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Adenotonsillectomy for Children with Mild Sleep-Disordered Breathing: Who Benefits?
Ronald D Chervin1, Seyni Gueye-Ndiaye2,3, Mengqi Cen4
1Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI, United States.
Sleep
|July 9, 2026
Summary
Early adenotonsillectomy (eAT) offers significant benefits for children with mild sleep-disordered breathing (MSDB) compared to watchful waiting. A high Mallampati score may predict positive outcomes, but other factors are less reliable indicators.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Clinical Trial Research
Background:
- Mild sleep-disordered breathing (MSDB) in children presents challenges for identifying optimal treatment.
- The Pediatric Adenotonsillectomy Trial for Snoring (PATS) evaluated early adenotonsillectomy (eAT) versus watchful waiting with supportive care (WWSC).
Purpose of the Study:
- To assess clinically meaningful benefits of eAT versus WWSC in children with MSDB.
- To identify predictors of treatment benefit based on baseline characteristics.
Main Methods:
- Secondary analysis of 363 children (aged 3.0-12.9 years) from the PATS randomized clinical trial.
- Clinically meaningful benefit defined as improvement in at least two of four domains: behavior, quality of life, sleepiness, and blood pressure.
Main Results:
- A significantly higher proportion of children in the eAT group (65%) experienced meaningful improvement compared to the WWSC group (39%) (p < 0.01).
- A high Mallampati score (III or IV) was the only significant predictor of benefit (OR 4.16, p=0.027).
Conclusions:
- Early adenotonsillectomy leads to more frequent clinically meaningful improvements in children with MSDB.
- Pre-treatment clinical features, except for Mallampati score, have limited value in predicting which children will benefit from eAT.
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