Subjective sleepiness and polysomnographic correlates in children scheduled for adenotonsillectomy vs other surgical care

• Published in: Sleep (New York, N.Y.) N.Y.), 2006-04, Vol.29 (4), p.495-503
• Main Authors: Chervin, Ronald D, Weatherly, Robert A, Ruzicka, Deborah L, Burns, Joseph W, Giordani, Bruno J, Dillon, James E, Marcus, Carole L, Garetz, Susan L, Hoban, Timothy F, Guire, Kenneth E
• Format: Article
• Language: English
• Subjects: Adenoidectomy - statistics & numerical data; Child; Child, Preschool; Cross-Sectional Studies; Disorders of Excessive Somnolence - diagnosis; Disorders of Excessive Somnolence - epidemiology; Female; Humans; Male; Polysomnography; Preoperative Care; Prospective Studies; Surgical Procedures, Operative; Surveys and Questionnaires; Tonsillectomy - statistics & numerical data
• ISSN: 0161-8105

To compare a validated subjective measure of childhood sleepiness to an objective determination, assess the frequency of problematic sleepiness among children with suspected sleep-disordered breathing (SDB), and examine what standard or investigational polysomnographic measures of SDB predict subjective sleepiness. Prospective, cross-sectional. University-based sleep disorders laboratory. Washtenaw County Adenotonsillectomy Cohort. Polysomnography followed by Multiple Sleep Latency Tests (MSLTs) in 103 children aged 5 to 12 years old: 77 were scheduled for clinically indicated adenotonsillectomy, usually for suspected SDB, and 26 for unrelated surgical care. Parents completed the previously validated, 4-item Pediatric Sleep Questionnaire-Sleepiness Subscale (PSQ-SS). Thirty-three (43%) of the children scheduled for adenotonsillectomy had high PSQ-SS scores, in comparison with only 3 (12%) of the controls (p = .004). The PSQ-SS scores correlated inversely with mean sleep latencies on the MSLTs (rho = -0.23, p = .006). The obstructive apnea index, apnea-hypopnea index, and respiratory disturbance index (which included respiratory event-related arousals identified by esophageal pressure monitoring) each correlated similarly with PSQ-SS scores, as did investigational quantification of esophageal pressures and respiratory cycle-related electroencephalographic changes (each rho approximately 0.30, p < .02). A stepwise regression identified sigma-frequency respiratory cycle-related electroencephalographic changes as the strongest independent predictor of subjective sleepiness among all subjects and particularly among those without obstructive sleep apnea. Sleepiness is a frequent problem among children with suspected SDB. Subjective sleepiness (PSQ-SS) reflects MSLT results to a limited extent, as in adults. Standard polysomnographic measures of SDB predict subjective sleepiness, but respiratory cycle-related electroencephalographic changes may offer additional clinical utility.