{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:05:33Z","timestamp":1792069533182,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82271167"],"award-info":[{"award-number":["82271167"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether children with rapid eye movement (REM)\u2013predominant obstructive sleep apnea (OSA) are less likely to achieve disease resolution following different management strategies compared with those with non\u2013REM\u2010predominant OSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a secondary analysis of the Childhood Adenotonsillectomy Trial. Children aged 5.0\u20139.9\u2009years with OSA were randomized to adenotonsillectomy (AT) or watchful waiting. REM\u2010predominant OSA was defined as a REM\u2010AHI to NREM\u2010AHI ratio of \u2265\u20092. The primary outcome was OSA resolution at 7\u2010month follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 382 children (48.2% male; median age 6.75\u2009years), 55.8% had REM\u2010predominant OSA. Black race and obesity were associated with a higher prevalence of this subtype. REM\u2010predominant OSA group exhibited increased daytime sleepiness (difference, 10%; 95% CI, 1%\u201317%), higher AHI (difference, 1.37; 95% CI, 0.67\u20132.22), and lower oxygen saturation nadirs (difference, \u22122.00; 95% CI, \u22123.00 to \u22122.00) compared with the non\u2013REM\u2010predominant OSA group. However, PSQ\u2010defined symptom burden (difference, \u22121%; 95% CI, \u22129% to 7%) and OSA\u201018\u2010defined quality\u2010of\u2010life impairment (difference, 3%; 95% CI, \u22126% to 12%) did not differ significantly between groups. At the 7\u2010month follow\u2010up, children in the REM\u2010predominant OSA group who underwent watchful waiting were significantly less likely to experience spontaneous resolution than those in the non\u2013REM\u2010predominant OSA group (aOR, 0.52; 95% CI, 0.28\u20130.97). However, no significant difference was observed in the OSA resolution rate between the two groups who underwent AT (aOR, 0.75; 95% CI, 0.34\u20131.66).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>REM\u2010predominant OSA was associated with greater daytime sleepiness and PSG severity but was not associated with significantly greater parent\u2010reported symptom burden or worse disease\u2010specific quality of life. Children with REM\u2010predominant OSA were less likely to experience spontaneous resolution after watchful waiting, underscoring the prioritization of AT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>3.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      Identifier: NCT00560859\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lio2.70524","type":"journal-article","created":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T15:36:13Z","timestamp":1785684973000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk Factors, Symptom Burden, and Treatment Response in Pediatric\n                    <scp>REM<\/scp>\n                    \u2010Predominant\n                    <scp>OSA<\/scp>\n                    : Evidence From the Childhood Adenotonsillectomy Trial"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5508-1811","authenticated-orcid":false,"given":"Chao","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, ENT Institute, EYE &amp; ENT Hospital Fudan University  Shanghai China"},{"name":"State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, Institutes of Brain Science Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Qingdao Central Hospital University of Health and Rehabilitation Sciences  Qingdao China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5743-1990","authenticated-orcid":false,"given":"Jingfang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, ENT Institute, EYE &amp; ENT Hospital Fudan University  Shanghai China"},{"name":"State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, Institutes of Brain Science Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3477-1562","authenticated-orcid":false,"given":"Yunfeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, ENT Institute, EYE &amp; ENT Hospital Fudan University  Shanghai China"},{"name":"State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, Institutes of Brain Science Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2022.0885"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202307\u2010653OC"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201609\u2010662OC"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2023.1160396"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2014.3049"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/mcp.0000000000000319"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.10.080"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2011.10.025"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.5678"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102869.2009.00760.x"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1215881"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.1388"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1389\u20109457(99)00009\u2010x"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhn.2000.105254"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004\u20100730"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0166\u20102023"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.162.2.9908058"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.3498"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201209\u20101654OC"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11325\u2010022\u201002602\u20105"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202006\u2010696FR"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.10892"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/7.1.18"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/ohn.366"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13073\u2010021\u201000917\u20108"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440\u20101843.2011.02037.x"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.10124"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2024.112168"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/00034894241227030"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431\u2010019\u201003557\u20108"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14\u20102873"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010genom\u2010120522\u2010012938"}],"container-title":["Laryngoscope 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