Childhood obstructive sleep apnoea: to treat or not to treat, that is the question

Childhood obstructive sleep apnoea (OSA) is relatively common, occurring in at least 2% of children1 with other studies estimating a much higher prevalence.2 Part of the reason for the controversy regarding the prevalence of OSA is the lack of a standardised definition. In children with OSA, clinical symptoms during wakefulness tend to be vague and non-specific (eg, behavioural issues) and are often attributed to other problems; excessive daytime sleepiness is relatively uncommon. Relying on diagnostic polysomnography is also problematic. An apnoea-hypopnoea index (AHI) ⩾1.5/h is considered statistically abnormal.3 4 5 However, this does not mean that every child with an AHI ⩾1.5/h will benefit from treatment. There is a paucity of data on the clinical outcomes of children with OSA, and virtually no data on the clinical correlates of polysomnographic abnormalities. The usual treatment for OSA in young children is adenotonsillectomy. Should children with mild OSA be subjected to this surgery, with all of its potential attendant complications? To resolve this controversy, we need the answer to two questions:

• What is the clinical outcome of mild OSA?

• What is the natural history of mild OSA if left untreated?

In this issue of Thorax, Li et al6 describe the natural history of mild OSA (AHI 1–5/h) in 6–13-year-old children over the course of …