Subjective sleepiness and polysomnographic correlates in children scheduled for adenotonsillectomy vs other surgical care.
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.
Chervin
Ronald D
RD
Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI, USA. chervin@umich.edu
Weatherly
Robert A
RA
Ruzicka
Deborah L
DL
Burns
Joseph W
JW
Giordani
Bruno J
BJ
Dillon
James E
JE
Marcus
Carole L
CL
Garetz
Susan L
SL
Hoban
Timothy F
TF
Guire
Kenneth E
KE