Tonsil surgery is an effective treatment for pediatric obstructive sleep apnea irrespective of underlying comorbidities

Objective To evaluate the effectiveness of tonsil surgery in managing obstructive sleep apnea (OSA) in children with comorbidities predisposing to OSA. Methods Children under 16 years of age with comorbidities who underwent tonsil surgery for OSA and had both pre- and postoperative polysomnography (PSG) within two years of surgery at Helsinki University Hospital, Finland, between 2009 and 2024 were retrospectively reviewed. Results The study comprised 33 children, of whom 26 (79%) underwent (adeno)tonsillotomy and 7 (21%) (adeno)tonsillectomy. All participants had medical comorbidities, such as craniofacial dysmorphisms and neurological disorders. The median obstructive apnea–hypopnea index (OAHI) decreased from 17.7 h -1 (interquartile range, IQR 6.5 – 42.9) preoperatively to 1.9 h -1 (IQR 0.3 – 8.4) postoperatively (p < 0.0001). Tonsil size was only weakly correlated with the postoperative reduction in OAHI ( R 2 0.11 , p = 0.035). In the tonsillotomy group, the median OAHI decreased from 23.1 h -1 (IQR 6.3–45.2) to 1.8 h -1 (IQR 0.2–8.5) (p < 0.0001). Improvements in PSG parameters were similar in the tonsillotomy and tonsillectomy groups. Postoperatively, 40% of the children needing ventilatory support were able to discontinue it. Conclusion Tonsillar surgery alleviates OSA in most children irrespective of underlying comorbidities associated with OSA. In children with comorbidities, even operating on relatively small tonsils can lead to significant improvement in OSA. TT resulted in highly significant improvements in PSG parameters and the effectiveness of tonsillotomy seems equal to tonsillectomy.