Author(s)
Jordyn K. Dinwiddie, MA
Emily L. Jensen, BSN
Melissa H. H. Scholes, MD
Affiliation(s)
Pediatric Otolaryngology, Univ. of Colorado Sch. of Med. & Children's Hosp. Colorado, Aurora, CO.
Abstract:
Introduction: Obstructive sleep apnea (OSA) in children has been increasingly recognized as a major health problem. Children with psychiatric disorders are often on medications that lead them to gain weight and disrupt sleep cycles. Unfortunately, this special population is not well-studied and we do not know how effective our routine treatment strategies for OSA are. This study aims to evaluate the effectiveness of adenotonsillectomy (T&A) in the treatment of OSA in children with psychiatric disorders as measured by polysomnogram (PSG) and the Epworth Sleepiness Scale (ESS). Our hypothesis is that this population does not have as much improvement compared to controls due to underlying mood disorders, medications and comorbidities.
Methods: After IRB approval, an electronic medical record search was performed for patients under the age 18 with diagnosis of OSA and a major psychiatric disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V). Inclusion criteria included pre- and postoperative PSG, history of T&A for treatment of their OSA, and pre- and postoperative ESS results. The data was compared to age and weight-matched controls without major psychiatric disorders.
Results: 14 of 33 control patients were able to be matched to study patients by age. The psychiatric diagnoses were anxiety, depression, bipolar and schizophrenia, or any combination of. 36% of subjects had anxiety, 30.3% had depression, the other diagnoses all occurred at less than 15%. All study subjects and controls had a T&A, pre-and postoperative PSG, ESS, but the control group had no documented psychiatric diagnoses. There was no significant difference in the postoperative apnea-hypopnea index, ESS or BMI between the study and control groups
Conclusion: The study group had an improvement in the ESS after airway surgery that was comparable to the control group. Although there are accompanying psychiatric diagnoses these children and young adults did subjectively find improvements. Additionally, there was significant improvement in the AHI following surgery compared to the control group. Despite psychiatric medication and sleep issues, our patients with major psychiatric disorders benefitted from T&A similarly to control subjects.