Children's snoring and mild obstructive sleep apnea (OSA) are not uncommon, but is surgery like adenotonsillectomy really worth it for snoring? Isn't it often said that such conditions improve as children grow older? A landmark study published in 2015 in the prestigious New England Journal of Medicine (NEJM), the CHAT study, examined whether surgery would improve functionality in children with OSA, concluding that it does improve some aspects. But what about children who primarily snore?

Thus, the Pediatric Adenotonsillectomy Trial for Snoring (PATS) was conducted, also published in a top-tier journal, JAMA. This study included 458 participants from 7 medical centers in the United States, comprising:

• 231 children underwent adenotonsillectomy, and 237 were in the watchful waiting group.
• The average age was 6.1 years (ranging from 3 to 12.9 years).
• The group was evenly divided by gender with 230 females (50%).
• Racial composition included 123 Black/African American (26.9%) and 75 Hispanic (16.3%) children.
• The median Apnea-Hypopnea Index (AHI) was 0.5 [interquartile range (IQR), 0.2-1.1].
• A total of 394 children (86%) completed the 12-month follow-up.
• Obese children were excluded from the study.

 Results demonstrated significant improvements in various health indicators for children undergoing adenotonsillectomy. Behaviorally and emotionally, as reported in the Child Behavior Checklist (CBCL) total scores, there was a noticeable reduction in overall problem scores. Additionally, there was a significant decrease in scores on the Sleep-Related Breathing Disorder questionnaire (PSQ-SRBD), reflecting improved sleep quality.

Physiologically, post-surgery children showed reductions in OSA-18 scores, indicating alleviation of sleep-breathing issues. Moreover, improvements were observed in the Pediatric Quality of Life Inventory (PedsQL) total, physical, and psychosocial health scores. Notably, improvements were also seen in blood pressure readings, both systolic and diastolic, as well as a significant decrease in the Apnea-Hypopnea Index (AHI), signifying substantial improvement in sleep apnea symptoms.

Specifically, the study found that in children who underwent adenotonsillectomy, compared to the watchful waiting group, there were:

• A 7.6% reduction (95% CI, -14.6% to -0.7%) in the prevalence of CBCL total problem scores.
• A 30.9% reduction (95% CI, -39.1% to -22.8%) in PSQ-SRBD scores.
• A 5.9% reduction (95% CI, -12.7% to 1.0%) in mESS scores.
• A 13.0% reduction (95% CI, -19.1% to -7.0%) in OSA-18 scores.
• A 27.3% reduction (95% CI, -34.5% to -20.1%) in the prevalence of frequent loud snoring.

While these two large studies, CHAT and PATS, clearly show that adenotonsillectomy can significantly improve behavioral issues, emotional problems, sleep quality, and reduce breathing problems during sleep in children with OSA or who snore, they lack comparison with other treatment methods. Additionally, physiological differences between Asian and Western populations may affect the applicability of these results. Therefore, whether surgery is the best treatment method remains a question that might require more time and research to answer definitively.