Excessive obesity in children can cause abnormal sleep breathing. The main symptoms of abnormal sleep breathing in children are snoring after falling asleep, open-mouth breathing, labored breathing, sweating during sleep, fidgety movement of limbs, easy to be woken up, urination, daytime drowsiness, easy to be fatigued, and lack of concentration. Abnormal sleep breathing deprives children of oxygen during sleep, which can have many adverse effects on children’s growth and development, and in severe cases, right heart failure can occur, and infants less than 1 year old may also cause sudden infant death. Children’s palatine tonsils and adenoids are the most developed in a person’s life and are large in size. Enlarged palatine tonsils and/or adenoids are the most common and predominant cause of the disease in children. Our data show that palatine tonsils and adenoids are enlarged to varying degrees in children with sleep apnea; among children with adenoid and tonsil hypertrophy, the symptom score of sleep apnea in over-obese children is significantly heavier than that of normal-weight children. It can be concluded that both obesity and adenoid hypertrophy of the palatine tonsils play an important role in the pathogenesis of sleep apnea in children. The combination of these two factors can worsen the symptoms. I have observed that even if there is no significant change in the child’s weight before and after surgery, palatotonsillectomy and adenoidectomy can also significantly improve the symptoms of sleep apnea and completely eliminate apnea and snoring during sleep. It can be concluded that removal of adenoids and tonsils can equally improve the symptoms of abnormal sleep breathing even without weight reduction. This conclusion is similar to the conclusion that it has been reported that weight reduction alone does not improve the symptoms of abnormal sleep breathing in obese children. We believe that adenoids are located in the nasopharynx and their enlargement can lead to nasal congestion, which directly affects normal breathing. In addition, due to the relaxation of the pharyngeal muscles after sleep, the enlarged palatine tonsils can rotate backward and inward, aggravating the narrowing of the pharyngeal cavity and directly obstructing the upper airway. This is the main cause of abnormal sleep breathing in children. Because the palatine tonsils and adenoids play an important role in local immunity in the pharynx and the entire upper airway in children, especially in children aged 3 to 5 years, premature palatine tonsil and adenoidectomy in children is still controversial. However, because abnormal sleep breathing in children has a large impact on their development, surgery should be necessary. The key lies in the preoperative close observation of the child’s sleep respiration, a reliable evaluation of the degree of breathing abnormalities during sleep, and a rigorous physical examination and lateral nasopharyngeal film examination. Acoustic reflex rhinomanometry, fiberoptic nasopharyngoscopy, polysomnography and other examinations can also be performed when available. As far as possible, the operation is selected according to the site and severity of the obstruction to reduce the destruction of local immune organs in children. Because of the complexity of the above examinations and the need for children’s cooperation, it is difficult to promote them, especially in primary hospitals. In this group, 76 children were scored according to the severity of symptoms, which can be used as a simple evaluation method. Because the main symptoms above can directly reflect the severity of sleep apnea in children, and an important indicator of the effectiveness of surgical treatment is the improvement of symptoms. In the author’s opinion, whether or not to perform surgical treatment should mainly depend on whether or not there is apnea that occurs two or more times per hour during sleep, each time more than 10 minutes; whether or not there is loud snoring that lasts more than 10 minutes and prolonged open-mouth breathing. If these symptoms are present and other diseases can be excluded, surgical treatment can be considered.