title: Association of sleep disordered breathing symptoms with early postoperative analgesic requirement in pediatric ambulatory surgical patients.
abstract: BACKGROUND
  Sleep disordered breathing (SDB) symptoms are associated with increased rates of opioid-induced respiratory depression as well as enhanced nociception. Consequently, practitioners often withhold or administer lower intraoperative doses of opioids out of concern for postoperative respiratory depression. Therefore, SDB may be a critical determinant of analgesic requirement in the post-anesthesia care unit (PACU). We investigated whether preoperative SDB classification was independently associated with need for PACU analgesic intervention in a cross-sectional sample of 985 children who underwent elective, painful ambulatory surgical procedures.
  
  
  METHODS
  Using prospectively collected data, children aged 4-17yr were grouped into two categories based on whether or not they had symptoms of SDB. Perioperative variables were compared between the exposed and control groups using Chi-squared test for categorical or t-test for continuous variables. Logistic regression analysis was used to assess the association between SDB and the odds of requiring PACU IV opioids.
  
  
  RESULTS
  Children with preoperative SDB symptoms (N = 325) compared with the reference group of children who did not have these symptoms had higher rates of PACU analgesic intervention (47.1% vs. 37.4%; p = 0.004) and higher mean arousal pain scores (3.7 ± 3.5 vs.1.9 ± 2.9; p < 0.001). In our primary multivariable logistic regression model adjusted for a number of variables, preoperative SDB symptoms was associated with a two-fold increased odds of receiving PACU intravenous opioid (OR = 2.01, 95%CI, 1.29-3.12; p = 0.002).
  
  
  CONCLUSIONS
  These results suggest that preoperative SDB symptoms in children undergoing ambulatory surgery, exerts a significant influence on PACU pain behavior and analgesic requirement. Mechanisms underlying this enhanced pain experience deserve further elucidation.
authors.affiliation: Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kamie
authors.initials: K
authors.lastname: Yang
authors.affiliation: Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Baetzel
authors.affiliation: Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Wilson T
authors.initials: WT
authors.lastname: Chimbira
authors.affiliation: Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Yuliya
authors.initials: Y
authors.lastname: Yermolina
authors.affiliation: Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Paul I
authors.initials: PI
authors.lastname: Reynolds
authors.affiliation: Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA. Electronic address: onafiu@med.umich.edu.
authors.forename: Olubukola O
authors.initials: OO
authors.lastname: Nafiu
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy*; D011184:Postoperative Period; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000175:diagnosis*
chemical_list: D000701:Analgesics, Opioid
keywords: Ambulatory surgery; Apnea; Children and adolescents; Habitual snoring; Postoperative pain; Sleep disordered breathing