European Journal of Pediatrics

, Volume 155, Issue 1, pp 56–62 | Cite as

Sleep disordered breathing: Effects of adenotonsillectomy on behaviour and psychological functioning

  • N. J. Ali
  • D. Pitson
  • J. R. Stradling
Psychology/Child Psychiatry


Children on the adenotonsillectomy waiting list aged 6 years or more were screened by questionnaire and overnight sleep monitoring to identify 12 with a moderate sleep and breathing disorder (SBD) group. They were matched by age and sex with 11 children who had a similar history of snoring and sleep disturbance but without an obvious sleep and breathing problem when monitored (snorer group) and also with a group of ten children most of whom were refered for an unrelated surgical procedure (control group). All children were studied before and 3–6 months after surgery. Pre-operatively the SBD and snorer groups both had significantly more restless sleep than the control group. The SBD group also had significantly more (>4%) dips in oxygen saturation than the other two groups. After surgery there were no longer any significant differences between the three groups. After adenotonsillectomy the SBD group showed a significant reduction in aggression, inattention and hyperactivity on the parent Conners scale, and an improvement in vigilance on the Continuous Performance Test. The snorer group also improved showing less hyperactive behaviour than pre-operatively and better vigilance. The control groups's behaviour and performance did not change significantly. There were no significant changes in the performance of the Matching Familiar Figures Test in any of the groups.

Key words

Sleep apnoea Snoring Sleep disordered breathing Children Adenotensillectomy 



sleep and breathing disorder


continuous performance test


matching familiar figures test


Wechsler intelligence scale for children


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ali NJ, Pitson D, Stradling JR (1993) Snoring, sleep disturbance and behaviour in 4–5 year olds. Arch Dis Child 68: 360–366PubMedGoogle Scholar
  2. 2.
    Ali NJ, Pitson D, Stradling JR (1994) The natural history of snoring and related behaviour problems between the ages of 4 and 7 years. Arch Dis Child 71: 74–76PubMedGoogle Scholar
  3. 3.
    Brouillette RT, Fernbach SK, Hunt CE (1982) Obstructive sleep apnea in infants and children. Pediatrics 100: 31–39Google Scholar
  4. 4.
    Cairns E, Cammock T (1978) Development of a more reliable version of the Matching Familiar Figures Test. Develop Psychol 14: 555–560Google Scholar
  5. 5.
    Chalmers DC, Stewart I, Silva P, Mulvena A (1989) Otitis media with effusion in children. Clin Dev Med 108Google Scholar
  6. 6.
    Cody RP, Smith JK (1991) Applied statistics and the SAS programming language. 3rd edn. Elsevier, New YorkGoogle Scholar
  7. 7.
    Conners CK (1969) A teacher rating scale for use in drug studies with children. Am J Psych 126: 884–888Google Scholar
  8. 8.
    Guilleminault C, Eldrige FL, Simmons FB, Dement WC (1976) Sleep apnea in eight children. Pediatrics 58: 23–31PubMedGoogle Scholar
  9. 9.
    Guilleminault C, Korobkin R, Winkle R (1981) A review of 50 children with obstructive sleep apnea syndrome. Lung 159: 275–287PubMedGoogle Scholar
  10. 10.
    Guilleminault C, Winkle R, Korbkin R, Simmons B (1982) Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resisitive load and daytime functioning. Eur J Pediatr 139: 165–171PubMedGoogle Scholar
  11. 11.
    Guilleminault C, Stoohs R, Duncan S (1991) Snoring (I). Daytime sleepiness in regular heavy snorers. Chest 99: 40–48PubMedGoogle Scholar
  12. 12.
    Hill W (1889) On some causes of backwardness and stupidity in children: and the relief of these symptoms in some instances by nasopharyngeal scarifications. BMJ II: 711–712Google Scholar
  13. 13.
    Office of Population and Census and Surveys (1980) Classification of occupations. HMSO, London HMSOGoogle Scholar
  14. 14.
    Rapoport JL, Benoit M (1975) The relation of direct home observations to the clinic evaluation of hyperactive school age boys. J Child Psychol Psychiatry 16: 141–147PubMedGoogle Scholar
  15. 15.
    Stradling JR, Crosby JH (1990) Relation between systemic hypertension and sleep hypoxaemia or snoring: analysis in 748 men drawn from general practice. BMJ 300: 75–78PubMedGoogle Scholar
  16. 16.
    Stradling JR, Thomas G, Warley ARH, Williams P, Freeland A (1990) Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. Lancet 335: 249–253PubMedGoogle Scholar
  17. 17.
    Stradling JR, Crosby JH, Payne CD (1991) Self-reported snoring and daytime sleepiness in men aged 35–65 years. Thorax 46: 807–810PubMedGoogle Scholar
  18. 18.
    Taylor Eric, Sandberg Seija, Thorley Geoffrey, Giles Susan (1993) The epidemiology of childhood hyperactivity. Maudsley Monograph Series, Oxford University Press, OxfordGoogle Scholar
  19. 19.
    Trites RL, Blouin AGA, Ferguson HB, Lynch GW (1981) The Conners teacher rating scale: an epidemiological inter-rater reliability and follow up investigation. In: Gadow K, Loney J (eds) Psychosocial aspects of drug treatment for hyperactivity. Westview Press, Boulder ColoradoGoogle Scholar
  20. 20.
    Warley AR, Mitchell JH, Stradling JR (1987) Evaluation of the Ohmeda 3700 pulse oximeter. Thorax 42: 892–896PubMedGoogle Scholar
  21. 21.
    Vos PJE, Stradling JR (1991) Assessment of sleep times and movement arousals from video recordings. J Amb Mon 4: 35–42Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • N. J. Ali
    • 1
    • 2
  • D. Pitson
    • 1
  • J. R. Stradling
    • 1
  1. 1.Osler Chest UnitChurchill HospitalHeadingtonUK
  2. 2.Department of MedicineKings Mill HospitalSutton in AshfieldUK

Personalised recommendations