DSM-IV Diagnoses and Obstructive Sleep Apnea in Children Before and 1 Year After Adenotonsillectomy

Abstract

Objectives-Obstructive sleep apnea, a common indication for adenotonsillectomy in children, has been linked to behavioral morbidity. We assessed psychiatric diagnoses in children before and after adenotonsillectomy and examined whether baseline sleep apnea predicted improvement after surgery.Method-Subjects of this prospective cohort study were children aged 5.0-12.9 years-old who had been scheduled for adenotonsillectomy (n = 79), or care for unrelated surgical conditions (n=27, among whom 13 had surgery after baseline assessment). Prior to intervention and one year later, subjects underwent structured diagnostic interviews and polysomnography. The main outcome measure was frequency of DSM-IV attention and disruptive behavior disorder diagnoses (A&DBDs) at baseline and follow-up.Results-At baseline, A&DBDs were diagnosed in 36.7% of adenotonsillectomy subjects and 11.1% of controls (p<.05); attention-deficit/hyperactivity disorder was found in 27.8% and 7.4%, respectively (p<.05). One year later, group differences were non-significant, A&DBDs were diagnosed in only 23.1% (p<.01), and 50% of subjects with baseline attention-deficit/hyperactivity disorders no longer met diagnostic criteria. Obstructive sleep apnea on polysomnography at baseline did not predict concurrent psychiatric morbidity or later improvement.Conclusions-Attention and disruptive behavior disorders, diagnosed by DSM-IV criteria, were more common before clinically-indicated adenotonsillectomy than one year later. Surgery may be associated with reduced morbidity even among subjects lacking polysomnographic evidence of obstructive sleep apnea.

Clinical Practice Guideline: Polysomnography for Sleep‐Disordered Breathing Prior to Tonsillectomy in Children

“…50 For perspective, the exposure to lead-based paint is associated with an average IQ point loss of less than 4 points. 51 Treatment of SDB has been shown to improve behavior, 39,[52][53][54] attention, 53 quality of life (QOL), 39,55 neurocognitive functioning, 56 enuresis, 57,58 parasomnias (unusual events that occur while asleep), 59 and restless sleep. 60 Even when a clinician strongly suspects SDB exists, some families require objective information to facilitate a clinical decision.…”

ADHD and Sleep Problems in Children

“…Early case studies reported ADHD symptoms in children referred for evaluation of SDB symptoms (Guilleminault C., 1981). In a study by Dillon et al, of children five to twelve years of age scheduled for adenotonsillectomy, nearly 37% had evidence of ADHD and disruptive behavior disorder (including oppositional and conduct disorder) and about 28% had ADHD (Dillon, 2007). This study also assessed behavioral outcomes after adenotonsillectomy.…”

“…This study also assessed behavioral outcomes after adenotonsillectomy. Fifty percent of the children who met criteria for ADHD at baseline before adenotonsillectomy no longer did so after surgery (Dillon, 2007). In a review of sixteen studies, parents who reported higher SDB symptoms for their children also reported they had higher inattention and hyperactivity symptoms Cortese, 2009).…”

Sleep and cognitive problems in patients with attention-deficit hyperactivity disorder

“…Moreover, it has been reported that these ADHD-like symptoms are improved with sleep disorder treatment. 18,19 Unfortunately, the findings describing the relationship between ADHD and sleep problems differ depending on the measurement tool used to evaluate sleep problems. For example, studies based on reporting from parents of ADHD patients reveal many sleep problems, but results based on objective measurements have yielded more controversial results.…”