Potential Risk Factors of Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children

TO THE EDITOR:We read Redline et al.'s article [1] with keen interest, aiming to highlight a potential risk factor for adenotonsillectomy. Obstructive sleep apnea (OSA) has emerged as a critical focus in modern health research due to its widespread prevalence and significant impact on overall health. This condition affects millions of individuals globally, with far-reaching implications for public health [2].It is known that after birth, the surfaces of human adenoids and palatine tonsils exhibit numerous folds and crypts inhabited by commensal microbiota. These microorganisms subsequently play a role in shaping the maturation of the innate mucosal immune response, potentially serving as a critical determinant in either safeguarding or predisposing individuals to mucosal infections [3-4]. Therefore, we are concerned that after adenotonsillectomy, the immune pathway of infants would be altered, thus causing lasting effects in adulthood. According to this study [5], which tracked children who underwent adenoidectomy or tonsillectomy up to 30 years old, the results show that tonsillectomy was associated with nearly tripled relative risk of diseases of the upper respiratory tract, and adenoidectomy was associated with more than doubled relative risk of chronic obstructive pulmonary disorder (COPD). The relative risk of upper respiratory tract diseases and conjunctivitis is nearly doubled. This finding provides a decision factor for those children who are at high risk of upper respiratory disease, such as a family history of lung cancer. Another similar article [6] compared the asthma conditions, emergency room visits, hospitalization rates, and asthma prescriptions of poorly controlled asthmatic children before and one year after undergoing adenotonsillectomy. The results indicate that undergoing the surgery can improve asthma symptoms. Despite providing the opposite result, this article lacks efficient observational outcome indicators and needs a longer observation period.Based on previous studies, we recommend that decision-making regarding surgery needs to consider the risks of various long-term health conditions.References:Redline S, Cook K, Chervin RD, et al. Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children: A Randomized Clinical Trial. JAMA . 2023;330(21):2084-2095.Kattimani V, Panneerselvam E, Tiwari R, Panga GSK, Sreeram RR. An Overview of Systematic Reviews on the Surgical Management of Obstructive Sleep Apnoea. J Maxillofac Oral Surg. 2023 Dec;22(4):781-793. doi: 10.1007/s12663-023-02051-x. Epub 2023 Nov 17. PMID: 38105854; PMCID: PMC10719205.Johnston JJ, Douglas R. Adenotonsillar microbiome: an update. Postgrad Med J. 2018;94(1113):398-403.Hara M, Morimoto N, Watabe T, Morisaki N, Matsumoto K. Can the effectiveness of tonsillectomy for PFAPA syndrome be predicted based on clinical factors. Int J Rheum Dis. 2023;26(3):480-486.Byars SG, Stearns SC, Boomsma JJ. Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood. JAMA Otolaryngol Head Neck Surg. 2018;144(7):594-603.Kaiser P. Obstructive sleep apnea in poorly controlled asthmatic children: effect of adenotonsillectomy. Pediatr Pulmonol. 2012;47(3):311-314.