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Improved behavior and sleep after adenotonsillectomy in children with sleep-disordered breathing.
Arch Otolaryngol Head Neck Surg. 2007 Oct; 133(10):974-9.AO

Abstract

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.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, and Medical Center, 3901 Rainbow Blvd, Mail Stop 3010, Kansas City, KS 66160, USA. jwei@kumc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17938319

Citation

Wei, Julie L., et al. "Improved Behavior and Sleep After Adenotonsillectomy in Children With Sleep-disordered Breathing." Archives of Otolaryngology--head & Neck Surgery, vol. 133, no. 10, 2007, pp. 974-9.
Wei JL, Mayo MS, Smith HJ, et al. Improved behavior and sleep after adenotonsillectomy in children with sleep-disordered breathing. Arch Otolaryngol Head Neck Surg. 2007;133(10):974-9.
Wei, J. L., Mayo, M. S., Smith, H. J., Reese, M., & Weatherly, R. A. (2007). Improved behavior and sleep after adenotonsillectomy in children with sleep-disordered breathing. Archives of Otolaryngology--head & Neck Surgery, 133(10), 974-9.
Wei JL, et al. Improved Behavior and Sleep After Adenotonsillectomy in Children With Sleep-disordered Breathing. Arch Otolaryngol Head Neck Surg. 2007;133(10):974-9. PubMed PMID: 17938319.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved behavior and sleep after adenotonsillectomy in children with sleep-disordered breathing. AU - Wei,Julie L, AU - Mayo,Matthew S, AU - Smith,Holly J, AU - Reese,Matt, AU - Weatherly,Robert A, PY - 2007/10/17/pubmed PY - 2007/11/2/medline PY - 2007/10/17/entrez SP - 974 EP - 9 JF - Archives of otolaryngology--head & neck surgery JO - Arch Otolaryngol Head Neck Surg VL - 133 IS - 10 N2 - 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. SN - 0886-4470 UR - https://www.unboundmedicine.com/medline/citation/17938319/Improved_behavior_and_sleep_after_adenotonsillectomy_in_children_with_sleep_disordered_breathing_ L2 - https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/archotol.133.10.974 DB - PRIME DP - Unbound Medicine ER -