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Validation of a clinical assessment score for pediatric sleep-disordered breathing
Nira A Goldstein1, Dimitre G Stefanov, Katharina D Graw-Panzer
1Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York, USA. nira.goldstein@downstate.edu
Insights
A new clinical assessment score (CAS-15) effectively identifies pediatric sleep-disordered breathing. This validated tool aids in diagnosing children and shows significant improvement post-treatment.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Clinical Diagnostics
Background:
- Sleep-disordered breathing (SDB) is prevalent in children.
- Accurate diagnosis of pediatric SDB is crucial for timely intervention.
- Existing diagnostic methods can be resource-intensive.
Purpose of the Study:
- To validate a novel clinical assessment score for diagnosing pediatric sleep-disordered breathing.
- To assess the correlation of the score with polysomnography results and other validated questionnaires.
- To evaluate the score's responsiveness to clinical change after treatment.
Main Methods:
- Prospective instrument validation involving 100 children undergoing polysomnography.
- Development and refinement of the Clinical Assessment Score-15 (CAS-15) through item reduction.
- Comparison of CAS-15 with Obstructive Sleep Apnea (OSA)-18, PedsQL 4.0, and Child Behavior Checklist.
- Assessment of intrarater and inter-rater reliability and correlation with external measures.
Main Results:
- The CAS-15 demonstrated good internal consistency (Cronbach α = .80) and predictive utility.
- High intrarater (ICC=0.78) and inter-rater (ICC=0.65) agreement were observed.
- The CAS-15 showed moderate to strong correlations with external measures (r=0.32-0.65) and predicted positive polysomnography with an AUC of 0.77.
- A CAS-15 score ≥32 indicated a sensitivity of 77.3% and specificity of 60.7% for diagnosing SDB.
Conclusions:
- The CAS-15 is a validated, reliable clinical tool for assessing pediatric sleep-disordered breathing in an office setting.
- The score accurately diagnosed 72% of referred children compared to polysomnography.
- CAS-15 demonstrated a good response to clinical changes following surgical intervention.
Objectives/Hypothesis:
To validate a clinical assessment score for pediatric sleep-disordered breathing.
Study Design:
Prospective instrument validation.
Methods:
One hundred children scheduled for overnight polysomnography were evaluated by a standardized history and physical examination and assigned a clinical assessment score. Parents completed the Obstructive Sleep Apnea (OSA)-18, the Pediatric Quality of Life Inventory (PedsQL) 4.0, and the Child Behavior Checklist questionnaires. Children with positive polysomnography underwent adenotonsillectomy or adenoidectomy. The identical assessments were performed at a mean follow-up of 8 months.
Results:
Item reduction yielded a score of 15 items (Clinical Assessment Score-15 [CAS-15]) that demonstrated the best internal consistency and predictive utility (Cronbach α = .80). Intraclass correlation (ICC) demonstrated good intrarater (ICC, 0.78; 95% confidence interval [CI], 0.58 to 0.89) and inter-rater agreement (ICC, 0.65; 95% CI, 0.26 to 0.84). All change scores were significantly improved after surgery. Effect sizes were large for the CAS-15 (2.6), OSA-18 (2.4), and apnea-hypopnea index (1.4), and moderate for the Child Behavior Checklist (0.7) and PedsQL 4.0 (-0.5). Moderate to strong correlation was found between the initial CAS-15 scores and the external measures (|r| between 0.32 and 0.65). Receiver operating characteristic curves were constructed to determine the optimal initial CAS-15 score for predicting positive polysomnography. The area under the curve was 0.77 (95% CI, 0.67 to 0.87); and a score ≥32 yielded a sensitivity of 77.3% (95% CI, 65.3 to 86.7) and a specificity of 60.7% (95% CI, 40.6 to 78.5).
Conclusions:
The CAS-15 proved useful in an office setting and correctly diagnosed 72% of referred children when compared to polysomnography. It correlated well with external measures and demonstrated a good response to clinical change.
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