Bakker Jessie P, Zhang Fang, Amin Raouf, Baldassari Cristina M, Chervin Ronald D, Garetz Susan L, Hassan Fauziya, Ibrahim Sally, Ishman Stacey L, Kirkham Erin M, Linden Ariel, Mitchell Ron B, Naqvi Kamal, Rosen Carol L, Ross Kristie, Tapia Ignacio E, Young Lisa R, Yu Phoebe K, Redline Susan, Wang Rui
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
JAMA Pediatr. 2025 Mar 17. doi: 10.1001/jamapediatrics.2025.0023.
The literature indicates that health care utilization (HCU) of children with untreated moderate-to-severe obstructive sleep apnea is greater than that of matched controls before diagnosis, and treatment is associated with a decline in HCU not observed in those who remain untreated. Research on this topic has been limited to retrospective analyses and observational cohort studies; little is known about HCU among the many children with snoring and mild sleep-disordered breathing (SDB).
To determine whether adenotonsillectomy in comparison with watchful waiting with supportive care is associated with fewer health care encounters and prescriptions.
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial, Pediatric Adenotonsillectomy Trial for Snoring (PATS), was a 12-month, parallel-arm trial conducted from 2016 to 2022 in tertiary care centers in the United States. Participants were recruited from otolaryngology, sleep, pulmonary, or general pediatric clinics; aged 3 to 13 years; diagnosed with mild SDB; had a tonsillar hypertrophy grade of 2 or more; and had a body mass index z score less than 3. Children referred from a clinician outside of the local electronic medical record system were excluded. Data analysis was conducted from June 2022 to April 2024.
Early adenotonsillectomy.
Evaluation of HCU was a prespecified secondary aim of PATS. Total encounters and total prescriptions over the 12 months after randomization were analyzed.
Among 459 children who were randomized, the analytic sample included 381 children, after excluding those referred from outside the local electronic medical record system. The median (IQR) age was 6 (4-8) years; 192 participants (50%) were female and 189 (50%) male. Adenotonsillectomy was associated with a 32% reduction in total health care encounters (mean difference, -1.25 per participant per year; 95% CI, -1.96 to -0.53) and a 48% reduction in prescriptions (mean difference, -2.53 per participant per year; 95% CI, -4.12 to -0.94). The difference in encounters was primarily driven by fewer office visits and outpatient procedures rather than by reduced hospitalizations or urgent care visits.
This study found that adenotonsillectomy was associated with reduced all-cause HCU in children with mild SDB, supporting early intervention for children with mild SDB. Future research focused on the cost effectiveness of adenotonsillectomy for pediatric SDB is warranted.
ClinicalTrials.gov Identifier: NCT02562040.
文献表明，未经治疗的中重度阻塞性睡眠呼吸暂停患儿在诊断前的医疗保健利用率高于匹配的对照组，且治疗与医疗保健利用率下降相关，而未接受治疗的患儿未出现这种情况。关于这一主题的研究仅限于回顾性分析和观察性队列研究；对于众多打鼾和轻度睡眠呼吸障碍（SDB）患儿的医疗保健利用率知之甚少。
确定与观察等待及支持性护理相比，腺样体扁桃体切除术是否会减少医疗保健就诊次数和处方数量。
设计、设置和参与者：这项随机临床试验，即儿童打鼾腺样体扁桃体切除术试验（PATS），是一项为期12个月的平行组试验，于2016年至2022年在美国的三级医疗中心进行。参与者从耳鼻喉科、睡眠、肺科或普通儿科诊所招募；年龄在3至13岁之间；被诊断为轻度SDB；扁桃体肥大分级为2级或更高；体重指数z评分小于3。排除从当地电子病历系统之外的临床医生转诊而来的儿童。数据分析于2022年6月至2024年4月进行。
早期腺样体扁桃体切除术。
医疗保健利用率评估是PATS预先设定的次要目标。分析了随机分组后12个月内的总就诊次数和总处方数量。
在459名随机分组的儿童中，排除从当地电子病历系统之外转诊而来的儿童后，分析样本包括381名儿童。中位（IQR）年龄为6（4 - 8）岁；192名参与者（50%）为女性，189名（50%）为男性。腺样体扁桃体切除术与总医疗保健就诊次数减少32%（平均差异为每名参与者每年 - 1.25；95% CI， - 1.96至 - 0.53）以及处方数量减少48%（平均差异为每名参与者每年 - 2.53；95% CI， - 4.12至 - 0.94）相关。就诊次数的差异主要是由于门诊就诊和门诊手术减少，而非住院或紧急护理就诊次数减少。
本研究发现，腺样体扁桃体切除术与轻度SDB患儿的全因医疗保健利用率降低相关，支持对轻度SDB患儿进行早期干预。有必要开展未来研究，聚焦于腺样体扁桃体切除术治疗小儿SDB的成本效益。
ClinicalTrials.gov标识符：NCT02562040。
