Objective ·To compare the clinical efficiency and safety of conventional treatment, recombinant human growth hormone (rhGH) monotherapy, and adenotonsillectomy combined with rhGH in children with moderate obstructive sleep apnea (OSA) and idiopathic short stature (ISS). Methods ·A total of 60 children with moderate OSA and ISS were enrolled between 2020 and 2023 in the Department of Otolaryngology Head and Neck Surgery and the Department of Endocrinology at Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine. Based on different clinical treatment regimens, the children were divided into three groups (conventional treatment group, rhGH treatment group, and adenotonsillectomy combined with rhGH treatment group), with 20 cases in each group. The dynamic changes in growth-related indicators [including height, height increase, bone age, bone age maturity, insulin-like growth factor-1 (IGF-1) level, and insulin-like growth factor-binding protein-3 (IGFBP-3) level] were analyzed among the three groups before and after treatment. In addition, clinical symptoms and therapeutic efficacy in three groups were evaluated before treatment and at 6 and 12 months post-treatment, including the obstructive apnea-hypopnea index (OAHI), minimum peripheral oxygen saturation, and Disease-Specific Quality of Life for Children with Obstructive Sleep Apnea-18 Items Survey (OSA-18). Results ·At 6 and 12 months post-treatment, the children in the rhGH treatment group showed superior improvements in height increase and growth hormone secretion (IGF-1 and IGFBP-3 levels) compared with those in the conventional treatment group. The surgery combined with rhGH treatment group also demonstrated better outcomes than the rhGH treatment group, with the differences being statistically significant (all P<0.05). After 12 months of treatment, height and bone age of the three groups of children increased compared with pre-treatment (all P<0.001), and no abnormalities in blood lipid levels or metabolism were observed. The bone age maturity of children in the surgery combined with rhGH treatment group showed a statistically significant difference compared with pre-treatment (P=0.002). In contrast, no statistically significant difference was observed in bone age maturity between the rhGH treatment group and the control group. Compared with pre-treatment levels, both the rhGH treatment group and the surgery combined with rhGH treatment group showed significant increases in IGF-1 and IGFBP-3 levels (both P<0.001); however, no statistically significant differences were observed in the control group compared with pre-treatment levels. Compared with pre-treatment levels, the OAHI and OSA-18 scores in the surgery combined with rhGH treatment group were significantly reduced, and the minimum peripheral oxygen saturation was improved, with all differences being statistically significant (all P<0.001). In contrast, no statistically significant differences were observed in these three indicators of the control group and the rhGH treatment group compared with pre-treatment levels. At 12 months, 16 children in the surgery combined with rhGH treatment group reached the standardized height growth curve (mean height of normal children of the same age and sex ±1 standard deviation), whereas only 2 children in the rhGH treatment group met this criterion. No child in the control group achieved this outcome. The differences between the surgery combined with rhGH treatment group and the rhGH treatment group, as well as between the rhGH treatment group and the control group, were statistically significant (all P<0.001). Conclusion ·In children with moderate OSA and ISS, rhGH therapy demonstrates generally acceptable metabolic safety, and adenoid-tonsillectomy combined with rhGH treatment shows significant synergistic effects in promoting height growth.