Multilevel Sleep Surgery Including the Palate in Nonsyndromic, Neurologically Intact Children with Obstructive Sleep Apnea

Objective To examine the effects of multilevel sleep surgery, including palate procedures, on obstructive sleep apnea parameters in the pediatric population. Study Design A case series with chart review was conducted to identify nonsyndromic, neurologically intact pediatric patients who underwent either uvulectomy or uvulopalatopharyngoplasty as part of multilevel sleep surgery from 2011 through 2017. Setting A tertiary care, university children’s hospital. Subjects and Methods Unpaired Student t test was used to compare average pre- and postsurgical apnea-hypopnea index (AHI) and oxygen saturation nadir (OSN). Paired Student t test was used to compare the mean pre- and postsurgical AHI and OSN within the same patient for the effects of adenotonsillectomy (T&A) vs multilevel sleep surgery. Results In patients who underwent T&A previously, multilevel sleep surgery, including palate procedures, resulted in improved OSA severity in 6 (86%) patients and worsened OSA in 1 (14%) patient. Multilevel sleep surgery, including palate procedures, significantly decreased mean AHI from 37.98 events/h preoperatively to 8.91 events/h postoperatively ( P = .005). However, it did not significantly decrease OSN. Conclusion This study includes one of the largest populations of children in whom palate procedures as a part of multilevel sleep surgery have been performed safely with no major complications and a low rate of velopharyngeal insufficiency. Therefore, palatal surgery as a part of multilevel sleep surgery is not necessarily the pariah that we have traditional thought it is in pediatric otolaryngology

Testing the Acquired Preparedness Model: Predicting College Student Gambling Frequency and Symptomatology

The acquired preparedness model posits that impulsivity influences the development of outcome expectancies that then influence the engagement in a specific risk taking behavior. The purpose of this study was to test the acquired preparedness model for gambling behavior of college students using a multidimensional approach to impulsivity. Employing a structural equation approach, it was predicted that a full mediational model that includes multiple dimensions of impulsivity and multiple outcome expectancies would predict gambling frequency and gambling symptomatology. Support was found for the acquired preparedness model in understanding why some college students gamble more frequently or problematically. Specifically, better model fit was found for the full mediational model that included outcome expectancies to predict both frequency and gambling symptomatology than the model that included the direct relation between impulsivity and gambling

Exploring a Multidimensional Approach to Impulsivity in Predicting College Student Gambling

Impulsivity has been implicated as a contributing factor in the development of gambling problems among college students, but attempts to confirm this relation have been inconsistent. One explanation for these incongruent findings is that impulsivity may be multidimensional and that distinct dimensions differentially predict separate behaviors. Using a large, diverse sample of college students, a factor analysis of self-report measures related to impulsivity revealed a three-factor structure of Behavioral Activation, Preference for Stimulation, and Inhibition Control that was similar to the structure found by Meda and colleagues (2009) in a different adult sample. Low risk gamblers and symptomatic gamblers scored significantly lower on Behavioral Activation and Inhibition Control than non-gamblers. Conversely, low risk gamblers and symptomatic gamblers scored significantly higher on Preference for Stimulation. Prevalence of gambling and gambling activity preference for this sample was also assessed