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Pre-anesthetic assessment with three core questions for the detection of obstructive sleep apnea in childhood: An
Joerg Schnoor1,2, Thilo Busch3, Nazar Turemuratov3
1Department of Anesthesia and Intensive Care Medicine, Collm-Klinik-Oschatz, Parkstr. 1, 03435, Oschatz, Germany. jschnoor@collm-klinik-oschatz.de.
Insights
A simple three-question screening tool can help identify children with obstructive sleep apnea (OSA), a condition that poses risks during anesthesia. This ultra-short questionnaire aids in detecting pediatric OSA in clinical settings.
Area of Science:
- Pediatric Anesthesiology
- Sleep Medicine
- Diagnostic Tools
Background:
- Children with obstructive sleep apnea (OSA) face significant risks of perioperative airway obstruction.
- Many at-risk children with OSA remain undiagnosed, increasing perioperative complications.
- A clinically practical screening test is needed to identify pediatric OSA.
Purpose of the Study:
- To evaluate the efficacy of parental questionnaires in identifying childhood obstructive sleep apnea.
- To develop a clinically practicable screening tool for pediatric OSA.
Main Methods:
- Prospective pilot study comparing four parental questionnaires against sleep laboratory findings in 53 children.
- Utilized the Pediatric Sleep Questionnaire, Sleep Related Breathing Disorder questionnaire subscale (PSQ-SRBD-Subscale), and derived questionnaires.
- Developed an ultra-short, three-core-questionnaire assessing snoring, labored breathing, and breathing pauses, analyzed via Receiver Operating Characteristic (ROC) analysis.
Main Results:
- The PSQ-SRBD-Subscale and an eight-item derived questionnaire did not yield statistically significant results for OSA detection.
- A three-core-questionnaire using a quotient score achieved statistical significance, with a sensitivity of 0.944 and moderate specificity of 0.543.
- A simple sum-score optimization slightly improved specificity to 0.571.
Conclusions:
- An ultra-short, three-core-questionnaire shows promise for detecting pediatric obstructive sleep apnea during anesthesia surveys.
- This screening tool may be advantageous in clinical practice for identifying children with OSA.
- Further studies with larger, unselected pediatric populations are warranted to validate this tool.
Background:
Children with obstructive sleep apnea are at high risk for perioperative airway obstruction. Many "at risk" children may remain unrecognized. The aim of this study is to find a clinically practicable test to identify obstructive sleep apnea in childhood.
Methods:
In this pilot study, we prospectively compared four parental questionnaires with the respective findings of subsequent sleep laboratory testing in children. Right before sleep laboratory testing, children's parents answered both the Pediatric Sleep Questionnaire, a subscale of the Sleep Related Breathing Disorder questionnaire (PSQ-SRBD-Subscale), and an eight-item questionnaire derived from it. Finally, we condensed the eight-item questionnaire to three core issues: Does your child regularly snore at night? Does your child demonstrate labored breathing during sleep? Does your child have breathing pauses during sleep? With it, two similar questionnaires were generated that differed in the formation of the resulting score. One questionnaire was built by a quotient comparable to the abovementioned questionnaires and a second as quick test that functioned as a simple sum score. Both sensitivity and specificity were determined by using a Receiver Operating Characteristic analysis.
Results:
In total, 53 children were included in the study. Both the PSQ-SRBD-questionnaire and self-derived eight-item questionnaire failed to reach statistically significant results in detecting obstructive sleep apnea. The set of three core questions with a score built by a quotient was statistically significant and provided sensitivity and a moderate specificity of 0.944 and 0.543, respectively. This could be slightly optimized by creating a simple sum-score (specificity of 0.571).
Conclusions:
The use of three core-questions may facilitate the detection of pediatric obstructive sleep apnea within the scope of the anesthesia survey. While the study has some limitations, future studies with both unselective collectives and older children might prove this ultra-short questionnaire to be advantageous in detecting pediatric OSA in clinical practices.
Trial Registration:
German Clinical Trial Register ( DRKS00010408 , https://www.drks.de ); date of registration 26.07.2016.
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