title: The STBUR questionnaire for identifying children at risk for sleep-disordered breathing and postoperative opioid-related adverse events.
abstract: Children with symptoms of sleep-disordered breathing (SDB) appear to be at risk for perioperative respiratory events (PRAE). Furthermore, these children may be more sensitive to the respiratory-depressant effects of opioids compared with children without SDB.
  
  
  
  The aim of this prospective observational study was to confirm that otherwise healthy children with symptoms of SDB are at greater risk for PRAE compared with children with no symptoms and to determine if these children are also at increased risk for postoperative opioid-related adverse events (ORAE).
  
  
  
  Six hundred and seventy-eight parents of children scheduled for surgery completed the Snoring, Trouble Breathing, and Un-Refreshed (STBUR) questionnaire preoperatively. Data regarding the incidence of PRAE were collected prospectively. Postoperative pulse oximetry desaturation alarm events were downloaded from the institutional secondary alarm notification system.
  
  
  
  Children with symptoms of SDB per STBUR (≥3 symptoms) had a two-fold increased likelihood of PRAE compared with children without SDB (52.8% vs 27.9% respectively, LR(+) = 2.00, 95% CI = 1.60-2.49, P = 0.0001). A subset analysis of children undergoing airway procedures requiring hospital admittance (n = 179) showed that those with SDB were given the same postoperative opioid doses as children without SDB. However, children with SDB symptoms generated a greater number of postoperative oxygen desaturation alarms (14.14 ± 29.3 vs 7.12 ± 13.2, mean difference = 7.02, 95% CI = 0.39-13.64, P = 0.038) and more frequently required escalation of care (15.3% vs 7.1%, LR(+) = 1.67, 95% CI = 1.22-2.16, P = 0.001) compared with children with no SDB symptoms.
  
  
  
  Children presenting for surgery with SDB symptoms are at increased risk for PRAE. Children undergoing airway-related procedures also appear to be at increased risk for ORAE. Furthermore, regardless of the preoperative assessment of risk using the STBUR questionnaire, children received the same doses of opioids postoperatively. Given the increased incidence of postoperative oxygen desaturations among children with SDB symptoms, it would seem prudent to consider titration of opioid doses according to identified risk.
authors.affiliation: Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Tait
authors.affiliation: Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.|The University of Michigan Medical School, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bickham
authors.affiliation: Department of Neurology, University of Michigan Health System, Ann Arbor, MI, USA.|Department of Oral/Maxillofacial Surgery, University of Michigan Health System, Ann Arbor, MI, USA.|The Michael S. Aldridge Sleep Disorders Center, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Louise M
authors.initials: LM
authors.lastname: O'Brien
authors.affiliation: Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.|The University of Michigan Medical School, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Quinlan
authors.affiliation: Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Terri
authors.initials: T
authors.lastname: Voepel-Lewis
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000139:chemically induced* / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000139:chemically induced* / Q000517:prevention & control; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid
keywords: adverse events; child; opioids; perioperative; sleep-disordered breathing