Children With Sleep Disordered Breathing: Tonsil, Adenoid Removal Results In Bet

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Tonsil, Adenoid Removal Results In Better Sleep,Behavior For Children

With Sleep Disordered Breathing

http://www.medicalnewstoday.com/medicalnews.php?newsid=44211

An adenotonsillectomy, or surgical removal of the tonsils and

adenoids, leads to an improvement in behavior and sleep for pediatric

patients diagnosed with sleep disordered breathing has been revealed

in a study from the University of Kansas Medical Center and School of

medicine.

Sleep disordered breathing (SDB), is usually caused by enlarged

tonsils causing upper airway obstruction during sleep. In children,

the terms " obstructive sleep disorders " (OSD) and " sleep disordered

breathing " (SDB) are more widely used as opposed to obstructive sleep

apnea syndrome (OSAS) because the former two terms recognized that

SDB is a spectrum of sleep-related breathing disorders including

primary snoring, upper airway resistance syndrome, obstructive

hypoventilation, and OSAS (the most severe aspect of the spectrum).

Traditionally, OSAS is identified only by a sleep study, and while

the prevalence of OSAS has been reported to range from 0.7 to three

percent, the prevalence of snoring and clinical suspicion of SDB in

children may be high as 11 percent.

How SDB affects childhood development and behavior, specifically

hyperactivity and inattention, has been addressed in past research.

Using sleep studies or polysomnograph, and parental surveys, one

study showed that while SDB was not more likely to occur among

children with significant ADHD symptoms, it is significantly highly

prevalent among children with mild hyperactive behavior. Habitual

snoring and SDB have been associated with ADHD as well as

neurocognitive impairment and poor school performance, leading to a

suggestion that treating SDB and habitual snoring may eliminate ADHD

in a subset of children. Unlike OSAS which is defined by specific

apnea-hypopnea index based on polysomnography, SDB may be diagnosed

clinically and not consistently meet PSG criteria for an obstructive

sleep breathing disorder.

A questionnaire specific for predicting SDB and improvement after

surgery, would bridge the gap between objective sleep study data on

every child with nocturnal airway obstructions on one hand and

clinical suspicion of SDB in children at the other end of the

spectrum. Such a questionnaire is the Pediatric Sleep Questionnaire

(PSQ), previously developed by Dr. Chervin and colleagues at the

University of Michigan, uses subscales in SDB, snoring, sleepiness,

and behavioral problems which has shown good validity and reliability

for predicting SDB when compared with polysomnography. The PSQ may be

used as a tool in clinical research when polysomnography may not be

feasible.

The Connor's Parent Rating Scale-Revised Short (CPRS-RS) survey has

been proved effective to assess behavior in subjects before and after

treatment intervention. Both the CPRS-RS and PSQ were used by Kansas

otolaryngologist-head and neck surgeons to determine change in sleep

and behavior before surgery and again at six months after

adenotonsillectomy, as well as to identify any correlations between

sleep and behavior pre and post surgical intervention in children

with SDB, without using sleep study or polysomnography. The authors

of " Improved Behavior and Sleep After Adenotonsillectomy in Children

with Sleep Disordered Breathing, " are L. Wei MD, and A.

Weatherly MD, both from the Department of Otolaryngology-Head and

Neck Surgery, University of Kansas School of Medicine; S.

Mayo PhD, and Holly J. , at the Center for Biostatistics and

Advanced Informatics, University of Kansas Medical Center; and Matt

Reese PhD, with the Developmental Disabilities Center, University of

Kansas Medical Center. Their findings will be presented at the 21st

Annual Meeting of the American Society of Pediatric Otolaryngology,

being held May 20-22, 2006, at the Hyatt Regency Hotel in Chicago,

IL.

Methodology: Within a pediatric otolaryngology practice, 117

consecutive children clinically diagnosed with sleep disordered

breathing and scheduled for surgical removal of the adenoids and

tonsils were enrolled as the research subjects. A convenience sample

of caregivers of patients, age two to 17, undergoing

adenotonsillectomy for SDB were eligible and asked to participate.

Patients were excluded if the primary reason for adenotonsillectomy

was recurrent infections. Data were collected on the day of the

surgery and at six months following the surgery date. This study was

modeled after previous studies examining the quality of life (QOL)

improvement after adenotonsillectomy. Caregivers completed two

questionnaires at both time intervals: the CPRS-RS as well as the

PSQ.

Changes in age appropriate T-scores for all four CPRS-RS behavior

categories (oppositional, cognitive problems/inattention,

hyperactivity, and Conner's ADHD index) were determined for each

subject pre- and post-operatively. Changes in PSQ scores from select

22-item sleep-related breathing disorder (SRBD) subscale were also

determined.

Results: The results offered evidence that before surgery, the mean

PSQ score for the 117 patient was 0.56, the scale is between 0 and 1,

with scores approaching 1 representing the most severe disturbance in

sleep. 112/117 (95.73 percent) had a PSQ score of >0.33, which

suggests high risk for SDB, and 5/117 (4.27 percent) had a PSQ score

of < 0.33. At six-months after adenotonsillectomy, the mean PSQ score

for the 71 patients who completed the study was 0.12[0.14]. Of these

71 patients, 7(9.86 percent) still had a PSQ score of >0.33, while 64

(90.14 percent) had a PSQ score of < 0.33. For the CPRS-RS scores, a

reduction was noted in aged and sexed norm T-scores for all four

behavior categories (oppositional, cognitive problems/inattention,

hyperactivity, and ADHD index), close to one standard deviation from

their preoperative score which is clinically significant. Also, the

researchers found that the higher the baseline T-score, the greater

the reduction in T-score after surgery. Correlations were found

between behavior and sleep both before and after adenotonsillectomy.

Conclusions: The study supports associations between

adenotonsillectomy to alleviate upper airway obstruction and changes

in both sleep and behavior, as evidenced by results in the PSQ and

CPRS-RS surveys. At six months after adenotonsillectomy, patients

experience improvement in both sleep and various behavior categories

as measured by these instruments.

American Society of Pediatric Otolaryngology

http://www.aspo.us