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Improved Behavior and Sleep After Adenotonsillectomy in Children With Sleep-Disordered Breathing
Julie L. Wei, MD;
Matthew S. Mayo, PhD;
Holly J. Smith, MA;
Matt Reese, PhD;
Robert A. Weatherly, MD
Arch Otolaryngol Head Neck Surg. 2007;133(10):974-979.
Objective To determine changes in behavior and sleep in children before and after adenotonsillectomy for sleep-disordered breathing (SDB) using the validated Pediatric Sleep Questionnaire (PSQ) and Conners' Parent Rating Scale–Revised Short Form (CPRS-RS).
Design Prospective, nonrandomized study.
Setting Ambulatory surgery center affiliated with an academic medical center.
Patients A total of 117 consecutive children (61 boys and 56 girls) (mean [SD] age, 6.5 [3.1] years) who were clinically diagnosed as having SDB and who had undergone adenotonsillectomy. Complete follow-up data were available in 71 of 117 patients (61%).
Interventions Parents completed the PSQ and CPRS-RS before surgery and 6 months after surgery.
Main Outcome Measures Changes in age- and sex-adjusted T scores for all 4 CPRS-RS behavior categories (oppositional behavior, cognitive problems or inattention, hyperactivity, and Conners' attention-deficit/hyperactivity disorder [ADHD] index) were determined for each subject before and after surgery. Changes in PSQ scores from a select 22-item sleep-related breathing disorder subscale were also determined.
Results Preoperatively, the mean (SD) T scores on the CPRS-RS for oppositional behavior, cognitive problems or inattention, hyperactivity, and ADHD index were 59.4 (13.7), 59.5 (13.6), 62.0 (14.4), and 59.9 (13.4), respectively. A T score of 60.0 in any category placed a child in the at-risk group. Postoperatively, T scores for each category were 51.0 (9.6), 51.2 (8.8), 52.4 (10.52), and 50.6 (7.8), respectively. All changes were statistically significant (P < .001) and clinically significant by approximating a change of 1 SD from the baseline score. For the PSQ, the preoperative and postoperative mean (SD) scores were 0.6 (0.1) and 0.1 (0.1), respectively, on a scale of 0 to 1, with scores higher than 0.33 suggesting obstructive sleep apnea. Correlations between sleep and behavior scores were statistically significant before surgery (P = .004 for ADHD index and cognitive problems, P = .008 for oppositional behavior) and after surgery (P = .049 for cognitive problems, P = .03 for oppositional behavior). Higher baseline T scores for the CPRS-RS were associated with larger changes in T scores for the CPRS-RS in all 4 domains (oppositional behavior, cognitive problems or inattention, hyperactivity, and ADHD index).
Conclusions Children diagnosed as having SDB experience improvement in both sleep and behavior after adenotonsillectomy. The PSQ and CPRS-RS may be useful adjuncts for screening and following children who undergo adenotonsillectomy for SDB.
Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs Wei and Weatherly) and Preventive Medicine and Public Health (Dr Mayo), University of Kansas School of Medicine, Kansas City; and Center for Biostatistics and Advanced Informatics (Dr Mayo and Ms Smith) and Developmental Disabilities Center (Dr Reese), University of Kansas Medical Center, Kansas City.
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AAP Grand Rounds 2008;19:33-34.
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