Adenotonsillotomy versus adenotonsillectomy in pediatric obstructive sleep apnea: A 5-year RCT

Area of Science:

• Pediatric Otolaryngology
• Sleep Medicine
• Surgical Outcomes Research

Background:

• Adenotonsillectomy (ATE) is a standard treatment for pediatric obstructive sleep apnea (OSA).
• Intracapsular adenotonsillotomy (ATT) is a less invasive alternative with potentially reduced morbidity.
• Previous studies showed no significant differences between ATE and ATT at one-year follow-up.

Purpose of the Study:

• To present the five-year long-term results of a randomized controlled trial comparing ATE and ATT for pediatric OSA.
• To evaluate the long-term efficacy and safety of ATT compared to ATE in non-obese children with moderate to severe OSA.

Main Methods:

• A randomized controlled trial followed 79 non-obese children (2-6 years) who underwent either ATE (n=40) or ATT (n=39).
• Polysomnography (PSG) and the OSA-18 questionnaire were administered five years post-surgery.
• Primary outcome was the difference in postoperative Obstructive Apnea/Hypopnea Index (OAHI); ATE was offered for OSA relapse in the ATT group.

Main Results:

• A high dropout rate (43%) was observed, with 57% completing the five-year follow-up.
• Both ATE and ATT groups showed significant reductions in OAHI post-surgery (ATE: 12.3 to 0.6; ATT: 12.6 to 0.5), with no significant difference between groups (mean difference 0.1).
• Median OSA-18 scores decreased similarly in both groups, indicating comparable long-term quality of life improvements.

Conclusions:

• ATT appears to be an effective treatment for pediatric OSA in the long term, comparable to ATE.
• The study highlights a significant risk of OSA recurrence after ATT, necessitating vigilant follow-up.
• Further research is required to fully understand the long-term implications and optimal management strategies for ATT in pediatric OSA.