Improved behavior and sleep after adenotonsillectomy in children with sleep-disordered breathing.
OBJECTIVE
To determine changes in behavior and sleep in children before and after adenotonsillectomy for sleep-disordered breathing (SDB) using the validated Pediatric Sleep Questionnaire (PSQ) and Conners' Parent Rating Scale-Revised Short Form (CPRS-RS).


METHODS
Prospective, nonrandomized study.


METHODS
Ambulatory surgery center affiliated with an academic medical center.


METHODS
A total of 117 consecutive children (61 boys and 56 girls) (mean [SD] age, 6.5 [3.1] years) who were clinically diagnosed as having SDB and who had undergone adenotonsillectomy. Complete follow-up data were available in 71 of 117 patients (61%).


METHODS
Parents completed the PSQ and CPRS-RS before surgery and 6 months after surgery.


METHODS
Changes in age- and sex-adjusted T scores for all 4 CPRS-RS behavior categories (oppositional behavior, cognitive problems or inattention, hyperactivity, and Conners' attention-deficit/hyperactivity disorder [ADHD] index) were determined for each subject before and after surgery. Changes in PSQ scores from a select 22-item sleep-related breathing disorder subscale were also determined.


RESULTS
Preoperatively, the mean (SD) T scores on the CPRS-RS for oppositional behavior, cognitive problems or inattention, hyperactivity, and ADHD index were 59.4 (13.7), 59.5 (13.6), 62.0 (14.4), and 59.9 (13.4), respectively. A T score of 60.0 in any category placed a child in the at-risk group. Postoperatively, T scores for each category were 51.0 (9.6), 51.2 (8.8), 52.4 (10.52), and 50.6 (7.8), respectively. All changes were statistically significant (P<.001) and clinically significant by approximating a change of 1 SD from the baseline score. For the PSQ, the preoperative and postoperative mean (SD) scores were 0.6 (0.1) and 0.1 (0.1), respectively, on a scale of 0 to 1, with scores higher than 0.33 suggesting obstructive sleep apnea. Correlations between sleep and behavior scores were statistically significant before surgery (P=.004 for ADHD index and cognitive problems, P=.008 for oppositional behavior) and after surgery (P=.049 for cognitive problems, P=.03 for oppositional behavior). Higher baseline T scores for the CPRS-RS were associated with larger changes in T scores for the CPRS-RS in all 4 domains (oppositional behavior, cognitive problems or inattention, hyperactivity, and ADHD index).


CONCLUSIONS
Children diagnosed as having SDB experience improvement in both sleep and behavior after adenotonsillectomy. The PSQ and CPRS-RS may be useful adjuncts for screening and following children who undergo adenotonsillectomy for SDB.
Wei
Julie L
JL
Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, and Medical Center, 3901 Rainbow Blvd, Mail Stop 3010, Kansas City, KS 66160, USA. jwei@kumc.edu
Mayo
Matthew S
MS
Smith
Holly J
HJ
Reese
Matt
M
Weatherly
Robert A
RA
D000233:Adenoidectomy; D000293:Adolescent; D000294:Adolescent Behavior / Q000502:physiology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D002648:Child; D002652:Child Behavior / Q000502:physiology*; D002675:Child, Preschool; D003071:Cognition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology*; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D011795:Surveys and Questionnaires; D014068:Tonsillectomy