Adenotonsillectomy or Watchful Waiting for Pediatric Sleep-Disordered Breathing

Habitual snoring and sleep-disordered breathing (SDB) are remarkably common conditions in children. Poor sleep has a significant effect on the neurobehavior and quality of life (QOL) of the child and therefore on the parent-child dyad, which exceeds the effect of a prevalent and treatable disease. When surgery is considered as treatment, the surgeon and family balance the potential benefit to the child, associated morbidity, related financial burden, and the cost-effectiveness of surgery compared with medical management or watchful waiting. When there is a choice, the collaborative process of shared decision-making between the surgeon and the child and their family to consider the family’s values and preferences to make treatment decisions using the best available evidence is often used. A study in this issue of JAMA, the Pediatric Adenotonsillectomy Trial for Snoring (PATS), provides evidence-based data on the benefits and limitations of surgical intervention in children with snoring or mild obstructive sleep apnea (OSA). The study supports current practice and provides further evidence for discussing surgery as part of shared decision-making.