Pediatric Sleep Questionnaire Scores Research Articles

Improved Behavior and Sleep After Adenotonsillectomy in Children With Sleep-Disordered Breathing: Long-term Follow-up

To determine whether previously published changes are maintained over time in children after adenotonsillectomy for sleep-disordered breathing using the validated Pediatric Sleep Questionnaire (PSQ) and the Conners Parent Rating Scale-Revised: Short Form (CPRS-R:S). Prospective, nonrandomized interventional study. Ambulatory surgery center affiliated with an academic medical center. Long-term follow-up data were available (ranging from 2.4 to 3.6 years after adenotonsillectomy) for 44 of the 71 patients who completed our initial study comparing PSQ and CPRS-R:S data before and 6 months after surgery. Parents completed the PSQ and CPRS-R:S at least 2 years after surgery. Follow-up PSQ data and long-term changes in age- and sex-adjusted T scores for all 4 CPRS-R:S behavior categories (oppositional behavior, cognitive problems or inattention, hyperactivity, and the attention-deficit/hyperactivity disorder [ADHD] index) were determined for each patient. Linear mixed models were used to analyze the data. Globally, across time, most variables remained below baseline levels (P < .05). There was a significant increase in PSQ scores during follow-up, but over this period they did not reach baseline levels. Comparing short-term with long-term follow-up, the Conners scores in all behavioral categories did not increase significantly (ADHD index, P = .61; cognitive problems or inattention, P = .02; hyperactivity, P < .001; and oppositional behavior, P < .001). The ADHD index at long-term follow-up was not different from that at baseline, a finding that might be attributable to the high degree of variability in this measure. Improvements in sleep experienced by children after adenotonsillectomy for sleep-disordered breathing were not as great 2.5 years after surgery as they were 6 months after surgery but were still significant compared with baseline levels. Improvements in behavior were maintained in all categories of the Conners scores except for the ADHD index.

Cerebral Blood Flow Velocity and Cognition in Children Before and After Adenotonsillectomy

The goal was to determine whether amelioration of sleep-disordered breathing through adenotonsillectomy would reduce middle cerebral artery velocity in parallel with improvements in cognition and behavior. For 19 children (mean age: 6 years) with mild sleep-disordered breathing, and 14 healthy, ethnically similar and age-similar, control subjects, parents repeated the Pediatric Sleep Questionnaire an average of 12 months after adenotonsillectomy. Children with sleep-disordered breathing underwent repeated overnight measurement of mean oxyhemoglobin saturation. Neurobehavioral tests that yielded significant group differences preoperatively were readministered. Middle cerebral artery velocity measurements were repeated with blinding to sleep study and neuropsychological results, and mixed-design analyses of variance were performed. The median Pediatric Sleep Questionnaire score significantly improved postoperatively, and there was a significant increase in mean overnight oxyhemoglobin saturation. The middle cerebral artery velocity decreased in the sleep-disordered breathing group postoperatively, whereas control subjects showed a slight increase. A preoperative group difference was reduced by the postoperative assessment, which suggests normalization of middle cerebral artery velocity in those with sleep-disordered breathing. The increase in mean overnight oxyhemoglobin saturation postoperatively was associated with a reduction in middle cerebral artery velocity in a subgroup of children. A preoperative group difference in processing speed was reduced postoperatively. Similarly, a trend for a preoperative group difference in visual attention was reduced postoperatively. Executive function remained significantly worse for the children with sleep-disordered breathing, compared with control subjects, although mean postoperative scores were lower than preoperative scores. Otherwise-healthy young children with apparently mild sleep-disordered breathing have potentially reversible cerebral hemodynamic and neurobehavioral changes.

Improved Behavior After T &amp; A

Uniform Services/Otolaryngology| March 01 2008 Improved Behavior After T & A AAP Grand Rounds (2008) 19 (3): 33–34. https://doi.org/10.1542/gr.19-3-33 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Improved Behavior After T & A. AAP Grand Rounds March 2008; 19 (3): 33–34. https://doi.org/10.1542/gr.19-3-33 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cognition disorders, hyperkinesis, sleep, tonsillectomy and adenoidectomy, hyperactive behavior, adult attention deficit hyperactivity disorder, attention-deficit/hyperactivity disorder Source: Wei JL, Mayo MS, Smith HJ, et al. Improved behavior and sleep after adenotonsillectomy in children with sleep-disordered breathing. Arch Otolaryngol Head Neck Surg. 2007;133(10):974–979; doi:10.1001/archotol.133.10.974 Researchers from Kansas City, Missouri, conducted a non-randomized prospective study to examine changes in behavior and sleep among children with sleep-disordered breathing (SDB) who underwent removal of their tonsils and adenoids. They enrolled 117 consecutive children (61 boys) with SDB who had undergone adenotonsillectomy (mean patient age 6.5±3.1 years). Children were excluded if the primary reason for adenotonsillectomy was recurrent infections or if significant comorbidities were present. Behavior and sleep changes were measured using the validated Pediatric Sleep Questionnaire (PSQ)1 and the Conners’ Parent Rating Scale-Revised Short Form (CPRS-R5). Parents completed the PSQ and CPRS-R5 before surgery and six months after the adenotonsillectomy. Complete follow-up data were available for 71 (61%) patients. As compared to before surgery, scores on the CPRS-R5 for four domains – oppositional behavior, inattention or cognitive problems, hyperactivity, and ADHD index – improved significantly (P<.001) six months after surgery. Higher baseline scores were associated with larger changes in scores after surgery in all four domains. The PSQ provides scores on a scale of 0 to 1 with scores higher than 0.33 suggesting obstructive sleep apnea. PSQ scores decreased from a mean of 0.6±0.1 preoperatively to 0.1±0.1 postoperatively. Correlations between sleep and behavior scores were found to be statistically significant after adenotonsillectomy for cognitive problems or inattention (P=.049; correlation coefficient, 0.24) and oppositional behavior (P=.03; correlation coefficient, 0.25), but not for the ADHD index or hyperactivity. Owing to the subjective nature of the caregiver-based, questionnaire-type study, the postoperative scores may have improved partly owing to expectations of improvement. The authors conclude that children diagnosed with SDB experience improvement in both sleep and behavior after adenotonsillectomy. They also suggest that the PSQ and the CPRS-R5 might be helpful for screening children prior to and following adenotonsillectomy for SDB. Dr. Dubik has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Although cause and effect cannot be determined in an observational study like the one reported here, these results should not be surprising. SDB, especially obstructive sleep apnea, has been found to be associated with enuresis, learning disabilities, behavioral difficulties, daytime sleepiness, and somatic complaints.2,3 Studies have also shown SDB to be associated with ADHD in children.4,5 In the same issue of the Archives of Otolaryngology, Head and Neck Surgery there is an article describing how adenotonsillectomy reduces the oropharyngeal carriage of potential respiratory pathogens.6 Is the otolaryngological pendulum swinging toward a more aggressive approach to removing tonsils and adenoids? (See AAP Grand Rounds, December 2007;18:66–67.7) Alas, our knowledge of physics has faded, but we recall a pendulum’s swing has something to do with its weight. With regard to the... You do not currently have access to this content.

Symptoms of sleep-disordered breathing in children with nocturnal enuresis

Objectives There is an association between sleep-disordered breathing (SDB) and nocturia in adults, raising the question as to whether SDB could play a role in the aetiology of nocturnal enuresis (NE) in children. The aim of this study was to determine whether there is an association between these two conditions. Methods The study group comprised 40 patients, aged 5–15 years, with enuresis and the control group 40 children undergoing routine day-case surgery. Subjects completed a Pediatric Sleep Questionnaire (PSQ) and a questionnaire assessing lower tract symptoms. Categorical variables were analysed using Pearson's Xi 2 test, and group differences for continuous variables using Mann–Whitney and Kruskal–Wallis tests or t-tests according to the distribution of data. Results The groups were well matched. Patients with NE had significantly higher total PSQ scores ( P < 0.001). PSQ subscales relating to daytime sleepiness ( P < 0.003) and daytime behaviour ( P < 0.000) were significantly worse in NE patients. The snoring subscale was not statistically different ( P < 0.051), but a comparison of females alone showed a highly significant difference ( P < 0.001) with higher snoring subscale scores in girls with NE. Conclusion Children with NE had significantly higher PSQ scores. The data suggest an association between NE and SDB in girls. The significantly higher level of reports of daytime sleepiness and behavioural problems in all NE children warrants further study to determine the potential causative pathways and clinical relevance of these findings. SDB could be usefully assessed in children with NE, particularly when they do not respond to standard treatment.

Dikkat Eksikliği Hiperaktivite Bozukluğu Olan Çocuklarda Uyku Sorunları ve Klinik Değişkenlerle İlişkisi

Purpose: Results from both subjective andobjective studies have reported that childrenwith Attention Deficit Hyperactivity Disorder (ADHD) had higher sleep-related problems than controls. The aim of the study is to assess the relationship between sleep problems and ADHD subtypes and ADHD comorbidities. Method: Subjects were 73 ADHD patients and 41 healthy controls mean age of 8,9 ± 2,8 (SD) who diagnosed with Kiddie –SADS-Present and Lifetime version (KSADS-PL), a semi-structured clinical schedule. Parents completed Pediatric Sleep Questionnaire (PSQ) to assess sleep-related problems. Findings: Subjects with ADHD had higher PSQ Behavior, Sleepiness and Other Problems scores when compared with control subjects. ADHD subjects also had higher Breathing score, which showed a statistical trend to significance (p=0.08). PSQ Sleepiness, Breathing and Other problems scores were not different between subjects with combined type or inattnetive types of ADHD. Comorbidity did not significantly effect PSQ scores. Results: The results are compatible with the previous literature and showed that ADHd cases have significantly higher sleep-related problems, but there is no significant relationship between ADHD comorbidities and level of sleep problems.

Improved Behavior and Sleep After Adenotonsillectomy in Children With Sleep-Disordered Breathing

To determine changes in behavior and sleep in children before and after adenotonsillectomy for sleep-disordered breathing (SDB) using the validated Pediatric Sleep Questionnaire (PSQ) and Conners' Parent Rating Scale-Revised Short Form (CPRS-RS). Prospective, nonrandomized study. Ambulatory surgery center affiliated with an academic medical center. A total of 117 consecutive children (61 boys and 56 girls) (mean [SD] age, 6.5 [3.1] years) who were clinically diagnosed as having SDB and who had undergone adenotonsillectomy. Complete follow-up data were available in 71 of 117 patients (61%). Parents completed the PSQ and CPRS-RS before surgery and 6 months after surgery. Changes in age- and sex-adjusted T scores for all 4 CPRS-RS behavior categories (oppositional behavior, cognitive problems or inattention, hyperactivity, and Conners' attention-deficit/hyperactivity disorder [ADHD] index) were determined for each subject before and after surgery. Changes in PSQ scores from a select 22-item sleep-related breathing disorder subscale were also determined. Preoperatively, the mean (SD) T scores on the CPRS-RS for oppositional behavior, cognitive problems or inattention, hyperactivity, and ADHD index were 59.4 (13.7), 59.5 (13.6), 62.0 (14.4), and 59.9 (13.4), respectively. A T score of 60.0 in any category placed a child in the at-risk group. Postoperatively, T scores for each category were 51.0 (9.6), 51.2 (8.8), 52.4 (10.52), and 50.6 (7.8), respectively. All changes were statistically significant (P<.001) and clinically significant by approximating a change of 1 SD from the baseline score. For the PSQ, the preoperative and postoperative mean (SD) scores were 0.6 (0.1) and 0.1 (0.1), respectively, on a scale of 0 to 1, with scores higher than 0.33 suggesting obstructive sleep apnea. Correlations between sleep and behavior scores were statistically significant before surgery (P=.004 for ADHD index and cognitive problems, P=.008 for oppositional behavior) and after surgery (P=.049 for cognitive problems, P=.03 for oppositional behavior). Higher baseline T scores for the CPRS-RS were associated with larger changes in T scores for the CPRS-RS in all 4 domains (oppositional behavior, cognitive problems or inattention, hyperactivity, and ADHD index). Children diagnosed as having SDB experience improvement in both sleep and behavior after adenotonsillectomy. The PSQ and CPRS-RS may be useful adjuncts for screening and following children who undergo adenotonsillectomy for SDB.

Allergic Rhinitis and Inner-City Children–Is There a Relationship to Sleep-Disordered Breathing?

RATIONALE: Allergic rhinitis (AR), common in children, causes increased upper airway resistance and may lead to sleep-disordered breathing (SDB), which often goes undiagnosed. The goals of this study were to assess the pattern of aeroallergen sensitization in inner-city pediatric patients with SDB and to determine if intranasal corticosteroid treatment improves SDB, using a validated Pediatric Sleep Questionnaire (PSQ). METHODS: Patients (ages 2-18) were evaluated for AR and completed the PSQ prior to treatment. Skin prick testing (SPT) to aeroallergens, including inner-city culprits (rat, cockroach, and mouse), was performed. Patients with a history of AR, SPT evaluation, and at least one positive response on the PSQ were treated with intranasal mometasone furoate monohydrate, environmental control, (+/−) antihistamines. After six weeks of treatment, PSQ responses were reassessed. RESULTS: Of the 24 patients recruited in this ongoing study, 100% had SDB as per PSQ responses; 91% had ≥1 positive SPT, 75% of which were SPT-positive to cockroach, mouse, or rat. Prior to treatment, patients' average PSQ score = 5.96 questions; following treatment, an average PSQ score = 2.38, indicating clinical improvement (p<0.0001 paired t test.) CONCLUSIONS: Children suffering from AR have increased nasal obstruction leading to sleep-disordered events. This study demonstrated adequate treatment, including an intranasal steroid, may significantly improve SDB, as per PSQ results. In inner-city children, elimination of indoor allergens such as cockroach, mouse, or rat may further improve SDB. Larger prospective studies are needed to further validate these preliminary results.

Sleep Disordered Breathing in Pediatric Patients with Tetralogy of Fallot

Adverse effects on the pulmonary circulation in obstructive sleep disordered breathing (SDB) may place children with heart lesions affecting the right ventricle at increased risk for morbidity and mortality. We examined the distribution and effects of SDB in pediatric patients with tetralogy of Fallot (TOF). Families of 37 pediatric patients with TOF completed a survey of cardiac symptoms and school performance as well as a Pediatric Sleep Questionnaire (PSQ), a validated questionnaire for the screening of SDB in children 2-18 years of age. Medical records were reviewed for growth parameters, medical history, and most recent electrocardiogram (ECG) findings. Data from patients with SDB (PSQ score > or = 8, n = 14) were compared to data from patients without SDB (PSQ score < 8; n = 23). The prevalence of SDB in this population (38%) was significantly higher than the published prevalence of 5% in a healthy general pediatric population (p < 0.001). No significant difference was found in age, gender, or age and sex standardized body mass index between patients with or without SDB. No difference was seen in medication use or timing of surgical repair, whether primary or palliative. Patients with SDB had a significantly higher cardiac symptom score (p = 0.01) and increasing PSQ scores correlated with worsening cardiac symptom scores (p = 0.006). Increasing PSQ scores also correlated with worsening school performance (p = 0.001). No differences were seen in ECG data. The screened prevalence of SDB in the pediatric population with TOF is higher than in the general population; patients with TOF and SDB are more likely to have worse cardiac symptoms and poor school performance.

Pediatric sleep questionnaire scores predict postop improvement on PSG and behavior

Problem: Children scheduled for adenotonsillectomy frequently also have reversible disruptive behavior disorders (DBD). We examined whether preoperative scores on a sleep questionnaire could assist in predicting postoperative improvement of both polysomnographic variables and disruptive behavior disorders. Methods: Sixty children, (mean age, 8.3 years) were studied. Behavior assessment, a sleep questionnaire, and nocturnal polysomnography were completed shortly before and 1 year after adenotonsillectomy. Psychiatric evaluation was performed by a child psychiatrist. The Sleep Disordered Breathing Subscale Questionnaire included questions pertaining to symptoms of nocturnal obstruction and behavior items. Obstructive apneas and hypopneas were defined as 2 breaths or longer in duration. Rates of respiratory event-related arousals plus apneas and hypopneas defined the respiratory disturbance index (RDI). Results: Severity of SDB generally improved after adenotonsillectomy. DBDs were initially diagnosed in 25 (42%) of subjects and resolved in 12 (48%) of the diagnosed children postoperatively. There were no significant differences noted in the preoperative obstructive apnea index, apnea/hypopnea index, RDI or minimum oxygen saturation ( t tests, all P > 0.05) in children whose DBD resolved as compared to those whose DBD did not. There were, however, significant correlations between high scores on the preoperative SDB subscale and postoperative improvement in apnea/hypopnea index (Pearson correlation coefficient r = .28, P < 0.03), obstructive apnea index (r = 0.32, P < 0.02), and RDI (r = 0.28, P < 0.04). There was also a strong correlation seen between high preoperative questionnaire scores and resolution of DBD (r = 0.28, P < 0.02). Conclusion: Questionnaires about preoperative symptoms of SDB are predictive of improvement in polysomnographic abnormalities and DBD after adenotonsillectomy. The use of a Pediatric Sleep Questionnaire may be useful in determining which patients have behavioral disorders potentially treatable with surgical intervention. Significance: Questionnaires may provide a simple, inexpensive method of predicting clinical improvement after adenotonsillectomy in children with SDB and DBDs. Support: None reported.

Biochemoprevention for dysplastic lesions of the upper aerodigestive tract.

To evaluate the efficacy and secondarily the toxic effects of biochemopreventive therapy (high-dose isotretinoin [13-cis-retinoic acid], alpha-tocopherol, and interferon alfa) in the reversal of advanced premalignant lesions of the upper aerodigestive tract and to correlate the therapeutic events with modulation of biomarkers. Prospective, nonrandomized chemoprevention trial. Tertiary cancer care referral center and ambulatory care. Thirty-six patients with advanced premalignant lesions of the upper aerodigestive tract, without cancer during the 2 years before the intervention, with evaluable lesions, and without retinoid therapy for 3 months before the trial. Administration of oral isotretinoin (100 mg/m2 per day), oral alpha-tocopherol (1200 IU/d), and subcutaneous interferon alfa (3 megaunits per square meter twice weekly) for 12 months, with serial biopsies and clinical examination at 0, 6, 12, and 18 months from study start. Clinical and histologic responses to the intervention. Of the 36 patients, evaluation was possible in 30 for response at 6 months and in 21 at 12 months. At 6 months, there were 10 pathologic complete responses and 7 partial responses; at 12 months, 7 complete and 3 partial responses. A striking difference in response was observed in favor of laryngeal lesions (9/19 [47%] complete response rate at 6 months and 7/14 [50%] at 12 months vs 1/11 [9%] and 0/7 [0%], respectively, for oral lesions). Toxic effects were acceptable and did not exceed grade 3. Biochemoprevention is a promising biologic approach for laryngeal dysplasia and needs to be investigated further.