Adenotonsillectomy and Health Care Utilization in Children With Snoring and Mild Sleep Apnea

JAMA Pediatrics · 2025-03-17 · 10 citations

Importance: The literature indicates that health care utilization (HCU) of children with untreated moderate-to-severe obstructive sleep apnea is greater than that of matched controls before diagnosis, and treatment is associated with a decline in HCU not observed in those who remain untreated. Research on this topic has been limited to retrospective analyses and observational cohort studies; little is known about HCU among the many children with snoring and mild sleep-disordered breathing (SDB). Objective: To determine whether adenotonsillectomy in comparison with watchful waiting with supportive care is associated with fewer health care encounters and prescriptions. Design, Setting, and Participants: This randomized clinical trial, Pediatric Adenotonsillectomy Trial for Snoring (PATS), was a 12-month, parallel-arm trial conducted from 2016 to 2022 in tertiary care centers in the United States. Participants were recruited from otolaryngology, sleep, pulmonary, or general pediatric clinics; aged 3 to 13 years; diagnosed with mild SDB; had a tonsillar hypertrophy grade of 2 or more; and had a body mass index z score less than 3. Children referred from a clinician outside of the local electronic medical record system were excluded. Data analysis was conducted from June 2022 to April 2024. Intervention: Early adenotonsillectomy. Main Outcomes and Measures: Evaluation of HCU was a prespecified secondary aim of PATS. Total encounters and total prescriptions over the 12 months after randomization were analyzed. Results: Among 459 children who were randomized, the analytic sample included 381 children, after excluding those referred from outside the local electronic medical record system. The median (IQR) age was 6 (4-8) years; 192 participants (50%) were female and 189 (50%) male. Adenotonsillectomy was associated with a 32% reduction in total health care encounters (mean difference, -1.25 per participant per year; 95% CI, -1.96 to -0.53) and a 48% reduction in prescriptions (mean difference, -2.53 per participant per year; 95% CI, -4.12 to -0.94). The difference in encounters was primarily driven by fewer office visits and outpatient procedures rather than by reduced hospitalizations or urgent care visits. Conclusions and Relevance: This study found that adenotonsillectomy was associated with reduced all-cause HCU in children with mild SDB, supporting early intervention for children with mild SDB. Future research focused on the cost effectiveness of adenotonsillectomy for pediatric SDB is warranted. Trial Registration: ClinicalTrials.gov Identifier: NCT02562040.

Non-invasive ventilation in pediatrics: a narrative review. Part 1: conventional non-invasive ventilation

Paediatric Respiratory Reviews · 2025-11-01

POINT: Is Watchful Waiting an Appropriate Treatment for OSA in Children? Yes

CHEST Journal · 2025-03-01 · 1 citations

Standard medical care versus enhanced interdisciplinary care for implementation of positive airway pressure in youth with Down syndrome: a randomised controlled trial protocol

BMJ Open · 2025-11-01

INTRODUCTION: Individuals with Down syndrome (DS) are predisposed to obstructive sleep apnoea (OSA) due to craniofacial features (eg, midface hypoplasia, glossoptosis) and studies have shown that the prevalence of OSA in this population is markedly increased compared with that of typically developing children. Adenotonsillectomy is considered the first-line treatment for childhood OSA. However, persistent OSA is common, thus many children with DS are referred for positive airway pressure (PAP) therapy initiation; PAP appears to be an important aspect of living with DS. PAP has been shown to be highly effective in the general population for treating OSA and improving OSA-associated neurobehavioural symptoms, such as quality of life, behaviour, mood, daytime sleepiness and school performance. However, PAP as a treatment for OSA has not been well-studied in children with DS. Therefore, we designed a multicentre randomised controlled trial recruiting children with DS and OSA at three academic institutions, aged 6-18 years, referred for PAP initiation to treat OSA. METHODS AND ANALYSIS: 86 participants will be randomised to a 6-month intensive behavioural intervention (INT) to improve PAP adherence versus standard clinical care and underwent standardised evaluations of quality of life, behaviour, attention, PAP adherence and healthcare utilisation at baseline, 6 months and 12 months. ETHICS AND DISSEMINATION: This study has been approved by the institutional review board at Children's Hospital of Philadelphia (IRB of record, IRB # 20-0 17 512). Cincinnati Children's Medical Center and University of Miami delegated IRB review and approval responsibility to Children's Hospital of Philadelphia through reliance agreements as mandated by National Institutes of Health (NIH). All participants will be minors; consent will be obtained from parents and assent from participants will be obtained when possible. The intervention tested in this trial is considered not greater than minimal risk, and no identifiable data will be reported. As required by the NIH, a data safety monitoring board (DSMB) has been formed, who will review and approve the protocol and any protocol changes prior to implementation. The study team will send biannual reports and hold a biannual meeting with the DSMB to review any safety and protocol concerns. Findings will be presented at national conferences pertinent to this topic and published in peer-reviewed medical journals. In addition, findings will be shared in the lay format with DS associations around the world and used for training of healthcare providers and trainees (R25HD118212). Further, data collected will be deposited in a repository (National Sleep Research Resource; sleepdata.org) after completion of the study to maximise use by scientific community. TRIAL REGISTRATION NUMBER: NCT04132999.

Optimizing infant and toddler sleep: a review on evidence-based approaches to promote sleep consolidation

Paediatric Respiratory Reviews · 2025-11-01

Inpatient outcomes among children with Down syndrome: a Kids’ Inpatient Database study

BMC Pediatrics · 2025-08-06 · 2 citations

BACKGROUND: Children with Down Syndrome (DS) are more likely to have multi-system comorbidities leading to more frequent hospitalizations than the general population. We aim to evaluate whether racial differences contribute to hospitalization outcomes and mortality among children with DS. METHODS: Hospital discharge records were obtained for children (< 21 y) with DS hospitalized between 2006 and 2019 from the Kid's Inpatient Database. The primary exposure was the Black race. Primary outcomes were invasive mechanical ventilation (IMV) and mortality. Secondary outcomes were non-invasive mechanical ventilation (NIMV), length of hospital stay (LOS), and inflation-adjusted cost of hospitalization (IACH). Multivariable logistic regression models were used to ascertain associations between Black race and outcomes. RESULTS: Among 163,870 hospitalizations in children with DS, 16,208 (9.89%) were Black children. Compared with non-Black children, Black children were younger, of lower household incomes, more likely to have public insurance, more likely to have asthma, OSA, obesity, prematurity, congenital heart disease, pulmonary hypertension, congenital airway anomalies, neuromuscular weakness, and dysphagia. Descriptive analyses indicated that Black race was associated with higher risks of mortality, IMV, NIMV, longer LOS, and greater IACH. After multivariable adjustment, Black race remained independently associated with mortality (OR:1.35, 95%-CI:1.15-1.59, p < 0.0001), IMV (OR:1.34, 95%-CI:1.23-1.45, p < 0.0001), NIMV (OR:1.41, 95%-CI:1.26-1.59, p < 0.0001) and increased LOS (IRR:1.08, 95%-CI:1.04-1.13, p < 0.0001), but not IACH. CONCLUSIONS: Hospitalized Black children with DS are more likely to be younger, of lower household incomes, with public insurance, and with other underlying comorbidities. Black children had increased risks of mortality and IMV and increased LOS.

Towards healthy sleep environments: Ambient, indoor, and personal exposure to PM2.5 and its implications in children's sleep health

Environmental Research · 2025-01-14 · 4 citations

The growing impact of climate change and escalating wildfire seasons has led to heightened ambient air pollution, potentially affecting children's sleep health. However, current epidemiological research often relies on outdoor weather data to model the environmental impacts on sleep health, potentially mischaracterizing the actual bedroom environment. To address these challenges, we conducted experiments to investigate the relationships among ambient, indoor, and personal exposure to PM 2.5 concentrations and obstructive sleep apnea (OSA) in children. We employed computational fluid dynamics (CFD) simulations to assess how personal exposures are influenced by factors such as air distribution design, supply air temperature (T sa ), body shape, and sleep position. Our statistical analysis revealed notable associations between OSA severity as measured by obstructive apnea-hypopnea index (OAHI) and indoor PM 2.5 concentrations ( β : 11.52; 95% CI: 5.07 to 17.96; p < 0.01) and personal PM 2.5 exposures ( β: 18.92; 95% CI: 9.80 to 28.04; p < 0.001), with personal exposure demonstrating a stronger relationship. Our findings highlighted the critical role of T sa and body shape in exacerbating personal exposure, as they could modify the bedding microenvironment around children's breathing zone during sleep. We assessed the effect of air filtration interventions on mitigating personal PM 2.5 exposure and modulating OSA severity in children. Higher air filter efficiencies such as MERV14 or above can modulate severe OSA for more than 80% of the year. However, during wildfire episodes, because air filtration interventions alone may be insufficient, comprehensive strategies, including the potential use of air cleaners and personal protective equipment (PPE), are necessary to ensure children's health. Our research demonstrated that quantifying personal exposure is a more informative predictor than solely relying on ambient or indoor measures for estimating OSA in children. • Personal exposure to PM 2.5 is associated with pediatric obstructive sleep apnea (OSA). • Body shape indicates variations in children's personal exposure during sleep. • HVAC supply air temperature suggests variability in children's nighttime exposure. • Air filtration appears insufficient for modulating OSA severity during wildfires. • Personal exposure is more informative in evaluating sleep-disordered breathing.

Nasal biomarker inflammatory profile in response to intranasal corticosteroids in pediatric obstructive sleep apnea syndrome

Journal of Clinical Sleep Medicine · 2025-03-07

1049 Characterizing the Complexity of REM Sleep Across Pediatric Development: A Novel Metric Approach

SLEEP · 2025-05-01

Abstract Introduction Rapid eye movement (REM) sleep plays a critical role in neurodevelopment, yet current measures lack the sensitivity to capture age-specific REM dynamics that reflect evolving neural architecture. Chaos analytics involves analyzing complex, nonlinear, and dynamic systems where traditional methods may fail to capture the underlying patterns. Recurrence Analyses is one primary method of visualizing and quantifying this alternating complex pattern of “chaos” and “order” that recur. We established Multilevel Heterogeneous Recurrence Analysis (MHRA) to increase specificity and quantification of complex EEG patterns. MHRA offers a flexible framework for uncovering dynamic brain characteristics across multiple scales. With recurrence-based approach using chaos-driven metrics, we described age-specific REM sleep micro- and macrostructural features in pediatric populations. Methods REM sleep data from children and adolescents aged 6–18 years were analyzed using MHRA. For microstructural analysis, electroencephalogram (EEG) signals were extracted from REM epochs, normalized, and analyzed to quantify dynamic properties within each epoch. For macrostructural analysis, sleep stages (Wake, N1, N2, N3, REM) were segmented into 30-second epochs, producing symbolic sequences to represent stage transitions throughout the night. MHRA was applied to visualize dynamic recurrence patterns using Heterogeneous Recurrence Plots and Fractal Maps. Machine learning techniques were integrated to identify age-specific features across the micro- and macrostructural levels. Results Principal Component Analysis was performed to identify and explore age-related variations in REM EEG micro- and macrostructural features across pediatric age groups. The analysis revealed that the extracted REM micro- and macrostructural dynamics exhibited clear and distinct age-related patterns among children and adolescents aged 6 to 18 years. These findings demonstrate that the proposed methods successfully captured age-specific neurodevelopmental signatures, reflecting the evolving characteristics of REM sleep across developmental stages. Conclusion Our findings suggest that both micro- and macrostructures of REM sleep contain distinct developmental signatures across different age groups. This methodology offers promise as a diagnostic tool for detecting atypical neurodevelopment early in life, potentially enabling earlier therapeutic interventions and improved outcomes for children with developmental concerns. Support (if any)

0980 Discrepancies in Caregiver-Reported and Laboratory-Assessed Early Childhood Sleep Problems

SLEEP · 2025-05-01

Abstract Introduction Sleep disordered breathing (SDB) and insufficient sleep are common in early childhood and linked to neurobehavioral functioning, highlighting the importance of screening for these sleep problems. However, few studies have examined variation in multi-method evaluations of these concerns. This study compared caregiver-reported symptoms of child SDB and sleep duration to subsequent polysomnography (PSG) and actigraphy. Methods Data from 95 3-5-year-olds (43% boys, 49% Black, 51% Non-Latine White; 96% maternal caregiver) were drawn from a larger study. Caregivers reported on symptoms of child SDB using the Pediatric Sleep Questionnaire (PSQ) and on insufficient sleep using the Brief Child Sleep Questionnaire (BCSQ). Preschoolers were initially categorized into 4 groups based on measure cut-offs and sleep duration guidelines: (A) SDB only (PSQ score □0.33 clinical cut-off, total 24-hour sleep duration &amp;gt;=10 hours); (B) insufficient sleep only (PSQ &amp;lt; 0.33, total sleep duration &amp;lt; 10 hours); (C) both SDB and insufficient sleep (PSQ □0.33, total sleep duration &amp;lt; 10 hours); (D) no sleep problems. Children then completed PSG scored according to diagnostic guidelines and # nights/weeks of actigraphy scored using validated procedures with daily sleep diaries. Results Based on initial caregiver-report, 29 (31%) preschoolers had SDB only (A); 10 (11%) had insufficient sleep only (B); 13 (14%) had both SDB and insufficient sleep (C); and 43 (45%) had no sleep problems (D). After PSG/actigraphy, 62% were reassigned from their initial caregiver-reported group. Twenty-one percent were reassigned based on PSG results only, 27% reassigned based on actigraphy only, and 14% reassigned based on both actigraphy and PSG. Initially, based on caregiver-report, the largest group (45%) were the no sleep problem group (D). However, after PSG and actigraphy, the no sleep problem group (D) only reflected 21% of the sample. Importantly, after PSG and actigraphy, the group reflecting co-occurring SDB and insufficient sleep (C) increased from 14% to 38% of the sample. Conclusion Early childhood sleep-disordered breathing and insufficient sleep may be underrecognized when based on caregiver report compared to more objective measures. Additional multi-method studies with early childhood samples may be needed to re-evaluate caregiver report-based clinical cutoffs for sleep issues in young children. Support (if any) R01HL163798 (AAW)