The Effect of Adenotonsillectomy on Sleep Efficiency in Pediatric Patients

Objectives To evaluate the impact of adenotonsillectomy (T&A) on sleep efficiency (SE) characteristics, a marker of sleep quality with implications for behavior and cognition in children with obstructive sleep apnea (OSA). Methods We analyzed 139 children who underwent full‐night polysomnography (PSG) before and after T&A between January 2021 and September 2023. Patients were stratified into three SE severity groups: normal (greater than or equal to 85%), mild–moderate (70%–84%), and severe (less than 70%). Results Our cohort (median age 5.15 years, IQR 7.62; 68% male; 55% Hispanic) showed notable changes post‐T&A: normal SE increased from 42.4% to 48.9%, while severe SE increased from 9.4% to 18.0%. Median AHI significantly decreased from 17.3 (IQR 26) to 6 (IQR 8.8), confirming T&A's effectiveness in treating OSA. Sleep architecture patterns persisted postsurgery ( p < 0.001 for NREM and REM differences), but respiratory parameters improved across SE categories. Down Syndrome (DS) was associated with poorer outcomes ( p = 0.013). The severe SE group showed a substantial decline in SE (−17%, SD: 23%, p < 0.001), with high individual variability. Conclusions T&A improves SE and resolves OSA for many pediatric patients. However, a subset experiences worsening SE, particularly those with comorbidities like DS. These findings highlight the importance of individualized postoperative care and the need for further research into predictors of T&A outcomes in pediatric OSA. Level of Evidence 4.