SpringerLink
Log in

Effects of multiple exposures to general anesthesia on the sleep quality of children after plastic surgery in Bei**g, China: a cohort study

  • Original Article
  • Published:
Sleep and Biological Rhythms Aims and scope Submit manuscript

Abstract

To assess the effects of the number and duration of general anesthesia exposure on the sleep quality of 6–15-year-old school children who underwent plastic surgery. The study was conducted on 688 children who underwent plastic surgery between the ages of 6 and 15 years using the Sleep Disorder Scale for Children (SDSC). The children were divided into two groups according to their exposure to general anesthesia: No General Anesthesia (NGA) and General Anesthesia (GA) groups. The GA group was further divided into three subgroups according to the number of exposures: Single-exposure, Double-exposure, and Multiple-exposure groups. The GA group was also subdivided into two groups according to the cumulative total time of anesthesia exposure: < 3 h and ≥ 3 h groups. Multivariate logistic regression analysis was used to confirm the potential factors that affect children with sleep disturbance (SDSC scores > 39) after general anesthesia exposure. Linear regression was used to analyze the correlation of the factors with the SDSC scores. The SDSC scores were higher in the GA group [35.4 ± 4.3 vs. 34.0 ± 3.6, P < 0.0001] as compared to the NGA group. The number of children with SDSC scores > 39 was also higher in the GA group [80 (17.5%) vs. 17 (7.4%), P < 0.0001]. More anesthesia exposure was correlated with higher total SDSC scores [34.5 ± 4.3 for single exposure vs 35.1 ± 3.9 for double exposure vs 37.5 ± 4.5 for multiple exposures, P < 0.0001] and a higher proportion of SDSC scores > 39 [24 (12.0%) for single exposure vs 24 (15.5%) for double exposure vs 32 (31.1%) for multiple exposures, P < 0.0001]. Longer anesthesia exposure was also correlated with higher total SDSC scores [34.4 ± 4.5 for < 3 h vs. 35.8 ± 4.2 for ≥ 3 h, P = 0.002]. The number of exposures to general anesthesia was a potential factor in sleep disturbance among children, determined based on logistic regression. Children who underwent plastic surgery between the ages of 6 and 15 years with general anesthesia exposure might have worse sleep quality and a higher incidence of sleep disorders. More frequent anesthesia exposure leads to worsened sleep quality and a higher incidence of sleep disorders. This study also confirmed that a longer duration of cumulative anesthesia exposure also leads to worse sleep quality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Sadeh A, Gruber R, Raviv A. Sleep, neurobehavioral functioning, and behavior problems in school-age children. Child Dev. 2002;73(2):405–17.

    Article  Google Scholar 

  2. Yang Y, Qi Y, Cui Y, Li B, Zhang Z, Zhou Y, Chen X, Zhu D, He F, Zheng Y. Emotional and behavioral problems, social competence, and risk factors in 6–16-year old students in Bei**g, China. PLoS ONE. 2019;14(10): e0223970.

    Article  CAS  Google Scholar 

  3. Carpena MX, Munhoz TN, Xavier MO, Rohde LA, Santos IS, Del-Ponte B, Barros FC, Matijasevich A, Tovo-Rodrigues L. The role of sleep duration and sleep problems during childhood in the development of ADHD in adolescence: findings from a population-based birth cohort. J Atten Disord. 2020;24(4):590–600.

    Article  Google Scholar 

  4. Burman D. Sleep disorders: circadian rhythm sleep-wake disorders. FP Essent. 2017;460:33–6.

    PubMed  Google Scholar 

  5. Brainard J, Gobel M, Bartels K, Scott B, Koeppen M, Eckle T. Circadian rhythms in anesthesia and critical care medicine: potential importance of circadian disruptions. Semin Cardiothorac Vasc Anesth. 2015;19(1):49–60.

    Article  Google Scholar 

  6. Selvadurai S, Maynes JT, McDonnell C, Cushing SL, Propst EJ, Lorenzo A, Lim A, Meltzer LJ, Lu Z, Horner RL, Narang I. Evaluating the effects of general anesthesia on sleep in children undergoing elective surgery: an observational case-control study. Sleep J. 2018;41(8):1–10.

    Google Scholar 

  7. Kain ZN, Mayes LC, Caldwell-Andrews AA, Alexander GM, Krivutza D, Teague BA, Wang SM. Slee** characteristics of children undergoing outpatient elective surgery. Anesthesiology. 2002;97(5):1093–101.

    Article  Google Scholar 

  8. U.S. Food & Drug Administration. FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women. [2018–07–01]. https://www.fda.gov/Drugs/DrugSafety/ucm532356.htm.

  9. Bruni O, Ottaviano S, Guidetti V, Romoli M, Innocenzi M, Cortesi F, Giannotti F. The Sleep Disturbance Scale for Children (SDSC). Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. J Sleep Res. 1996;5(4):251–61.

    Article  CAS  Google Scholar 

  10. Kotiniemi LH, Ryhanen PT, Moilanen IK. Behavioural changes in children following day-case surgery: a 4-week follow-up of 551 children. Anaesthesia. 1997;52:970–6.

    Article  CAS  Google Scholar 

  11. Ayuse T, Kurata S, Sanuki T, Mishima G, Kiriishi K, Kawai M, Watanabe T, Ozaki-Honda Y, Tanoue N, Magata N, Yamaguchi K, Yoshida M, Ayuse T. Effects of general anesthesia on postoperative sleep cycles in dentally disabled patients. Spec Care Dentist. 2019;39(1):3–9.

    Article  Google Scholar 

  12. Åslund L, Arnberg F, Kanstrup M, Lekander M. Cognitive and behavioral interventions to improve sleep in school-age children and adolescents: a systematic review and meta-analysis. J Clin Sleep Med. 2018;14(11):1937–47.

    Article  Google Scholar 

  13. Gruber R, Somerville G, Enros P, Paquin S, Kestler M, Gillies-Poitras E. Sleep efficiency (but not sleep duration) of healthy school-age children is associated with grades in math and languages. Sleep Med. 2014;1512(12):1517–25.

    Article  Google Scholar 

  14. Zaccariello MJ, Frank RD, Lee M, Kirsch AC, Schroeder DR, Hanson AC, Schulte PJ, Wilder RT, Sprung J, Katusic SK, Flick RP, Warner DO. Patterns of neuropsychological changes after general anaesthesia in young children: secondary analysis of the Mayo Anesthesia Safety in Kids study. Br J Anaesth. 2019;122(5):671–81.

    Article  Google Scholar 

  15. Marriner AM, Pestell C, Bayliss DM, McCann M, Bucks RS. Confirmatory factor analysis of the Sleep Disturbance Scale for Children (SDSC) in a clinical sample of children and adolescents. J Sleep Res. 2017;26(5):1–7.

    Article  Google Scholar 

  16. Olutoye OA, Baker BW, Belfort MA, Olutoye OO. Food and Drug Administration warning on anesthesia and brain development: implications for obstetric and fetal surgery. Am J Obstet Gynecol. 2018;218(1):98–102.

    Article  Google Scholar 

  17. Slikker W Jr, Zou X, Hotchkiss CE, Divine RL, Sadovova N, Twaddle NC, Doerge DR, Scallet AC, Patterson TA, Hanig JP, Paule MG, Wang C. Ketamine-induced neuronal cell death in the perinatal rhesus monkey. Toxicol Sci. 2007;98(1):145–58.

    Article  CAS  Google Scholar 

  18. Jevtovic-Todorovic V, Hartman RE, Izumi Y, Benshoff ND, Dikranian K, Zorum Ski CF, Olney JW, Wozniak DF. Early exposure to common anesthetic agents causes widespread neurodegeneration in the develo** rat brain and persistent learning deficits. J Neurosci. 2003;23(3):876–82.

    Article  CAS  Google Scholar 

  19. Keaney A, Diviney D, Harte S, Lyons B. Postoperative behavioral changes following anesthesia with sevoflurane. Pediatr Anesth. 2004;14(10):866–70.

    Article  Google Scholar 

  20. Kain ZN, Mayes LC, O’Connor TZ, Cicchetti DV. Preoperative anxiety in children. Predictors and outcomes. Arch Pediatr Adolesc Med. 1996;150(12):1238–45.

    Article  CAS  Google Scholar 

  21. Mellon RD, Simone AF, Rappaport BA. Use of anesthetic agents in neonates and young children. Anesth Analg. 2007;104(3):509–20.

    Article  CAS  Google Scholar 

  22. Yon JH, Carter LB, Reiter RJ, Jevtovic-Todorovic V. Melatonin reduces the severity of anesthesia-induced apoptotic neurodegeneration in the develo** rat brain. Neurobiol Dis. 2006;21(3):522–30.

    Article  CAS  Google Scholar 

  23. Li A, Chen S, Quan SF, Silva GE, Ackerman C, Powers LS, Roveda JM, Perfect MM. Sleep patterns and sleep deprivation recorded by actigraphy in 4th-grade and 5th-grade students. Sleep Med. 2020;67:191–9.

    Article  Google Scholar 

  24. da Silva AC, Vieira ÉLM, Dos Santos LC. Sleep, social behavior and food consumption of school children of a large Brazilian city. Public Health Nutr. 2021;24(6):1531–41.

    Article  Google Scholar 

  25. Kain ZN, Caldwell-Andrews AA, Weinberg ME, Mayes LC, Wang SM, Gaal D, Saadat H, Maranets I. Sevoflurane versus halothane: postoperative maladaptive behavioral changes: a randomized, controlled trial. Anesthesiology. 2005;102(4):720–6.

    Article  CAS  Google Scholar 

  26. Eid B, Bou Saleh M, Melki I, Torbey PH, Najem J, Saber M, El Osta N, Rabbaa KL. Evaluation of chronotype among children and associations with BMI, sleep, anxiety, and depression. Front Neurol. 2020;11:416.

    Article  Google Scholar 

  27. Many BT, Rizeq YK, Kwon S, Vacek JC, Goldstein SD, Hunter CJ, Ghomrawi H, Abdullah F. Quantifying postoperative sleep loss associated with increased pain in children undergoing a modified Nuss operation. J Pediatr Surg. 2020;55(9):1846–9.

    Article  Google Scholar 

  28. Rabbitts JA, Zhou C, Narayanan A, Palermo TM. Longitudinal and temporal associations between daily pain and sleep patterns after major pediatric surgery. J Pain. 2017;18(6):656–63.

    Article  Google Scholar 

  29. Min CB, Kain ZN, Stevenson RS, Jenkins B, Fortier MA. A randomized trial examining preoperative sedative medication and postoperative sleep in children. J Clin Anesth. 2016;30:15–20.

    Article  Google Scholar 

  30. Buxton OM, Chang AM, Spilsbury JC, Bos T, Emsellem H, Knutson KL. Sleep in the modern family: protective family routines for child and adolescent sleep. Sleep Health. 2015;1(1):15–27.

    Article  Google Scholar 

  31. Matsumoto Y, Kaneita Y, Jike M, Osaki Y, Kanda H, Higuchi S, Itani O, Otsuka Y. Clarifying the factors affecting the implementation of the “early to bed, early to rise, and don’t forget your breakfast” campaign aimed at adolescent in Japan. Sleep Biol Rhythms. 2021;19(3):325–36.

    Article  Google Scholar 

Download references

Funding

No Funding was received.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-da-chu Rd., Shi**gshan District, Bei**g, 100144, China

    Ye Wang, Juhui Liu, Zibin **, Weiou Li, Lingxin Wei, Dong Yang & **aoming Deng

  2. Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 North-li-shi Rd., **cheng District, Bei**g, 100037, China

    Fuxia Yan

Authors
  1. Ye Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juhui Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zibin **
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Weiou Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lingxin Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dong Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. **aoming Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fuxia Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YW: helped design the study, conduct the study, collect the data, analyze the data, and prepare the manuscript. JL and LW: helped to conduct the study, analyze the data, and prepare the manuscript. ZJ: helped conduct the study and analyze the data. WL and DY: helped conduct the study. XD and FY: helped conduct the study, and prepare the manuscript.

Corresponding authors

Correspondence to **aoming Deng or Fuxia Yan.

Ethics declarations

Conflict of interest

Author Ye Wang declares that she has no conflict of interest. Author Juhui Liu declares that he has no conflict of interest. Author Zibin ** declares that he has no conflict of interest. Author Weiou Li declares that she has no conflict of interest. Author Lingxin Wei declares that he has no conflict of interest. Author Dong Yang declares that she has no conflict of interest. Author **aoming Deng declares that he has no conflict of interest. Author Fuxia Yan declares that she has no conflict of interest.

Ethical approval

Compliance with ethical standards: This study met ethical standards and was approved by the Ethics Committee of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (Z202034), and written informed consent was obtained from all patients. The study was registered with the China Clinical Trial Registration Center (http://www.chictr.org.cn) before patient enrollment (ChiCTR2000032784, Principal investigator: Ye Wang, Date of registration May 10, 2020). The trial was conducted at Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College in Bei**g, China.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, Y., Liu, J., **, Z. et al. Effects of multiple exposures to general anesthesia on the sleep quality of children after plastic surgery in Bei**g, China: a cohort study. Sleep Biol. Rhythms 20, 509–519 (2022). https://doi.org/10.1007/s41105-022-00397-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41105-022-00397-2

Keywords

Search

Navigation