Skip Polysomnography Before Adenotonsillectomy for Snoring?

To the Editor In December 2023, results of the Pediatric Adenotonsillectomy Trial for Snoring (PATS) were published in JAMA and JAMA Otolaryngology –Head& Neck Surgery. Like other elegantly designed and executed clinical trials, PATS triggers more questions than the answers provided. The novel term mild sleep-disordered breathing (SDB) is introduced that combines snoring with an apnea-hypopnea index (AHI) of less than 1 event/h (primary snoring) and AHI 1 to less than 3 events/h (mild obstructive sleep apnea [OSA]). Although both subgroups are indistinguishable regarding symptoms and morbidity, this term could confuse the literature. Mild OSA is defined traditionally as AHI of 1 to 5 events/h, yet the authors provide no convincing explanation as to why this definition should change. In CHAT (the Childhood Adenotonsillectomy Trial), adenotonsillectomy candidates manifested variable success rates to early surgery (eAT) depending on SDB severity; 5 participants with mild OSA needed eAT vs only 3 with moderate to severe OSA (AHI>4.7 events/h) to prevent abnormal AHI in 1 at follow-up.
Source: JAMA Otolaryngology - Head and Neck Surgery - Category: ENT & OMF Source Type: research