Behavioral Changes in Children With Mild Sleep-Disordered Breathing or Obstructive Sleep Apnea After Adenotonsillectomy


  • Ron B. Mitchell MD,

    Corresponding author
    1. Division of Pediatric Otolaryngology, Department of Otolaryngology–Head and Neck Surgery, St. Louis University School of Medicine, St. Louis, Missouri, U.S.A.
    • Dr. Ron B. Mitchell, Professor of Otolaryngology, Saint Louis University School of Medicine, Cardinal Glennon Children's Medical Center, 1465 S. Grand, Suite 4740, St. Louis, MO 63104
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  • James Kelly PhD

    1. Division of Otolaryngology, Department of Surgery, University of New Mexico, Health Sciences Center, Albuquerque, New Mexico, U.S.A.
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  • This study was presented at the annual meeting of the American Society for Pediatric Otolaryngology, Chicago, IL, May 21, 2006.


Objective: To compare changes in behavior after adenotonsillectomy in children with either mild sleep-disordered breathing (SDB) or obstructive sleep apnea (OSA).

Study Design: Prospective cohort study.

Methods: Children at the University of New Mexico Children's Hospital, Albuquerque with mild SDB or OSA were included in the study. All children underwent preoperative polysomnography before adenotonsillectomy. Mild SDB was defined as an apnea-hypopnea index (AHI) less than 5 or an apnea index (AI) less than 1. OSA was defined as an AHI 5 or greater or an AI 1 or greater. Pre- and postoperative scores from the Behavioral Assessment System for Children (BASC) survey were compared using repeated measures analysis of variance.

Results: The mean preoperative AHI for children with mild SDB (n = 17) was 3.1 (range, 1.7–4.7), and for children with OSA (n = 23) it was 25.3 (range, 10.0–48.0). The mean preoperative BASC scores for children with mild SDB were not significantly different from the scores for children with OSA. The demographics in the two groups of children were similar. The behavior symptom index, a global measure of behavior, showed significant improvement after surgery for both groups of children (P < .01). Children also showed significant improvement after adenotonsillectomy in the BASC scales of atypicality, depression, hyperactivity, and somatization. Mean changes in BASC scores after adenotonsillectomy were not significantly different in the two groups of children.

Conclusions: Behavioral problems are prevalent in children with either mild SDB or OSA, and both groups of children show significant improvements in behavior after adenotonsillectomy.