Indications for Adenoidectomy and Tonsillectomy for Obstructive Sleep Apnea in Children and Adolescents

Obstructive sleep apnea (OSA) in children is a common disorder with significant effects on behavior, cognition, and quality of life. Its diagnosis is primarily based on clinical history and examination, supported by standardized questionnaires such as the Sleep-Related Breathing Disorder subscale of the Pediatric Sleep Questionnaire (SRDB-PSQ), which provides high diagnostic accuracy. Although polysomnography remains the gold standard, its use should be limited to high-risk patients or unclear cases due to availability and cost constraints. Adenotonsillar hypertrophy represents the main cause of pediatric OSA and is often self-limiting. For children with mild symptoms, a watchful waiting approach may be appropriate. Randomized controlled trials (e.g., CHAT, POSTA) demonstrate that spontaneous improvement in polysomnographic parameters occurs in some children, though clinical symptoms often persist. Patients with low apnea-hypopnea-index (AHI), mild obesity, and mild symptoms appear suitable for observation but require a close follow-up. Adenotonsillectomy remains the most effective treatment for clinically significant OSA, leading to marked improvements in sleep quality, daytime symptoms, and quality of life, largely independent of polysomnographic findings. Partial tonsillectomy offers similar efficacy with reduced postoperative morbidity. Management should be individualized and focus on clinical presentation more than on sleep recordings. Future research should focus on identifying which children benefit most from conservative or surgical strategies.