Early Surgery for Childhood Sleep-Disordered Breathing Reduces Healthcare Visits

SLEEP-DISORDERED breathing (SDB) in children, particularly when untreated, has been shown to result in higher health care utilisation (HCU) compared to children without the condition. While treatment with adenotonsillectomy has been associated with improved symptoms in children with obstructive sleep apnea, less is known about its impact on children with milder forms of SDB. A recent study aimed to determine whether early adenotonsillectomy could reduce HCU and prescription use in children with mild SDB, compared to watchful waiting with supportive care. The researchers’ findings provide new evidence supporting early surgical intervention for children with mild SDB. 

The randomized clinical trial was conducted in the United States over 12 months, from 2016 to 2022. It included 381 children aged 3 to 13 years with mild SDB, tonsillar hypertrophy Grade 2 or above, and body mass index z-score of <3. The study compared the outcomes of adenotonsillectomy against watchful waiting with supportive care. Data on HCU and prescriptions were collected as secondary outcomes, specifically measuring the total number of health care encounters and prescriptions over the 12 months following randomization. 

Results showed that adenotonsillectomy was associated with a 32% reduction in total health care encounters (mean difference of –1.25 encounters per participant per year [95% CI: –1.96––0.53]). Additionally, there was a 48% reduction in prescriptions (mean difference of –2.53 prescriptions per participant per year [95% CI: –4.12––0.94]). Subgroup analyses suggested that children over five years of age (at the time of surgery) saw the most significant reductions in HCU and prescriptions. 

In conclusion, this study provides strong evidence that adenotonsillectomy can significantly reduce HCU in children with mild SDB. These findings support the early intervention of adenotonsillectomy, which not only alleviates symptoms but also reduces healthcare-related costs. The authors did note limitations in the study, notably the lack of blinding in the data collection process and potential biases related to healthcare-seeking behaviour. Future research should focus on the cost-effectiveness of adenotonsillectomy for children with SDB. 

Reference 

Bakker PJ et al. Adenotonsillectomy and Health Care Utilization in Children With Snoring and Mild Sleep Apnea: A Randomized Clinical Trial. JAMA Pediatr. 2025; DOI: 10.1001/jamapediatrics.2025.0023.