Children with mild sleep-disordered breathing experience significant reductions in healthcare utilization following surgical removal of their tonsils and adenoids, according to a new NIH-supported clinical trial published in JAMA Pediatrics.
The randomized study of 459 children aged 3 to 12 found that adenotonsillectomy led to a 32% reduction in medical visits and a 48% decrease in medication use during the year following surgery, compared to children who received only supportive care without surgical intervention.
"For every 100 children, 125 encounters and 253 prescriptions can be avoided in the first year following surgery," noted senior researcher Dr. Susan Redline, a professor of sleep medicine at Brigham and Women's Hospital.
Sleep-Disordered Breathing in Children
Sleep-disordered breathing (SDB) affects approximately 6-17% of children in the United States, manifesting as symptoms ranging from loud snoring to occasional breathing pauses during sleep. While adenotonsillectomy has been a standard treatment for moderate to severe cases, its efficacy for children with milder forms of the condition had not been thoroughly evaluated until now.
The condition can significantly impact children's health and development, potentially leading to behavioral issues, high blood pressure, and full-blown sleep apnea if left untreated.
Study Design and Findings
The clinical trial, conducted across seven academic sleep centers in the U.S., recruited participants between 2016 and 2021. Children were randomly assigned to one of two groups:
- Surgical intervention group: Received adenotonsillectomy
- Control group: Received supportive care without surgery, including education on healthy sleep habits and referrals for untreated allergies or asthma
After 12 months of follow-up, researchers analyzed healthcare utilization patterns between the two groups. The surgical group showed markedly reduced healthcare needs, particularly for sleep- and respiratory-related problems.
"The reduction in the rates of both total encounters and total prescriptions associated with surgery was more pronounced among children older than 5 years than among children 5 years and younger," the researchers noted in their study.
The prescriptions avoided included medications for pain, skin conditions, and respiratory issues.
Clinical Implications
Dr. Marishka Brown, director of the National Center on Sleep Disorders Research within NIH's National Heart, Lung, and Blood Institute, suggests these findings could influence treatment decisions for children with mild sleep-disordered breathing.
The study builds on previous research showing that adenotonsillectomy in children with mild SDB helps lower blood pressure and improve sleep quality and overall quality of life.
However, researchers acknowledge that the exact mechanisms linking SDB treatment to improved health outcomes remain unclear. Additionally, further research is needed to establish the cost-effectiveness of adenotonsillectomy compared to other care approaches for mild cases.
Considerations for Treatment Decisions
While the results are promising, healthcare providers will need to weigh several factors when considering adenotonsillectomy for children with mild sleep-disordered breathing:
- The child's age (benefits appear greater in children over 5)
- Severity of symptoms
- Presence of other medical conditions
- Potential surgical risks
- Family preferences
The study provides valuable evidence that surgical intervention may reduce the healthcare burden for families dealing with childhood sleep-disordered breathing, even in milder cases that might previously have been managed through watchful waiting alone.
As research continues to clarify the mechanisms behind these improvements, clinicians will be better equipped to make evidence-based recommendations for the management of sleep-disordered breathing across its full spectrum of severity in pediatric populations.
