Isolated Adenoidectomy for Pediatric Sleep-Disordered Breathing: A Systematic Review and Meta-analysis.

Abstract

To evaluate the efficacy of isolated adenoidectomy in managing pediatric sleep-disordered breathing (SDB) and upper airway obstruction (UAO). MEDLINE, EMBASE, and CENTRAL were systematically searched from inception through March 2025. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we included studies reporting outcomes of isolated adenoidectomy in children with SDB and UAO. Two reviewers independently screened studies, extracted data, and assessed risk of bias. A meta-proportion analysis was conducted to evaluate symptomatic improvement and the need for further surgical intervention. Twenty-two observational studies including 4460 children were analyzed. The weighted mean age was 5.2 years. Isolated adenoidectomy led to a mean apnea-hypopnea index reduction of 11.3 events/h across four studies. The pooled proportion of symptomatic improvement was 75% (95% CI 60-88), while the pooled rate of further surgical intervention was 17% (95% CI 11-24). Subgroup analyses suggested greater symptomatic improvement and lower reoperation rates in children older than 3 years. Isolated adenoidectomy improves both objective sleep parameters and subjective outcomes. In appropriately selected children, it may represent a conservative alternative to adenotonsillectomy. These findings, however, require confirmation through well-designed randomized controlled trials.