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Sleeping characteristics of children undergoing outpatient elective surgery
Zeev N Kain1, Linda C Mayes, Alison A Caldwell-Andrews
1Department of Anesthesiology, The Children's Clinical Research Center, Yale University School of Medicine, New Haven, Connecticut 06510, USA. kain@biomed.med.yale.edu
Insights
Many children experience new sleep problems after surgery. Objective sleep monitoring revealed significant disturbances and links to increased pain and anxiety in young patients.
Area of Science:
- Pediatric Anesthesia and Surgery
- Sleep Medicine
- Behavioral Pediatrics
Background:
- Postoperative sleep disturbances are common in children following anesthesia and surgery.
- Previous research highlights the need for objective sleep assessment methods.
Purpose of the Study:
- To investigate postoperative sleep-related problems in children undergoing outpatient surgery using objective actigraphy technology.
- To compare sleep patterns between surgical patients and a community control group.
Main Methods:
- A longitudinal cohort study comparing 92 children undergoing general anesthesia with 77 community-based controls.
- Sleep assessment using actigraphy and the Post Hospitalization Behavioral Questionnaire (PHBQ) for at least 3 nights pre-surgery and 5 days post-surgery.
- Collection of data on coping, temperament, anxiety, surgical procedures, and postoperative pain.
Main Results:
- 47% of children experienced postoperative sleep disturbances (actigraphy or PHBQ).
- Actigraphy showed a significant decrease in sleep percentage in 14.4% of surgical patients.
- Sleep problems correlated with higher postoperative pain and lower sociability-temperament scores, alongside increased perioperative anxiety.
Conclusions:
- A substantial proportion of children develop sleep issues after outpatient surgery.
- The clinical significance of these postoperative sleep problems requires further investigation.
Background:
A significant number of children undergoing anesthesia and surgery exhibit new-onset sleep-related problems postoperatively. The aim of this longitudinal cohort study was to expand previous research in this area by using a new objective technology.
Methods:
This study compared children undergoing general anesthesia and outpatient surgery (n = 92) to a community-based control group of children (n = 77). Data regarding coping, temperament, anxiety, surgical procedures, and postoperative pain were collected. Subjects underwent actigraphy sleep monitoring for at least 3 nights before surgery and 5 postoperative days (POD). Sleep assessment was performed with actigraphy sleep monitoring and the Post Hospitalization Behavioral Questionnaire (PHBQ).
Results:
Forty-three children (47%) in the surgery group experienced postoperative sleeping disturbances as determined by either the actigraphy or the PHBQ. Only 13 children (14.4%), however, experienced a decrease of at least 1 SD in percentage sleep as assessed by actigraphy. Postoperative pain scores on POD 1 and POD 2 were significantly higher among children who exhibited sleep problems as diagnosed by actigraphy (F = 4.283; P= 0.047). Also, children who exhibited actigraph-based sleep problems scored lower sociability-temperament (14.1 +/- 4.3 vs. 17.5 +/- 3.4; P= 0.04) scores compared with the community group and had a higher rate of change in their perioperative anxiety levels (group x time interaction, F = 5.1; P= 0.03).
Conclusion:
A significant number of children undergoing outpatient surgery experience postoperative sleep-related problems. The clinical significance of this finding, however, is unclear.