title: Psychological predictors of postoperative sleep in children undergoing outpatient surgery.
abstract: BACKGROUND
  The purpose of this study was to examine psychological predictors of postoperative sleep in children undergoing outpatient surgery.
  
  
  METHODS
  We used hierarchical multivariate regression to examine the impact of demographic and personality variables such as parental worry/anxiety [NEO-personality inventory, revised (NEO-PI-R) Neuroticism], parental coping style (Miller Behavioral Style Scale), children's aggressive behavior [child behavior checklist (CBCL) externalizing], and children's temperament (emotionality, activity, sociability, and impulsivity) on postoperative sleep in 52 consecutive, healthy, children undergoing outpatient surgery. Sleep was assessed using actigraphy, a valid, reliable and objective measure of sleep quality. All perioperative protocols were strictly controlled and standardized.
  
  
  RESULTS
  We found that 22% of the children experienced difficulty with postoperative sleep as defined by actigraphy. A hierarchical multiple regression model that was constructed to identify predictors of postoperative sleep efficiency in children accounted for 82% of the variance (R = 0.906, F = 19.42, P = 0.0001). Significant predictors in this model included preoperative sleep patterns (60%), postoperative pain (8.2%), parental anxiety/worry (NEO-PI-R Neuroticism scale; 9%), and children's aggressive behavior (CBCL externalizing; 5%).
  
  
  CONCLUSIONS
  We conclude that psychological factors such as parental anxiety/worry and children's aggressive behavior are predictive of children's postoperative sleep above and beyond the influence of preoperative sleep patterns and postoperative pain.
authors.affiliation: The Center for the Advancement of Perioperative Health, Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, USA. alison.caldwell-andrews@yale.edu
authors.forename: Alison A
authors.initials: AA
authors.lastname: Caldwell-Andrews
authors.forename: Zeev N
authors.initials: ZN
authors.lastname: Kain
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000374:Aggression / Q000523:psychology; D000556:Ambulatory Surgical Procedures / Q000523:psychology*; D001007:Anxiety / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000150:complications; D010290:Parents / Q000523:psychology; D010551:Personality / Q000502:physiology; D010555:Personality Inventory; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012016:Reference Values; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000150:complications / Q000523:psychology*; D013694:Temperament / Q000502:physiology