title: Subjective sleepiness and polysomnographic correlates in children scheduled for adenotonsillectomy vs other surgical care.
abstract: OBJECTIVE
  To compare a validated subjective measure of childhood sleepiness to an objective determination, assess the frequency of problematic sleepiness among children with suspected sleep-disordered breathing (SDB), and examine what standard or investigational polysomnographic measures of SDB predict subjective sleepiness.
  
  
  METHODS
  Prospective, cross-sectional.
  
  
  METHODS
  University-based sleep disorders laboratory.
  
  
  METHODS
  Washtenaw County Adenotonsillectomy Cohort.
  
  
  METHODS
  Polysomnography followed by Multiple Sleep Latency Tests (MSLTs) in 103 children aged 5 to 12 years old: 77 were scheduled for clinically indicated adenotonsillectomy, usually for suspected SDB, and 26 for unrelated surgical care. Parents completed the previously validated, 4-item Pediatric Sleep Questionnaire-Sleepiness Subscale (PSQ-SS).
  
  
  RESULTS
  Thirty-three (43%) of the children scheduled for adenotonsillectomy had high PSQ-SS scores, in comparison with only 3 (12%) of the controls (p = .004). The PSQ-SS scores correlated inversely with mean sleep latencies on the MSLTs (rho = -0.23, p = .006). The obstructive apnea index, apnea-hypopnea index, and respiratory disturbance index (which included respiratory event-related arousals identified by esophageal pressure monitoring) each correlated similarly with PSQ-SS scores, as did investigational quantification of esophageal pressures and respiratory cycle-related electroencephalographic changes (each rho approximately 0.30, p < .02). A stepwise regression identified sigma-frequency respiratory cycle-related electroencephalographic changes as the strongest independent predictor of subjective sleepiness among all subjects and particularly among those without obstructive sleep apnea.
  
  
  CONCLUSIONS
  Sleepiness is a frequent problem among children with suspected SDB. Subjective sleepiness (PSQ-SS) reflects MSLT results to a limited extent, as in adults. Standard polysomnographic measures of SDB predict subjective sleepiness, but respiratory cycle-related electroencephalographic changes may offer additional clinical utility.
authors: Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI, USA. chervin@umich.edu
authors: Ronald D
authors: RD
authors: Chervin
authors: Robert A
authors: RA
authors: Weatherly
authors: Deborah L
authors: DL
authors: Ruzicka
authors: Joseph W
authors: JW
authors: Burns
authors: Bruno J
authors: BJ
authors: Giordani
authors: James E
authors: JE
authors: Dillon
authors: Carole L
authors: CL
authors: Marcus
authors: Susan L
authors: SL
authors: Garetz
authors: Timothy F
authors: TF
authors: Hoban
authors: Kenneth E
authors: KE
authors: Guire