Surgery beneficial for some children with mild sleep-disordered breathing

Dec. 6, 2023
NIH-supported study shows better sleep, blood pressure after adenotonsillectomy.

Surgical removal of the tonsils and adenoids in children with snoring and mild breathing problems during sleep appears to improve their sleep, quality of life, and blood pressure a year after surgery, a clinical trial supported by the National Institutes of Health has found.

The study, funded by the National Heart, Lung, and Blood Institute (NHLBI), part of NIH, is believed to be the first large, randomized trial to address the effects of adenotonsillectomy on children with mild sleep-disordered breathing (SDB). Adenotonsillectomy is among the most common surgical procedures in children, and mild SDB is an issue for a large proportion of these patients. The findings were published in the Journal of the American Medical Association.

The Pediatric Adenotonsillectomy Trial for Snoring (PATS) was a randomized clinical trial that involved 459 children and adolescents with mild SDB who were enrolled at seven academic sleep centers in the United States between 2016 to 2021. The participants were ages 3 to 12, racially diverse, and followed for a year. The study did not include children with moderate to severe SDB.

During the trial, half the participants received an adenotonsillectomy and the other half received supportive care without surgery, which included standardized education on healthy sleep and lifestyle and referral for untreated allergies or asthma. Researchers then evaluated neurodevelopmental, behavioral, health, and sleep-related outcomes in these groups, using measurements of attention and executive function, which includes a set of cognitive skills that help children manage everyday activities. Sleep outcomes were measured by polysomnography, a standard sleep test that measures breathing, heart rate, eye movement, and other factors. 

At the end of the study period, cognition and attention improved in both groups, but improvement was not significantly greater in the children who were treated with surgery compared to the group who did not receive surgery. However, the secondary results of the study did show several beneficial changes in the surgery group. These included less daytime sleepiness, reduced SDB, less snoring, fewer behavioral problems, better quality of life, and lower blood pressure. The children treated with surgery were also less likely to show disease progression into full-blown sleep apnea, the researchers said.

NIH release

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