Background: sleep apnea is a clinical entity characterized by the presence of apnea events during sleep present in his side rapid eye movement to an obstruction of the airway. Among the therapeutic strategies exist surgical management (tonsillectomy) and medical management with positive pressure devices in the area continues (CPAP), which can be used according to the selection of the case by the characteristics of our patients. Objective: to evaluate the therapeutic efficacy of tonsillectomy comparing it with other therapeutic alternatives for obstructive sleep apnea syndrome through a systematic literature review. Methods: a systematic literature review of randomized controlled trials was performed. Studies were included if the target population was included child and if the clinical and / or surgical evaluation of such interventions tonsillectomy in the management of sleep apnea syndrome; outcome measures included, improvement in polysomnography parameters, improvement instruments in functionality for this health condition, intraoperative blood loss, operative time and post operative pain. Results: were included for this review 5 studios and a significantly higher quality of life improvement, and behavioral outcomes , polysomnographic was observed in the adenotonsillectomy group early in the watchful waiting group . Normalization of polysomnographic findings were observed in a higher proportion of children in the adenotonsillectomy group early in the expectant management group (79% vs 46%). Conclusions: the primary tonsillectomy is an effective intervention for the management of obstructive sleep apnea syndrome in children between 0-18 years old.