Sleep disordered breathing in young children: Should we wait for spontaneous resolution?

Introduction: Sleep disordered breathing(SDB) is common in children and associated to complications. Adenotonsillar hypertrophy is the main risk factor and adenotonsillectomy(AT) is the first-line treatment. High rates of post-surgical recurrence of symptoms and high risk of surgical complications have been reported in young children submitted to AT. Objective: to compare the outcome of AT versus watchful waiting (WW) in children under 4yrs with SDB. Methods: Retrospective study. Children under 4yrs referred to a Pediatric Consult for SDB were included. Data on symptoms on presentation and treatment (surgical/non-surgical) was obtained from clinical records. Parents answered a telephone questionnaire looking for their children9s current symptoms. Descriptive data analysis; non-parametric tests; p Results: 28 children included; 57.1% male; median age at 1st consultation 2.2yrs. 96.4% patients reported snoring and 85.7% had witnessed apneas during sleep. Sleep apnea was diagnosed in 35.7%. Twenty-one(75%) were treated with AT and 7(25%) were on WW. Parents were contacted latter, at a mean time of 13mths after surgery in operated patients and 18mths of follow-up in non-operated children (p=0.175). At that time, the rate of snoring was reduced by -57.1% in operated patients and -28.6% of non-operated (p=0.198) and witnessed apneas were reduced in -76.2% in the operated and -85.7% in the non-operated (p=0.444). Conclusion: No significant differences were observed in the outcome of operated and non-operated children under 4yrs old, in terms of symptoms. These results seem to support watchful waiting as an approach for SDB in young children but careful decisions should be made case-by-case.