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Long-term Follow-up

Julie L. Wei, MD; Justin Bond, MD; Matthew S. Mayo, PhD; Holly J. Smith, MA; Matt Reese, PhD; Robert A. Weatherly, MD

Arch Otolaryngol Head Neck Surg. 2009;135(7):642-646.

Objective  To determine whether previously published changes are maintained over time in children after adenotonsillectomy for sleep-disordered breathing using the validated Pediatric Sleep Questionnaire (PSQ) and the Conners Parent Rating Scale-Revised: Short Form (CPRS-R:S).

Design  Prospective, nonrandomized interventional study.

Setting  Ambulatory surgery center affiliated with an academic medical center.

Patients  Long-term follow-up data were available (ranging from 2.4 to 3.6 years after adenotonsillectomy) for 44 of the 71 patients who completed our initial study comparing PSQ and CPRS-R:S data before and 6 months after surgery.

Interventions  Parents completed the PSQ and CPRS-R:S at least 2 years after surgery.

Main Outcome Measures  Follow-up PSQ data and long-term changes in age- and sex-adjusted T scores for all 4 CPRS-R:S behavior categories (oppositional behavior, cognitive problems or inattention, hyperactivity, and the attention-deficit/hyperactivity disorder [ADHD] index) were determined for each patient. Linear mixed models were used to analyze the data.

Results  Globally, across time, most variables remained below baseline levels (P < .05). There was a significant increase in PSQ scores during follow-up, but over this period they did not reach baseline levels. Comparing short-term with long-term follow-up, the Conners scores in all behavioral categories did not increase significantly (ADHD index, P = .61; cognitive problems or inattention, P = .02; hyperactivity, P < .001; and oppositional behavior, P < .001). The ADHD index at long-term follow-up was not different from that at baseline, a finding that might be attributable to the high degree of variability in this measure.

Conclusions  Improvements in sleep experienced by children after adenotonsillectomy for sleep-disordered breathing were not as great 2.5 years after surgery as they were 6 months after surgery but were still significant compared with baseline levels. Improvements in behavior were maintained in all categories of the Conners scores except for the ADHD index.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, University of Kansas School of Medicine (Drs Wei, Bond, and Weatherly), and Department of Biostatistics (Dr Mayo and Ms Smith) and Developmental Disabilities Center (Dr Reese), University of Kansas Medical Center, Kansas City.

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