The Effect of Tonsillectomy on Sleep Architecture in Pediatric Patients With Obstructive Sleep Apnea

ABSTRACT Objectives To evaluate the impact of pediatric adenotonsillectomy (T&A) on sleep architecture, related sleep factors, and respiratory parameters in children with obstructive sleep apnea ( OSA ), stratified by disease severity. Methods We analyzed 300 consecutive children who underwent full‐night polysomnography ( PSG ) before and after T&A between January 2021 and March 2022. Patients were stratified into severe (apnea–hypopnea index [ AHI ] > 10 events/h or SpO 2 < 80%) and very severe ( AHI > 30 events/h) OSA groups. Correlations were assessed using Spearman analysis. Results The cohort included 233 (78%) severe, with a mean age of 6.85 years ( SD = 4.83), BMI 103% of the 95th percentile ( SD = 47.4), 61% male, and 55% Hispanic. T&A reduced the mean AHI from 23.51 to 6.25 ( p < 0.001). Persistent severe OSA was observed in 23% of patients, who demonstrated significantly shorter total sleep time ( TST ) (350.54 vs. 413.73 min, p < 0.001), less Stage N3 sleep (89.54 vs. 109.63 min, p = 0.001), less Stage R sleep (69.56 vs. 91.43 min, p < 0.001), and a higher arousal index (15.65 vs. 10.34, p < 0.001) compared with those without persistent severe OSA . Changes in TST strongly correlated with changes in Stage N2 sleep ( r = 0.74; 95% CI , 0.68–0.79; p < 0.001) and Stage R sleep ( r = 0.68; 95% CI , 0.61–0.74; p < 0.001). Conclusions T&A significantly improves sleep architecture and respiratory outcomes in pediatric OSA . However, deficits in restorative sleep stages persist in a subset of patients. Level of Evidence 4