Impact of treatment of mild sleep-disordered breathing on children’s health

This will be a randomized, single-blind 12-month intervention study that compares the impact of aT on measures of behavior, quality of life and HCu in children with MSDB. The proposed study will involve participation of children and their caregivers. Children with symptoms of MSDB will be recruited from each site's sleep clinics and laboratories, otolaryngology clinics, asthma clinics and general pediatric clinics. Potentially eligible children who are reported to be snorers at each site will be identified through systematic screening of health records and parent interviews. Children who meet study eligibility criteria will be randomized to having either eaT or WWSC for 12 months. in addition to the enrollment PSG at baseline, participants will receive behavioral testing, assessment of SDB symptoms, sleepiness, and quality of life, anthropometry and blood pressure. all measures will be repeated at 6 and 12 months except the PSG at 12 months only. Potential factors that may affect response to aT will also be assessed (asthma and atopy, second hand smoke exposure, sleep duration by actigraphy, family functioning). approximately 920 participants will undergo baseline screening PSG, and 460 participants will be randomized. Both genders and all racial and ethnic groups will be eligible for participation. Participants failing baseline screening PSG will be referred for clinical care. it is anticipated that ~50% of participants will be eligible after PSG. 460 eligible children, 230 per treatment arm, will be randomized to one of two treatment groups, and followed for a 12-month period. eligible participants will be randomized to one of two management groups: 1. early adenotonsillectomy (eaT) performed by participating enT surgeons within 1-4 weeks of randomization. 2. Watchful waiting with Supportive Care (WWSC) Participants in both groups will receive verbal and written information about healthy sleep habits guidance. Participants will be referred for appropriate [Quote]usual care[Quote] for any co-morbidities (for example, poorly controlled asthma, allergies) identified by the study team as needing further optimization of management. Participants will undergo a standardized assessment of behavior, behavioral performance testing, and other health-related evaluations at baseline and 6 and 12 month follow-up time points. Participants will receive monthly telephone calls in order to maximize retention and to collect additional symptom and HCu reports. after 12 months, children who did not get surgery who have a 12-month PSG showing obstructive sleep apnea (apnea hypopnea index [Greater Than]2/hr or obstructive index [Greater Than] 1/hr) or whose parent reports ongoing symptoms/concerns will be referred back to enT for further clinical management (such as adenotonsillectomy) as per standard clinical care.