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Risk Factors, Symptom Burden, and Treatment Response in Pediatric REM-Predominant OSA: Evidence From the Childhood

Chao Wang1,2, Aheng Wang3, Jingfang Wu1,2

  • 1Department of Otorhinolaryngology, ENT Institute, EYE & ENT Hospital Fudan University Shanghai China.

Laryngoscope Investigative Otolaryngology
|August 3, 2026
PubMed

Insights

Children with REM-predominant obstructive sleep apnea (OSA) are less likely to resolve spontaneously with watchful waiting. Adenotonsillectomy (AT) is a more effective treatment for this OSA subtype.

Area of Science:

  • Pediatric Sleep Medicine
  • Respiratory Medicine
  • Otolaryngology

Background:

  • Obstructive sleep apnea (OSA) is common in children, with varying subtypes.
  • Rapid eye movement (REM)-predominant OSA is characterized by a higher apnea-hypopnea index (AHI) during REM sleep.
  • Understanding subtype-specific resolution rates is crucial for effective management.

Purpose of the Study:

  • To compare disease resolution rates in children with REM-predominant OSA versus non-REM-predominant OSA.
  • To evaluate the effectiveness of different management strategies (adenotonsillectomy vs. watchful waiting) for REM-predominant OSA.

Main Methods:

  • Secondary analysis of the Childhood Adenotonsillectomy Trial (NCT00560859).
  • Included 382 children aged 5-9.9 years with OSA, randomized to adenotonsillectomy (AT) or watchful waiting.
  • REM-predominant OSA defined as a REM-AHI to NREM-AHI ratio ≥ 2; primary outcome was OSA resolution at 7 months.

Main Results:

  • 55.8% of children had REM-predominant OSA, associated with higher AHI and increased daytime sleepiness.
  • Children with REM-predominant OSA were significantly less likely to achieve spontaneous resolution with watchful waiting (aOR, 0.52).
  • No significant difference in OSA resolution rates was observed between REM-predominant and non-REM-predominant OSA groups who underwent AT (aOR, 0.75).

Conclusions:

  • REM-predominant OSA is associated with greater PSG severity but not necessarily greater symptom burden or quality of life impairment.
  • Children with REM-predominant OSA show reduced likelihood of spontaneous resolution, highlighting the importance of timely intervention.
  • Adenotonsillectomy (AT) appears to be a more effective management strategy for REM-predominant OSA compared to watchful waiting.
Abstract

Keywords:
adenotonsillectomyobstructive sleep apnearapid‐eye‐movementwatchful waiting

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