{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T20:23:12Z","timestamp":1787862192048,"version":"build-2784847793"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"Importance<\/jats:title>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).<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine whether adenotonsillectomy in comparison with watchful waiting with supportive care is associated with fewer health care encounters and prescriptions.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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<\/jats:italic> 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.<\/jats:p><\/jats:sec>Intervention<\/jats:title>Early adenotonsillectomy.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Evaluation of HCU was a prespecified secondary aim of PATS. Total encounters and total prescriptions over the 12 months after randomization were analyzed.<\/jats:p><\/jats:sec>Results<\/jats:title>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, \u22121.25 per participant per year; 95% CI, \u22121.96 to \u22120.53) and a 48% reduction in prescriptions (mean difference, \u22122.53 per participant per year; 95% CI, \u22124.12 to \u22120.94). The difference in encounters was primarily driven by fewer office visits and outpatient procedures rather than by reduced hospitalizations or urgent care visits.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT02562040<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapediatrics.2025.0023","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T15:32:23Z","timestamp":1742225543000},"page":"600","source":"Crossref","is-referenced-by-count":13,"title":["Adenotonsillectomy and Health Care Utilization in Children With Snoring and Mild Sleep Apnea"],"prefix":"10.1001","volume":"179","author":[{"given":"Jessie P.","family":"Bakker","sequence":"first","affiliation":[{"name":"Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School 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