Adenotonsillectomy in Children With Obstructive Sleep Apnea: A Systematic Review of Clinical Outcomes and Long-Term Complications

Introduction: Pediatric obstructive sleep apnea (OSA) is a prevalent disorder linked to cognitive, behavioral, and cardiovascular consequences. Adenotonsillectomy remains the first-line surgical treatment, yet uncertainties persist regarding its effectiveness and long-term complications. Objective: The primary objective was to evaluate clinical outcomes and adverse events after adenotonsillectomy in children with OSA. Secondary objectives included assessing quality of life improvements, recurrence rates, and predictors of surgical success or failure. Methods: Searches were conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Eligible studies were published within the last 5 years, with inclusion extended to 10 years if fewer than 10 studies were found. Human pediatric studies were prioritized. Risk of bias was assessed with RoB 2, ROBINS-I, and QUADAS-2, and evidence certainty graded using GRADE. Results and Discussion: A total of 1,243 records were identified, of which 26 studies met the eligibility criteria. Adenotonsillectomy improved polysomnographic indices and quality of life in most patients. However, residual OSA was observed in up to 40% of cases, particularly among obese children. Long-term complications included velopharyngeal insufficiency, recurrent infections, and speech alterations, although rates were low. Conclusion: Adenotonsillectomy is effective in improving short-term outcomes in pediatric OSA, but residual disease and long-term complications highlight the need for individualized approaches, careful follow-up, and further high-quality research. Descriptors: Adenoidectomy, Tonsillectomy, Sleep Apnea Syndromes, Pediatrics