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Snoring and sleep-disordered breathing in young children: subjective and objective correlates
Hawley E Montgomery-Downs1, Louise M O'Brien, Cheryl R Holbrook
1Kosair Children's Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA.
Insights
Parental reports of snoring and other behaviors are effective predictors of sleep-disordered breathing in children. A score based on multiple behaviors offers better prediction than snoring alone, with age and risk status influencing interpretation.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Clinical Psychology
Background:
- Sleep-disordered breathing (SDB) is a prevalent condition in children.
- Accurate screening tools are crucial for early detection and intervention.
- Parental reports are a common, yet unvalidated, method for initial SDB assessment.
Purpose of the Study:
- To evaluate the predictive validity of parental reports of snoring and other behaviors against objective polysomnography findings.
- To compare the predictive accuracy of snoring alone versus a multi-behavioral score for SDB in children.
- To assess these predictive capabilities in at-risk preschoolers and a general community sample.
Main Methods:
- Retrospective observational study design.
- Inclusion of 122 preschoolers and 172 older children (5-7 years) and their parents.
- Utilized parental questionnaires and objective overnight polysomnography.
Main Results:
- Parental report of frequent snoring demonstrated high sensitivity and specificity compared to polysomnography.
- A parental-report score incorporating multiple child behaviors showed superior predictive ability for SDB over snoring alone.
- Predictive behavior profiles and their accuracy varied between the preschool and older child groups.
Conclusions:
- Parental questionnaires assessing snoring and other behaviors can serve as reliable surrogate predictors for SDB in children.
- Screening tool interpretation requires consideration of the child's age, risk status, and the specific assessment's objective.
- These findings support the use of validated parental-report tools for SDB screening in pediatric populations.
Study Objectives:
We sought to assess the predictive validity of parental report of snoring and other behaviors by comparing such reports with objective findings from overnight polysomnography for the evaluation of sleep-disordered breathing in 2 nonclinical samples, namely, at-risk preschoolers and an older group reflective of the general community. Predictive validity of snoring alone and a score based on multiple child behaviors were compared to outcome at different levels of severity of sleep-disordered breathing.
Design:
Retrospective observational study.
Setting:
Questionnaires were distributed through school programs; polysomnography was performed at Kosair Children's Hospital in Louisville, Kentucky.
Participants:
One hundred twenty-two preschoolers and 172 5- to 7-year-olds, and their parents, participated in both subjective-report and objective-recording portions of the study.
Measurements And Results:
Compared to the presence of snoring on polysomnography, parental report of frequent snoring was highly sensitive and specific for both age groups. At all but the lowest level of severity of sleep-disordered breathing, predictive ability was higher for both groups when a parental-report score based on multiple measures of child behavior was applied, compared to parental report of snoring alone. The profiles of these predictive child behaviors differed between the 2 groups, as did their sensitivity and specificity, at their high ranges of parental report.
Conclusions:
Scores derived from parental-report questionnaires of children's snoring and other sleep and wake behaviors can be used as surrogate predictors of snoring or sleep-disordered breathing in children. However, design and interpretation should consider age, risk status, and the purpose of the screening assessment.
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