Growth and sleep outcomes after adenotonsillectomy in pediatric mild sleep-disordered breathing

Adenotonsillectomy has been shown to promote "catch-up growth" in children with obstructive sleep apnea. However, its impact on children with mild sleep-disordered breathing (SDB) (i.e., habitual snoring but not frequent obstructive breathing events) remains unclear. This secondary analysis utilized data from the Pediatric Adenotonsillectomy Trial for Snoring (PATS), a multicenter, randomized, single-blinded interventional study. PATS enrolled 459 children aged 3-12 years with mild SDB, all of whom had an obstructive apnea-hypopnea index (OAHI) no greater than 3. These children were randomized to either adenotonsillectomy or watchful waiting and were followed for 12 months. Growth outcomes included height, weight, and body mass index (BMI) expressed in sex- and age-specific percentiles. Sleep parameters were measured using polysomnography. We used multivariable linear regression to assess the statistical significance of differences in these outcomes at 12 months after adenotonsillectomy or randomization between the surgery and watchful waiting groups. Among the 330 children who consented to share data (median age 6.4 years), 231 had an OAHI below 1. After multivariable adjustment, the adenotonsillectomy group had significantly higher increase in height (mean difference: 2.74, 95% confidence interval [CI] 0.33 to 5.15) and weight (mean difference: 2.79, 95% CI 0.29 to 5.28) percentiles at 12-month follow-up, compared with the watchful waiting group. Significant differences were also observed for sleep parameters, including OAHI (mean difference: -1.36, 95% CI -2.07 to -0.65), respiratory disturbance index (mean difference: -0.47, 95% CI -0.74 to -0.20), and oxygen desaturation index (mean difference: -0.99, 95% CI -1.85 to -0.13). The adenotonsillectomy group further demonstrated better sleep architecture, including decreased Stage 1 sleep (mean difference: -1.00, 95% CI -1.90 to -0.11) and increased Stage 2 sleep (mean difference: 2.06, 95% CI 0.54 to 3.59). Subgroup analysis indicated greater benefit of adenotonsillectomy for children at 3-5 years, boys, children with grade III or IV tonsillar hypertrophy, and non-asthmatic children. In conclusion, adenotonsillectomy improved not only sleep-related outcomes but also growth in children with mild SDB, suggesting that surgical intervention may provide additional health benefits beyond symptom relief, particularly in younger children with tonsillar hypertrophy. Trial registration: ClinicalTrials.gov NCT02562040, registered on September 25, 2015.