{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T13:53:07Z","timestamp":1781877187821,"version":"3.54.5"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T00:00:00Z","timestamp":1775952000000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the impact of adenotonsillectomy (T&amp;A) on sleep efficiency (SE) characteristics, a marker of sleep quality with implications for behavior and cognition in children with obstructive sleep apnea (OSA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 139 children who underwent full\u2010night polysomnography (PSG) before and after T&amp;A between January 2021 and September 2023. Patients were stratified into three SE severity groups: normal (greater than or equal to 85%), mild\u2013moderate (70%\u201384%), and severe (less than 70%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our cohort (median age 5.15\u2009years, IQR 7.62; 68% male; 55% Hispanic) showed notable changes post\u2010T&amp;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&amp;A's effectiveness in treating OSA. Sleep architecture patterns persisted postsurgery (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 for NREM and REM differences), but respiratory parameters improved across SE categories. Down Syndrome (DS) was associated with poorer outcomes (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013). The severe SE group showed a substantial decline in SE (\u221217%, SD: 23%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with high individual variability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>T&amp;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&amp;A outcomes in pediatric OSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>4.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lio2.70404","type":"journal-article","created":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T15:40:22Z","timestamp":1776008422000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Adenotonsillectomy on Sleep Efficiency in Pediatric Patients"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3581-3422","authenticated-orcid":false,"given":"Basir S.","family":"Mansoor","sequence":"first","affiliation":[{"name":"Department of Otolaryngology UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asim","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5216-639X","authenticated-orcid":false,"given":"Ahmed","family":"Abdi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2322-5347","authenticated-orcid":false,"given":"Romaine F.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology UT Southwestern Medical Center  Dallas Texas USA"},{"name":"Department of Pediatric Otolaryngology Children's Medical Center Dallas  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14\u20100970"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202310\u20101857ST"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1393272"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460\u20109592.2011.03597.x"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1586\/17476348.2016.1163224"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfma.2023.09.004"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000508055"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsz078"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0028204"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.13225"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0224139"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2017.12.020"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2009.23.3363"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016\u20103491"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12185826"},{"issue":"2","key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1055\/s-0046-1820390","article-title":"Adenotonsillectomy Improves Gastroesophageal Reflux, Sleep and Quality of Life in Children With Obstructive Sleep Apnea Syndrome\u2014A Pilot Study","volume":"6","author":"Noronha A. 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