- Design
- Retrospective nested cohort with inverse probability weighting
- Population
- 174 children with pre- and post-tonsillectomy polysomnography (of 940 operated)
- Primary outcome
- Postoperative AHI <5 events/h
- Effect
- Success 70.1% overall; 41.7% with AHI >30; OR 0.96 per event/h
A retrospective cohort at a quaternary children's centre reviewed 940 children who had tonsillectomy for obstructive sleep apnoea (2016–2024), of whom 174 had polysomnography both before and after surgery. Because sicker children were more likely to be retested, the analysis used inverse probability weighting to correct for that selection.
Median preoperative AHI was 16.5 and 45% were obese. Overall, 70.1% reached a postoperative AHI under 5. Each additional event per hour before surgery was associated with lower odds of success (OR 0.96 per event/h). Children with AHI over 30 were cured in only 41.7%. Obesity lowered the estimate (OR 0.53) but was not statistically significant.
This is single-centre and observational, and success depends on the definition used. But it gives families a clearer expectation than a general promise of improvement.
The practical change is in counselling and follow-up: for very severe OSA, plan postoperative polysomnography and discuss that further treatment, such as CPAP or weight management, may be needed.
- Counsel families of children with AHI over 30 that surgery alone cures fewer than half.
- Plan postoperative polysomnography for children with severe or very severe OSA.
- Address weight in children with obesity alongside surgery.
- Discuss CPAP or other options in advance for persistent apnoea.
Why it matters
Families who expect a cure may not return when symptoms persist, leaving residual apnoea untreated.
Don't overread it
Observational, single-centre data; the obesity effect was not statistically clear.
The statistics, in plain English
An odds ratio of 0.96 per event means every extra apnoea per hour before surgery lowers the odds of cure by about 4%; across 20 or 30 extra events, that compounds substantially. Weighting adjusts for which children were retested, but cannot remove all selection.
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