Progression of mild sleep-disordered breathing in children managed with watchful waiting

作者：Kirkham EM, Ishman S, Garetz S, Baldassari CM, Mitchell RB, Liu C, Tapia IE, Elden LM, Hassan F, Ibrahim S, Ross K, Cen M, Wang R, Redline S, Chervin RD · 发表于：Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 年份：2026 · DOI：10.1007/s44470-026-00082-y · 被引用次数：76 · 研究领域：Sleep Apnea Syndromes、Watchful Waiting、Child、Child, Preschool、Female、Humans、Male、Adenoidectomy、Disease Progression、Polysomnography、Severity of Illness Index、Snoring

PURPOSE: To identify clinical characteristics that may be associated with persistence or progression of mild sleep-disordered breathing (SDB) in children who are observed without surgery. METHODS: This is a secondary analysis of the control arm of the Pediatric Adenotonsillectomy Trial for Snoring (PATS), which randomized 458 children aged 3.0 to 12.9 years with mild SDB (snoring with obstructive apnea-hypopnea index [oAHI] < 3 events/hour) to early adenotonsillectomy (eAT) versus watchful waiting with supportive care (WWSC). Participants were assessed at baseline and 12 months with the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder (PSQ-SRBD) scale and polysomnography (PSG). We tested for factors predictive of either (1) PSG progression defined by a 12-month oAHI ≥ 3 or (2) symptom persistence or progression defined by a 12-month PSQ-SRBD score ≥ 0.33. RESULTS: A total of 234 participants were observed (mean age 6.2 years, 111 [47%] female, 65 [28%] Black or African American, 37 [16%] Hispanic). Overall, only 13% (n = 20/150) progressed to an oAHI ≥ 3 on repeat PSG, whereas over half (n = 110/192, 57%) had symptom persistence/progression. Of the children with persistent or progressive symptoms, 18% (n = 16/103) progressed to oAHI ≥ 3. In unadjusted analyses, PSG progression was associated with Black race (OR 2.71, 95% CI 1.03-7.17) and higher baseline PSQ-SRBD (OR 1.74, 95% CI 1.03-3.08). Symptom persistence/progression was predicted by asthma (OR 2.70 [95%...