Postsurgical behaviors in children with and without symptoms of sleep-disordered breathingReport as inadecuate

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Perioperative Medicine

, 3:8

First Online: 14 October 2014Received: 11 August 2014Accepted: 23 September 2014


BackgroundAlthough some children undergo formal preoperative testing for obstructive sleep apnea, it is likely that many children present for surgery with undetected sleep-related disorders. Given that these children may be at increased risk during the perioperative period, this study was designed to compare postoperative behaviors between those with and without symptoms of sleep-disordered breathing SDB.

MethodsThis study represents a secondary analysis of data from a study examining the effect of SDB on perioperative respiratory adverse events in children. Parents of children aged 2–14 years completed the Sleep-Related Breathing Disorder SRBD subscale of the Pediatric Sleep Questionnaire prior to surgery. Children were classified as having SDB if they had a positive score ≥0.33 on the SRBD subscale. Seven to ten days following surgery, the SRBD subscale was re-administered to the parents who also completed the Children’s Post Hospitalization Behavior Questionnaire. Children were classified as exhibiting increased problematic behaviors if their postoperative behaviors were considered to be -more-much more- relative to normal.

ResultsThree hundred thirty-seven children were included in this study. Children with SDB were significantly more likely to exhibit problematic behaviors following surgery compared with children without SDB. Logistic regression identified adenotonsillectomy OR 9.89 3.2–30.9, P < 0.01 and posthospital daytime sleepiness OR 2.8 1.3–5.9, P < 0.01 as risk factors for postoperative problematic behaviors.

ConclusionsChildren presenting for surgery with symptoms of SDB have an increased risk for problematic behaviors following surgery. These results are potentially important in questioning whether the observed increase in problematic behaviors is biologically grounded in SDB or simply a response to poor sleep habits-hygiene.

KeywordsPediatric surgery Postoperative behaviors Sleep-disordered breathing Obstructive sleep apnea Children AbbreviationsSDBsleep-disordered breathing

OSASobstructive sleep apnea syndrome

SRBDSleep-Related Breathing Disorder

PSQPediatric Sleep Questionnaire

PHBQPost Hospitalization Behavior Questionnaire

ADHDattention deficit-hyperactivity disorder

ASAAmerican Society of Anesthesiologists

ORodds ratio.

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Author: Alan R Tait - Terri Voepel-Lewis - Louise M O’Brien


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