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REM-predominant OSA is associated with lower spontaneous resolution rates in children managed with watchful waiting, but adenotonsillectomy yields similar resolution rates regardless of OSA subtype.

In a secondary analysis of the Childhood Adenotonsillectomy Trial, children with REM-predominant OSA (REM-AHI/NREM-AHI ≥2) had lower odds of spontaneous resolution at 7 months under watchful waiting compared to non-REM-predominant OSA (aOR 0.52, 95% CI 0.28-0.97). However, adenotonsillectomy resulted in similar resolution rates between the two groups (aOR 0.75, 95% CI 0.34-1.66). REM-predominant OSA was also associated with greater daytime sleepiness and PSG severity but not with worse parent-reported symptom burden or quality of life.

Last updated: Aug 5, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score44/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Risk Factors, Symptom Burden, and Treatment Response in Pediatric REM-Predominant OSA: Evidence From the Childhood Adenotonsillectomy Trial.

observational

Wang C, Wang A, Wu J, Wang Y · Laryngoscope investigative otolaryngology (2026)

Participants: N/A
Duration: 7 months
Intervention: Adenotonsillectomy (AT) versus watchful waiting
Outcome: OSA resolution at 7-month follow-up, daytime sleepiness, AHI, oxygen saturation nadir, PSQ symptom burden, OSA-18 quality of life
Effect Size: aOR for spontaneous resolution in REM-predominant vs non-REM-predominant under watchful waiting = 0.52 (95% CI 0.28-0.97); aOR for resolution after AT = 0.75 (95% CI 0.34-1.66)
Population: Children aged 5.0-9.9 years with OSA from the Childhood Adenotonsillectomy Trial (n=382, 48.2% male, median age 6.75 years)

Result:

PubMed: 42544299DOI: 10.1002/lio2.70524

Mechanism Graph

REM-predominant OSA is defined by a REM-AHI to NREM-AHI ratio ≥2
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This subtype is associated with greater daytime sleepiness and PSG severity (higher AHI, lower oxygen nadir)
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Under watchful waiting, spontaneous resolution is less likely in REM-predominant OSA
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Adenotonsillectomy appears to overcome this difference, leading to similar resolution rates

Limitations

  • ⚠Secondary analysis of a randomized trial, not a pre-specified subgroup analysis
  • ⚠Definition of REM-predominant OSA (ratio ≥2) may not be universally accepted
  • ⚠Follow-up limited to 7 months, long-term outcomes not assessed
  • ⚠Parent-reported symptom burden and quality of life may not capture all clinically relevant differences

Frequently Asked Questions

What is REM-predominant OSA?▼

REM-predominant OSA is a subtype of obstructive sleep apnea where apneas and hypopneas occur predominantly during rapid eye movement (REM) sleep, defined here as a REM-AHI to NREM-AHI ratio of ≥2.

Does adenotonsillectomy work as well for REM-predominant OSA as for non-REM-predominant OSA?▼

Yes, the study found no significant difference in OSA resolution rates at 7 months between children with REM-predominant and non-REM-predominant OSA after adenotonsillectomy (aOR 0.75, 95% CI 0.34-1.66).

Are children with REM-predominant OSA more likely to have symptoms?▼

They have greater daytime sleepiness and more severe PSG measures (higher AHI, lower oxygen nadir), but parent-reported symptom burden (PSQ) and quality of life (OSA-18) were not significantly different from non-REM-predominant OSA.

Should children with REM-predominant OSA be treated differently?▼

The findings suggest that watchful waiting is less likely to lead to spontaneous resolution in REM-predominant OSA, so adenotonsillectomy may be prioritized for these children.

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References

  1. 1.Wang C, Wang A, Wu J, Wang Y. "Risk Factors, Symptom Burden, and Treatment Response in Pediatric REM-Predominant OSA: Evidence From the Childhood Adenotonsillectomy Trial.." Laryngoscope investigative otolaryngology, 2026. PMID: 42544299 DOI: 10.1002/lio2.70524
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.