Running 73 pages, The MAHA (Make Our Children Healthy Again) Report, spearheaded by Robert F. Kennedy Jr., alludes to the toll of sleep deprivation in about 10 different paragraphs—a commonly agreed upon concern. But sleep specialists may disagree on the reference to sleep apnea surgery in the section about “the crisis of overdiagnosis and overtreatment in children.”
The MAHA report specifically condemns adenotonsillectomy for children with sleep apnea as an example of overtreatment. Citing Cognition After Early Tonsillectomy for Mild OSA, the report states that adenotonsillectomy “conferred no benefit in trials, suggesting the many, and often severe, harms of this surgery are unnecessary.”
“While excessive medical intervention in the US healthcare system is broadly recognized, there has been less attention given to direct harms experienced by Americans due to overtreatment,” the MAHA Report states. “Despite this there exists a robust evidence base demonstrating significant and costly (both financially and in terms of human suffering) harms experienced by children due to overtreatment at the hands of American healthcare.”
In other areas of the report, sleep deprivation is mentioned within the context of documented changes to children’s lifestyle and behavior over generations and linked to increasingly sedentary lifestyles and the use of technology.
“Over the past four decades, American children have transitioned from an active, play-based childhood to a sedentary, technology-driven lifestyle, contributing to declines in physical and mental health. Specifically, these declines have been driven by increased screen time, reduced physical activity, and psychosocial stressors like loneliness, chronic stress, and sleep deprivation,” the report states.
A section on psychosocial factors and mental health crisis provides statistics showing how “American children, particularly adolescents, face a nationwide sleep crisis.”
The research initiative related to sleep that The MAHA Report recommends is: “Large-scale Lifestyle Interventions: Launch a coordinated national lifestyle-medicine initiative that embeds real-world randomized trials—covering integrated interventions in movement, diet, light exposure, and sleep timing—within existing cohorts and EHR networks.”
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While the potential benefits of adenotonsillectomy are unambiguous, “cognitive function” has long been a challenging choice for a primary clinical trial outcome. The perception of “no benefit” will likely continue until an alternative primary outcome is promoted as the professional consensus.
TIMELINE of Selected Events
2002: AAP recommends children have sleep study before surgery
2006: NHLBI funds Phase III CHAT RCT (HL083075)
>2013: Primary Outcome
“surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function ”
2009: Obama questions need for tonsillectomy
https://www.realclearpolitics.com/video/2009/07/22/obama_doctors_taking_tonsils_out_for_money_instead_of_diagnosing_it_as_allergies.html
2015: NHLBI funds a second Phase III RCT clinical trial grant (PATs, HL125295, HL125307)
>2023: Primary Outcome
“adenotonsillectomy, compared with watchful waiting,
did not significantly improve executive function or attention at 12 months
2025: MAHA Commission: tonsillectomy not beneficial.
MAHA cites a 2020 Australian study concluding…
“no treatment-attributable improvement in cognitive functioning of preschool children 12 months after adenotonsillectomy compared with NoAT.”