title: Sleeping characteristics of children undergoing outpatient elective surgery.
abstract: BACKGROUND
  A significant number of children undergoing anesthesia and surgery exhibit new-onset sleep-related problems postoperatively. The aim of this longitudinal cohort study was to expand previous research in this area by using a new objective technology.
  
  
  METHODS
  This study compared children undergoing general anesthesia and outpatient surgery (n = 92) to a community-based control group of children (n = 77). Data regarding coping, temperament, anxiety, surgical procedures, and postoperative pain were collected. Subjects underwent actigraphy sleep monitoring for at least 3 nights before surgery and 5 postoperative days (POD). Sleep assessment was performed with actigraphy sleep monitoring and the Post Hospitalization Behavioral Questionnaire (PHBQ).
  
  
  RESULTS
  Forty-three children (47%) in the surgery group experienced postoperative sleeping disturbances as determined by either the actigraphy or the PHBQ. Only 13 children (14.4%), however, experienced a decrease of at least 1 SD in percentage sleep as assessed by actigraphy. Postoperative pain scores on POD 1 and POD 2 were significantly higher among children who exhibited sleep problems as diagnosed by actigraphy (F = 4.283; P= 0.047). Also, children who exhibited actigraph-based sleep problems scored lower sociability-temperament (14.1 +/- 4.3 vs. 17.5 +/- 3.4; P= 0.04) scores compared with the community group and had a higher rate of change in their perioperative anxiety levels (group x time interaction, F = 5.1; P= 0.03).
  
  
  CONCLUSIONS
  A significant number of children undergoing outpatient surgery experience postoperative sleep-related problems. The clinical significance of this finding, however, is unclear.
authors.affiliation: Department of Anesthesiology, The Children's Clinical Research Center, Yale University School of Medicine, New Haven, Connecticut 06510, USA. kain@biomed.med.yale.edu
authors.forename: Zeev N
authors.initials: ZN
authors.lastname: Kain
authors.forename: Linda C
authors.initials: LC
authors.lastname: Mayes
authors.forename: Alison A
authors.initials: AA
authors.lastname: Caldwell-Andrews
authors.forename: Gerianne M
authors.initials: GM
authors.lastname: Alexander
authors.forename: Dawn
authors.initials: D
authors.lastname: Krivutza
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Teague
authors.forename: Shu-Ming
authors.initials: SM
authors.lastname: Wang
mesh_terms: D000556:Ambulatory Surgical Procedures; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012893:Sleep Wake Disorders / Q000209:etiology*; D011795:Surveys and Questionnaires