Adenotonsillectomy Enhances Sleep and Respiratory Health in Children with OSA

According to a new study published in The Laryngoscope, adenotonsillectomy produces substantial improvements in children with obstructive sleep apnea.

In a cohort of 233 pediatric patients, the mean apnea-hypopnea index (AHI) fell from roughly 23.5 events/hour preoperatively to about 6.3 events/hour afterward. The study population comprised children with severe and very severe OSA, and AHI was the prespecified primary respiratory endpoint.

Postoperative sleep architecture showed consistent, favorable shifts: increased time in restorative stages (notably N3 and REM), fewer microarousals, and a lower arousal index compared with preoperative measures. These stage-level gains accompanied longer total sleep time and tighter correlations between changes in N2/N3 and REM durations, suggesting an integrated recovery of sleep depth and continuity that likely supports faster daytime symptom resolution and behavioral recovery.

Nonetheless, about 23% of children remained in the severe OSA range after surgery, representing a nontrivial residual-disease subgroup. Those with persistent severe disease had shorter total sleep time, reduced N3 and REM sleep, and higher arousal indices; contributors may include obesity or craniofacial anatomy. Patients with these risk features or ongoing symptoms warrant prioritized postoperative testing and targeted evaluation.