Polysomnography results in pediatric patients with mild obstructive sleep apnea: Adenotonsillectomy vs. watchful waiting

There is a lack of consensus and a paucity of data regarding how to best treat pediatric patients with mild obstructive sleep apnea. The objective of our study was to compare outcomes following adenotonsillectomy vs. observation in children with mild obstructive sleep apnea based on polysomnography results. A retrospective chart review was performed on children ages 9 months to 9 years with 2 or more polysomnograms completed at a tertiary care academic center. Children diagnosed with mild obstructive sleep apnea (obstructive apnea–hypopnea index 1–5) on polysomnography performed from 1999 to 2013 were included. Patients underwent adenotonsillectomy or watchful waiting for obstructive sleep apnea. The primary outcome was the change in apnea–hypopnea index. There were 62 patients who met inclusion criteria for the study; 19 of the 62 patients were obese, while 15 had a craniofacial syndrome or hypotonia. Eighteen patients underwent adenotonsillectomy for mild obstructive sleep apnea while 44 were observed. The mean apnea–hypopnea index of patients after adenotonsillectomy improved from 3.50 (95% Confidence Interval [CI] 2.97–4.03) to 2.69 (95% CI 1.48–3.90), while the mean apnea–hypopnea index of the observation group worsened from 3.09 (95% CI 2.76–3.42) to 5.18 (95% CI 2.46–7.90). Between-group analysis showed significant improvement in the surgery group (p = 0.03), with a persistent improvement on multivariate analysis adjusting for baseline apnea–hypopnea index (p = 0.05). This difference was seen mostly in non-obese, non-syndromic children (p = 0.04). There was no significant difference between groups amongst obese (p = 0.25) and syndromic (p = 0.36) patients. Adenotonsillectomy leads to a significant improvement in apnea–hypopnea index on follow-up polysomnography over an observational approach, especially in non-obese, non-syndromic children. A prospective, randomized trial is necessary to help determine appropriate treatment strategies for pediatric mild obstructive sleep apnea.