Adenotonsillectomy or Watchful Waiting for Pediatric Sleep-Disordered Breathing | Otolaryngology | JAMA

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.1 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).² The study supports current practice and provides further evidence for discussing surgery as part of shared decision-making.