I agree with Pelayo et al that otolaryngologists and sleep medicine physicians should aim to improve the health of children. However, I do not agree that every child who snores, is a constant mouth breather, has daytime symptoms, and has big tonsils and adenoids needs to have a sleep study prior to tonsillectomy and adenoidectomy.
In their letter, Pelayo et al equate sleep apnea in adults to that in children. Children are not small adults. Children's sleep apnea is much more commonly caused by enlarged tonsils and adenoids; it is consistently although not universally cured by tonsillectomy and adenoidectomy.1
Messner AH. Evaluation of Obstructive Sleep Apnea by Polysomnography Prior to Pediatric Adenotonsillectomy—Reply. Arch Otolaryngol Head Neck Surg. 1999;125(11):1283. doi: