Revisiting the efficiency and necessity of adenotonsillectomy in children with mild obstructive sleep apnea: a systematic review and meta-analysis

Background Adenotonsillar hypertrophy is the leading cause of obstructive sleep apnea (OSA) in children, with adenotonsillectomy (AT) being the most common surgical treatment. Although AT is widely performed, its efficacy in treating mild OSA remains uncertain. Current literature suggests that children with mild OSA might benefit from non-surgical management, but there is a lack of evidence ND studies evaluating the outcomes of AT specifically for mild OSA. The aim of this systematic review and meta-analysis is to provide conclusive insights into the effectiveness of adenotonsillectomy in improving health outcomes and quality of life for children with mild obstructive sleep apnea. Methods PubMed, Scopus, Embase, Cochrane, and Web of Science databases have been searched for relevant studies. We included original studies that evaluated the safety or effectiveness of AT in the management of mild OSA among pediatric patients. For quantitative analysis, data were synthesized using a random-effects model in R (version 4.3.3), and heterogeneity was assessed using statistical methods including the restricted maximum-likelihood estimator and the I2 statistic. We also conducted analyses of change scores and covariance to estimate the effect of AT on the severity of mild OSAS. Results Our review included 27 studies after screening 1851 citations. The meta-analysis demonstrated significant improvements with AT for mild OSA. The Pediatric Sleep Questionnaire scores improved with a mean difference (MD) of -0.32 (95% CI [-0.39; -0.25], p < 0.001). AHI decreased significantly with an MD of -1.45 (95% CI [-2.11; -0.80], p < 0.001). Comparison with watchful waiting revealed AT to be more effective: AHI showed an MD of -1.22 (95% CI [-1.92; -0.53], p < 0.001), and the arousal index had an MD of -1.73 (95% CI [-2.95; -0.51], p = 0.005). Safety data indicated that while AT is generally safe, it is associated with minor complications such as postoperative desaturation and occasional bleeding. Long-term serious adverse events were rare. Conclusion AT effectively improves symptoms in children with mild OSA, outperforming watchful waiting in several key metrics. This review supports AT as a viable option but underscores the importance of considering individual patient factors in treatment decisions.