Adenotonsillectomy in Pediatric Sleep-Disordered Breathing: A Shift Toward Surgical Intervention?

Recent evidence shows that adenotonsillectomy improves growth and sleep-related outcomes in children with mild sleep-disordered breathing — a finding that could shift thresholds for offering operative care.

Until now, management of mild sleep-disordered breathing typically favored watchful waiting: low symptom burden and concerns about perioperative risk supported conservative pathways, and short-term courses were generally benign. The new data challenge that stance and prompt reconsideration of selection criteria for surgery in select patients.

The report found that children who underwent adenotonsillectomy experienced measurable gains in growth percentiles and sleep-related symptom scores compared with conservative management, with most improvements apparent within the first year.

Short-term postoperative effects included better sleep quality, reduced symptom scores, and accelerated growth velocity; adverse events were infrequent and consistent with expected postoperative morbidity. Long-term durability beyond the first year remains uncertain because follow-up was limited.

Key Takeaways:

• Adenotonsillectomy was associated with early improvements in growth percentiles and sleep symptoms versus watchful waiting, with benefits evident within about one year.
• Children with mild sleep-disordered breathing who have growth faltering or persistent symptoms appear most likely to benefit; these factors may help prioritize surgical candidacy.
• Findings support updating counseling on growth expectations and incorporating multidisciplinary evaluation to individualize decisions rather than defaulting to observation.