title: Postsurgical behaviors in children with and without symptoms of sleep-disordered breathing.
abstract: BACKGROUND
  Although some children undergo formal preoperative testing for obstructive sleep apnea, it is likely that many children present for surgery with undetected sleep-related disorders. Given that these children may be at increased risk during the perioperative period, this study was designed to compare postoperative behaviors between those with and without symptoms of sleep-disordered breathing (SDB).
  
  
  METHODS
  This study represents a secondary analysis of data from a study examining the effect of SDB on perioperative respiratory adverse events in children. Parents of children aged 2-14 years completed the Sleep-Related Breathing Disorder (SRBD) subscale of the Pediatric Sleep Questionnaire prior to surgery. Children were classified as having SDB if they had a positive score (≥0.33) on the SRBD subscale. Seven to ten days following surgery, the SRBD subscale was re-administered to the parents who also completed the Children's Post Hospitalization Behavior Questionnaire. Children were classified as exhibiting increased problematic behaviors if their postoperative behaviors were considered to be "more/much more" relative to normal.
  
  
  RESULTS
  Three hundred thirty-seven children were included in this study. Children with SDB were significantly more likely to exhibit problematic behaviors following surgery compared with children without SDB. Logistic regression identified adenotonsillectomy (OR 9.89 [3.2-30.9], P < 0.01) and posthospital daytime sleepiness (OR 2.8 [1.3-5.9], P < 0.01) as risk factors for postoperative problematic behaviors.
  
  
  CONCLUSIONS
  Children presenting for surgery with symptoms of SDB have an increased risk for problematic behaviors following surgery. These results are potentially important in questioning whether the observed increase in problematic behaviors is biologically grounded in SDB or simply a response to poor sleep habits/hygiene.
authors.affiliation: Department of Anesthesiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Tait
authors.affiliation: Department of Anesthesiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
authors.forename: Terri
authors.initials: T
authors.lastname: Voepel-Lewis
authors.affiliation: Department of Neurology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA ; Department of Oral/Maxillofacial Surgery, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA ; Michael S. Aldridge Sleep Disorders Center, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
authors.forename: Louise M
authors.initials: LM
authors.lastname: O'Brien
keywords: Children; Obstructive sleep apnea; Pediatric surgery; Postoperative behaviors; Sleep-disordered breathing