DSM-IV diagnoses and obstructive sleep apnea in children before and 1 year after adenotonsillectomy.
OBJECTIVE
Obstructive sleep apnea, a common indication for adenotonsillectomy in children, has been linked to behavioral morbidity. We assessed psychiatric diagnoses in children before and after adenotonsillectomy and examined whether baseline sleep apnea predicted improvement after surgery.


METHODS
Subjects of this prospective cohort study were children ages 5.0 to 12.9 years old who had been scheduled for adenotonsillectomy (n = 79) or care for unrelated surgical conditions (n = 27, among whom 13 had surgery after baseline assessment). Before intervention and 1 year later, subjects underwent structured diagnostic interviews and polysomnography. The main outcome measure was frequency of DSM-IV attention and disruptive behavior disorder diagnoses at baseline and follow-up.


RESULTS
At baseline, attention and disruptive behavior disorders were diagnosed in 36.7% of adenotonsillectomy subjects and 11.1% of controls (p < .05); attention-deficit/hyperactivity disorder was found in 27.8% and 7.4%, respectively (p < .05). One year later, group differences were nonsignificant; attention and disruptive behavior disorders were diagnosed in only 23.1% (p < .01), and 50% of subjects with baseline attention-deficit/hyperactivity disorder no longer met diagnostic criteria. Obstructive sleep apnea on polysomnography at baseline did not predict concurrent psychiatric morbidity or later improvement.


CONCLUSIONS
Attention and disruptive behavior disorders, diagnosed by DSM-IV criteria, were more common before clinically indicated adenotonsillectomy than 1 year later. Surgery may be associated with reduced morbidity, even among subjects lacking polysomnographic evidence of obstructive sleep apnea.
Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA. dillonje@michigan.gov
James E
JE
Dillon
Sarah
S
Blunden
Deborah L
DL
Ruzicka
Kenneth E
KE
Guire
Donna
D
Champine
Robert A
RA
Weatherly
Elise K
EK
Hodges
Bruno J
BJ
Giordani
Ronald D
RD
Chervin
D000233:Adenoidectomy; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D015331:Cohort Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017286:Polysomnography; D011184:Postoperative Period; D011446:Prospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D013997:Time Factors; D014068:Tonsillectomy