Related Experiment Video
Updated: Jan 10, 2026
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Association between obstructive sleep-disordered breathing severity and pain trajectories after adenotonsillectomy in
Chantal Frigon1, Ramanakumar V Agnihotram2, Annick Bérard-Giasson1
1Department of Anaesthesia, Division of Paediatric Anaesthesia, McGill University, Montreal, QC, Canada.
Insights
Children with severe obstructive sleep-disordered breathing (oSDB) often experience prolonged post-adenotonsillectomy pain and increased hospital visits. Higher oSDB severity correlates with more severe pain trajectories and greater analgesic use.
Area of Science:
- Pediatric surgery
- Sleep medicine
- Pain management
Background:
- Obstructive sleep-disordered breathing (oSDB) is linked to inflammation and may influence pain perception.
- The relationship between oSDB severity and post-adenotonsillectomy pain requires further investigation.
Purpose of the Study:
- To investigate the correlation between obstructive sleep-disordered breathing (oSDB) severity and post-adenotonsillectomy pain.
- To analyze analgesic use and hospital revisit rates in relation to oSDB severity.
Main Methods:
- Prospective cohort study of children aged 2-12 undergoing adenotonsillectomy.
- oSDB severity assessed using the modified Snoring, Trouble Breathing, Un-Refreshed (mSTBUR) questionnaire.
- Postoperative pain measured via the Parents' Postoperative Pain Measure (PPPM) and analgesic records over 14 days.
Main Results:
- Three distinct pain trajectories identified: mild/brief, moderate, and severe/prolonged.
- Higher preoperative mSTBUR scores were associated with severe/prolonged pain trajectories (OR 0.52-0.58, P<0.05).
- Children in severe pain trajectories required more analgesics and had significantly higher odds of unscheduled hospital revisits (OR 3.5-10.5, P<0.05).
Conclusions:
- Post-adenotonsillectomy pain follows predictable trajectories, influenced by oSDB severity.
- Children with severe oSDB face higher risks of prolonged pain and hospital readmission.
- oSDB assessment may aid in predicting and managing postoperative pain.
Background:
Obstructive sleep-disordered breathing (oSDB) is pro-inflammatory and might modulate pain. We hypothesised that post-adenotonsillectomy pain and analgesic use would correlate with oSDB severity.
Methods:
We conducted a prospective cohort study of children aged 2-12 yr undergoing adenotonsillectomy. Symptom severity of oSDB was assessed with the modified Snoring, Trouble Breathing, Un-Refreshed (mSTBUR) questionnaire. Parents recorded the Parents' Postoperative Pain Measure (PPPM) and analgesic medications for 14 postoperative days (PODs).
Results:
Complete PPPM data (2480 scores) for 10 PODs were recorded for 124/245 (51%) patients. An additional 1539 PPPM scores were recorded in 121 patients; imputed values were derived for 941 missing PPPM scores. In this dataset (n=245), group-based trajectory models identified three trajectory groups for mild/brief (Trajectory1, n=108), moderate (Trajectory2, n=90), and severe/prolonged (Trajectory3, n=47) pain. Trajectories exhibited distinct PPPM scores on POD1. Children with higher preoperative mSTBUR scores were significantly less likely to be in the low or moderate pain trajectory groups compared with the severe pain group (odds ratio [OR], 0.52; 95% confidence interval [95% CI], 0.27-0.97; P=0.040 and OR, 0.58; 95% CI, 0.35-0.97; P=0.037). The association between mSTBUR and the PPPM scores was stronger for younger children. When compared with Trajectory1, children in Trajectory2 and Trajectory3 received more daily doses of analgesics (P=0.04) and had, respectively, four-fold and 11-fold higher odds for unscheduled revisits (OR, 3.5; 95% CI, 1.0-11.7; P=0.044 and 10.5; 95% CI, 3.1-35.7; P=0.0002).
Conclusions:
Post-adenotonsillectomy pain at home followed three distinct pain trajectories. Children with severe oSDB (higher mSTBUR scores) were more likely to have severe prolonged pain and to return more often to hospital.
Clinical Trial Registration:
NCT03378830.
Related Concept Videos
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.
01:26Tonsillitis II: Management
01:25Analgesia and Pain Management
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...