Association of sleep disordered breathing symptoms with early postoperative analgesic requirement in pediatric ambulatory surgical patients

Abstract

Introduction: Sleep disordered breathing (SDB) symptoms are associated with increased rates of opioid-induced respiratory depression as well as enhanced nociception. Consequently, practitioners often withhold or administer lower intraoperative doses of opioids out of concern for postoperative respiratory depression. Therefore, SDB may be a critical determinant of analgesic requirement in the post-anesthesia care unit (PACU). We investigated whether preoperative SDB classification was independently associated with need for PACU analgesic intervention in a cross-sectional sample of 985 children who underwent elective, painful ambulatory surgical procedures.

Methods: Using prospectively collected data, children aged 4-17yr were grouped into two categories based on whether or not they had symptoms of SDB. Perioperative variables were compared between the exposed and control groups using Chi-squared test for categorical or t-test for continuous variables. Logistic regression analysis was used to assess the association between SDB and the odds of requiring PACU IV opioids.

Results: Children with preoperative SDB symptoms (N = 325) compared with the reference group of children who did not have these symptoms had higher rates of PACU analgesic intervention (47.1% vs. 37.4%; p = 0.004) and higher mean arousal pain scores (3.7 ± 3.5 vs.1.9 ± 2.9; p < 0.001). In our primary multivariable logistic regression model adjusted for a number of variables, preoperative SDB symptoms was associated with a two-fold increased odds of receiving PACU intravenous opioid (OR = 2.01, 95%CI, 1.29-3.12; p = 0.002).

Conclusion: These results suggest that preoperative SDB symptoms in children undergoing ambulatory surgery, exerts a significant influence on PACU pain behavior and analgesic requirement. Mechanisms underlying this enhanced pain experience deserve further elucidation.

Keywords: Ambulatory surgery; Apnea; Children and adolescents; Habitual snoring; Postoperative pain; Sleep disordered breathing.

Fig. 1

Showing patient distribution by surgical specialties Abbreviations: GI= gastrointestinal

Fig. 2

Proportion of patients receiving post-anesthesia care unit analgesia (any, IV or oral opioid and any non-opioid by SDB category. Abbreviations: PACU = Post anesthesia care unit; IV= intravenous; SDB = sleep disordered breathing

Fig. 3

Receiver operator characteristic (ROC) curve for model predicting need for PACU IV opioid. Area under the curve (AUC) for the predictors was 0.82; 95% CI = 0.79–0.77; p=0.001. AUC for the ROC indicates the usefulness of a test (our model) in predicting a binomial outcome (receipt of PACU IV opioid yes/no). A value of 0.82 shows ‘good’ predictive ability for our model