Pediatric Sleep Questionnaire Scores Predict PostOp Improvement on PSG and Behavior

Abstract

Problem: Children scheduled for adenotonsillectomy frequently also have reversible disruptive behavior disorders (DBD). We examined whether preoperative scores on a sleep questionnaire could assist in predicting postoperative improvement of both polysomnographic variables and disruptive behavior disorders.

Methods: Sixty children, (mean age, 8.3 years) were studied. Behavior assessment, a sleep questionnaire, and nocturnal polysomnography were completed shortly before and 1 year after adenotonsillectomy. Psychiatric evaluation was performed by a child psychiatrist. The Sleep Disordered Breathing Subscale Questionnaire included questions pertaining to symptoms of nocturnal obstruction and behavior items. Obstructive apneas and hypopneas were defined as 2 breaths or longer in duration. Rates of respiratory event-related arousals plus apneas and hypopneas defined the respiratory disturbance index (RDI).

Results: Severity of SDB generally improved after adeno-tonsillectomy. DBDs were initially diagnosed in 25 (42%) of subjects and resolved in 12 (48%) of the diagnosed children postoperatively. There were no significant differences noted in the preoperative obstructive apnea index, apnea/hypopnea index, RDI or minimum oxygen saturation (t tests, all P > 0.05) in children whose DBD resolved as compared to those whose DBD did not. There were, however, significant correlations between high scores on the preoperative SDB subscale and postoperative improvement in apnea/hypopnea index (Pearson correlation coefficient r = .28, P < 0.03), obstructive apnea index (r = 0.32, P < 0.02), and RDI (r = 0.28, P < 0.04). There was also a strong correlation seen between high preoperative questionnaire scores and resolution of DBD (r = 0.28, P < 0.02).

Conclusion: Questionnaires about preoperative symptoms of SDB are predictive of improvement in polysomnographic abnormalities and DBD after adenotonsillectomy. The use of a Pediatric Sleep Questionnaire may be useful in determining which patients have behavioral disorders potentially treatable with surgical intervention.

Significance: Questionnaires may provide a simple, inexpensive method of predicting clinical improvement after adenotonsillectomy in children with SDB and DBDs.

Support: None reported.