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Published on: December 6, 2016
Pediatric sleep questionnaire: prediction of sleep apnea and outcomes
Ronald D Chervin1, Robert A Weatherly, Susan L Garetz
1Sleep Disorders Center, Department of Neurology, School of Public Health, University of Michigan, Ann Arbor, USA. chervin@umich.edu
Insights
The Sleep-Related Breathing Disorder scale effectively predicts childhood obstructive sleep apnea (OSA) and its neurobehavioral impact, offering a valuable research tool but requiring caution for individual patient diagnosis.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Neurobehavioral Pediatrics
Background:
- Childhood obstructive sleep apnea (OSA) is associated with significant neurobehavioral morbidities.
- Accurate diagnostic tools are crucial for timely intervention and management.
- Adenotonsillectomy is a common treatment for pediatric OSA.
Purpose of the Study:
- To validate the Sleep-Related Breathing Disorder (SRBD) scale of the Pediatric Sleep Questionnaire for childhood OSA.
- To compare the predictive ability of the SRBD scale and polysomnography (PSG) for adenotonsillectomy outcomes.
- To assess the SRBD scale's utility in predicting neurobehavioral outcomes in children with suspected OSA.
Main Methods:
- Retrospective analysis of a longitudinal cohort of 105 children (aged 5.0-12.9 years).
- Parents completed the 22-item SRBD scale; children underwent PSG before and 1 year after surgery.
- Outcomes included OSA diagnosis, hyperactivity ratings, attention, and sleepiness tests.
Main Results:
- A high SRBD scale score at baseline predicted a ~3-fold increased risk of OSA on PSG (OR, 2.80).
- The SRBD scale predicted hyperactivity and sleepiness outcomes post-adenotonsillectomy as well as or better than PSG.
- The SRBD scale showed limited ability to predict attention deficits.
Conclusions:
- The SRBD scale is a useful research tool for predicting PSG-confirmed OSA in children.
- While not fully reliable for individual diagnosis, the SRBD scale shows promise in predicting OSA-related neurobehavioral morbidity.
- The SRBD scale may be as effective as PSG in predicting treatment response to adenotonsillectomy for neurobehavioral symptoms.
Objectives:
To further validate a questionnaire about symptoms of childhood obstructive sleep apnea (OSA) and to compare the questionnaire with polysomnography in their ability to predict outcomes of adenotonsillectomy.
Design:
Retrospective analysis of data from a longitudinal study.
Setting:
University-based sleep disorders laboratory.
Participants:
The Washtenaw County Adenotonsillectomy Cohort, comprising 105 children aged 5.0 to 12.9 years at entry. Intervention Parents completed the 22-item Sleep-Related Breathing Disorder (SRBD) scale of the Pediatric Sleep Questionnaire, and children underwent polysomnography before and 1 year after clinically indicated adenotonsillectomy (n = 78, usually for suspected OSA) or unrelated surgical care (n = 27).
Main Outcome Measures:
Findings from commonly used hyperactivity ratings, attention tests, and sleepiness tests.
Results:
At baseline, a high SRBD scale score (1 SD above the mean) predicted an approximately 3-fold increased risk of OSA on polysomnography (odds ratio, 2.80; 95% confidence interval, 1.68-4.68). One year later, OSA and symptoms had largely resolved, but a high SRBD score still predicted an approximately 2-fold increased risk of residual OSA on polysomnography (odds ratio, 1.89; 95% confidence interval, 1.13-3.18). Compared with several standard polysomnographic measures of OSA, the baseline SRBD scale better predicted initial hyperactivity ratings and 1-year improvement, similarly predicted sleepiness and its improvement, and similarly failed to predict attention deficit or its improvement.
Conclusions:
The SRBD scale predicts polysomnographic results to an extent useful for research but not reliable enough for most individual patients. However, the SRBD scale may predict OSA-related neurobehavioral morbidity and its response to adenotonsillectomy as well or better than does polysomnography.
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