical group, the crossover group had more moderate OSA, a higher total OSA-18 score, and larger tonsils.
“The findings of this small, long-term RCT in young children suggest that ATE was not more effective than WW,” the authors write. “However, due to the study criteria, almost half of the children in the WW group had remaining signs of OSA and underwent surgery.”
More information:
Isabella Sjölander et al, Adenotonsillectomy vs Watchful Waiting in Pediatric Mild to Moderate Obstructive Sleep Apnea, JAMA Otolaryngology–Head & Neck Surgery (2025). DOI: 10.1001/jamaoto.2025.2831
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