Children who underwent adenotonsillectomy for mild obstructive sleep-disordered breathing showed no significant increase in undesirable weight gain compared to those under watchful waiting, according to a new clinical trial.

An exploratory analysis of the Pediatric Adenotonsillectomy Trial for Snoring randomized clinical trial assessed whether adenotonsillectomy (AT) is associated with undesirable weight gain in children with mild obstructive sleep-disordered breathing (oSDB). The study, conducted from June 29, 2016, to February 1, 2021, included 375 children aged 3 to 12 years across seven U.S. pediatric tertiary care centers, with an average age of 6.1 years, and 50.2% were female. Mild oSDB was defined as snoring with an obstructive apnea-hypopnea index (oAHI) of <3 events/hour. At the start of the study, 38% of the participants were classified as having overweight or obesity.

The study compared the effects of early adenotonsillectomy (eAT) with watchful waiting and supportive care (WWSC) on changes in body mass index (BMI) over 12 months. The primary outcome measured was the 12-month change in the percentage of the 95th BMI percentile (%BMIp95), with undesirable weight gain defined as an increase in weight from normal or underweight to overweight/obesity or any weight gain in children already overweight or obese.

Results, published in JAMA Otolaryngology–Head & Neck Surgery, showed no significant difference in undesirable weight gain between the eAT and WWSC groups. Specifically, children in the eAT group exhibited a 1.25-point increase in %BMIp95, compared with a 0.59-point increase in the WWSC group, with a mean difference of 0.93 (95% confidence interval [CI], −0.39 to 2.25). The incidence of undesirable weight gain was 32% in the eAT group versus 27% in the WWSC group, a difference that was not statistically significant.

Regression analysis revealed that early adenotonsillectomy was associated with a 0.84-point higher %BMIp95 at 12 months, but this was not statistically significant. Notably, the study found a significant association between higher oAHI and undesirable weight gain, regardless of treatment group.

These findings suggest that clinicians may inform parents that AT alone is unlikely to contribute to excessive weight gain in children with mild oSDB. However, the study's generalizability is limited to elementary school-aged children with mild oSDB and may not apply to adolescents or those with severe OSA or severe obesity.

Full disclosures can be found in the published study.