Adenotonsillectomy for children with mild sleep-disordered breathing: who benefits?
Ronald D Chervin, Seyni Gueye-Ndiaye, Mengqi Cen et al.
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In 30 seconds
This secondary analysis of a 12-month, multicentre randomised trial examined children aged 3.0–12.9 years with mild sleep-disordered breathing, comparing early adenotonsillectomy (eAT) with watchful waiting and supportive care (WWSC). Clinically meaningful benefit was defined as improvement in at least two of four domains: behavior, quality of life, subjective sleepiness, and blood pressure. Such improvement occurred in 115 (65%) children in the eAT arm versus 73 (39%) in the WWSC arm (p < .01). Of the baseline features assessed, only Mallampati score III or IV predicted greater benefit.
Key findings
- Improvement in at least two outcome domains occurred in 115 (65%) with eAT versus 73 (39%) with WWSC (p < .01).
- Mallampati score III or IV versus I or II was the only assessed baseline feature with predictive value (OR 4.16, 95% CI [1.22, 15.6], p = .027).
- Most demographic, health, symptom, examination, and polysomnographic features did not identify which children would benefit.
Why it matters
The findings suggest that clinically meaningful improvement across several domains is more common after early surgery than with supportive observation in children with mild sleep-disordered breathing. However, the limited ability of routinely assessed baseline features to predict benefit underscores the uncertainty in selecting individual children who are most likely to improve.
What to keep in mind
This was a secondary analysis, and the composite benefit outcome required improvement in at least two of four domains. The reported predictive finding for high Mallampati score had a wide confidence interval.