Evidence map›Paper›PMID 42414790›Full record

Trial reportJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine2026

Progression of mild sleep-disordered breathing in children managed with watchful waiting.

Erin M Kirkham, Stacey Ishman, Susan Garetz, Cristina M Baldassari, Ron B Mitchell, Christopher Liu, Ignacio E Tapia, Lisa M Elden, Fauziya Hassan, Sally Ibrahim and 5 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Prognostic risk does not establish greater adenotonsillectomy benefit in children with mild sleep-disordered breathing.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Erin M KirkhamDepartment of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA. ekirkham@umich.edu.ORCID http://orcid.org/0000-0001-8975-3022
Stacey IshmanAscension St Vincent-Peyton Manning Children's Hospital, Indianapolis, IN, USA.
Susan GaretzDepartment of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
Cristina M BaldassariDepartment of Otolaryngology, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, VA, USA.
Ron B MitchellDepartments of Otolaryngology-Head and Neck Surgery and Pediatric Sleep Disorders Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Christopher LiuDepartments of Otolaryngology-Head and Neck Surgery and Pediatric Sleep Disorders Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Ignacio E TapiaDivision of Pediatric Pulmonology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA.
Lisa M EldenDivision of Pediatric Otolaryngology, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
Fauziya HassanSleep Disorders Center, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA.
Sally IbrahimDepartment of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA.
Kristie RossDepartment of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA.
Mengqi CenDepartment of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA.
Rui WangDepartment of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA.
Susan RedlineDepartment of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Ronald D ChervinSleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI, USA.

Funding

NHLBI NIH HHS 1U01HL125295NHLBI NIH HHS 1U01HL125307
6 · The paper itself

Abstract

purposeTo identify clinical characteristics that may be associated with persistence or progression of mild sleep-disordered breathing (SDB) in children who are observed without surgery.

methodsThis is a secondary analysis of the control arm of the Pediatric Adenotonsillectomy Trial for Snoring (PATS), which randomized 458 children aged 3.0 to 12.9 years with mild SDB (snoring with obstructive apnea-hypopnea index [oAHI] < 3 events/hour) to early adenotonsillectomy (eAT) versus watchful waiting with supportive care (WWSC). Participants were assessed at baseline and 12 months with the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder (PSQ-SRBD) scale and polysomnography (PSG). We tested for factors predictive of either (1) PSG progression defined by a 12-month oAHI ≥ 3 or (2) symptom persistence or progression defined by a 12-month PSQ-SRBD score ≥ 0.33.

resultsA total of 234 participants were observed (mean age 6.2 years, 111 [47%] female, 65 [28%] Black or African American, 37 [16%] Hispanic). Overall, only 13% (n = 20/150) progressed to an oAHI ≥ 3 on repeat PSG, whereas over half (n = 110/192, 57%) had symptom persistence/progression. Of the children with persistent or progressive symptoms, 18% (n = 16/103) progressed to oAHI ≥ 3. In unadjusted analyses, PSG progression was associated with Black race (OR 2.71, 95% CI 1.03-7.17) and higher baseline PSQ-SRBD (OR 1.74, 95% CI 1.03-3.08). Symptom persistence/progression was predicted by asthma (OR 2.70 [95% CI 1.29, 6.01]), ADHD (OR 3.73 [95% CI 1.13, 16.88]), and tobacco smoke exposure (OR 2.41 [95% CI 1.08-5.82]), while children with larger tonsils (grade III-IV) had lower odds of progression (OR 0.42 [95% CI 0.22-0.78]).

conclusionsA high symptom burden is common after a year of WWSC for mild SDB, but only a minority of children progressed on PSG. Black race and several clinical characteristics and symptom scores were associated with higher likelihood of progression.

trial registrationClinicalTrials.gov Identifier: NCT0256204. CURRENT KNOWLEDGE/STUDY RATIONALE: Can clinical information predict persistence or progression of mild sleep-disordered breathing in children who are observed for 1 year without adenotonsillectomy? STUDY IMPACT: Polysomnographic progression to obstructive sleep apnea occurs in a minority (13%) of those observed while symptom persistence or progression is more common (57%). Children who are Black or who have asthma, attention-deficit hyperactivity disorder, environmental tobacco exposure, and a high symptom burden could be considered stronger candidates than their peers for earlier adenotonsillectomy for symptomatic mild sleep-disordered breathing.

Indexed as

Sleep Apnea SyndromesWatchful WaitingAdenoidectomyChildChild, PreschoolDisease ProgressionFemaleHumansMalePolysomnographySeverity of Illness IndexSnoringSurveys and QuestionnairesTonsillectomyAdenotonsillectomyPATSPediatricSleep apneaSleep-disordered breathingSnoring

Identifiers

PMID42414790
PMCPMC13341984

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.