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The OSA-5: Development and validation of a brief questionnaire screening tool for obstructive sleep apnea in children
Han Jie Soh1, Katherine Rowe2, Margot J Davey3
1The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Australia.
Insights
A new screening tool, the OSA-5, effectively identifies children with obstructive sleep apnea (OSA) among those referred for sleep-disordered breathing (SDB). This simple questionnaire aids in efficient triage for pediatric sleep studies.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Clinical Diagnostics
Background:
- Sleep-disordered breathing (SDB) is common in children, with obstructive sleep apnea (OSA) being a primary concern.
- Accurate and efficient screening is crucial for timely diagnosis and management of pediatric OSA.
- Existing screening methods may require refinement for optimal triage of referrals.
Purpose of the Study:
- To develop and validate a brief screening questionnaire, the OSA-5, for identifying children at risk of OSA.
- To assess the OSA-5's performance as a triage tool for pediatric SDB referrals.
- To simplify the initial assessment process for suspected pediatric OSA.
Main Methods:
- Development of an 11-item questionnaire based on the OSA-18, followed by exploratory factor analysis.
- Identification of 5 key questions (snoring, breath holding, choking, mouth breathing, parental concern) through ANOVA.
- Prospective testing of the 5-question OSA-5 instrument on 112 children undergoing polysomnography (PSG) or overnight oximetry.
Main Results:
- The OSA-5 demonstrated significant differences in scores between children with and without OSA (7.7 vs 4.5, p < 0.001).
- At a threshold score of <5/15, the OSA-5 achieved a sensitivity of 82% and a negative predictive value (NPV) of 70% for OSA.
- Prospective testing confirmed high sensitivity (82%) and NPV (81%) for moderate/severe OSA.
Conclusions:
- The OSA-5 is a simple, effective screening tool for identifying children at risk of OSA.
- It performs well in triaging large numbers of pediatric referrals for SDB.
- The OSA-5 can aid clinicians in prioritizing patients for further sleep evaluation.
Objective:
To develop and test a screening tool based on the OSA-18 questionnaire for triage of referrals for sleep-disordered breathing (SDB) in children.
Study Design:
Consecutive children aged >2y without major comorbidities referred for polysomnography (PSG) or overnight oximetry for suspected obstructive sleep apnea (OSA) between 11 January and 31 May 2017 were included. OSA was defined by an obstructive apnea/hypopnea index (OAHI) >1event/h on PSG or an abnormal overnight oximetry (McGill Oximetry Score 2-4). An 11-item questionnaire derived from a previous validation study of the OSA-18 underwent exploratory factor analysis (EFA) with varimax rotation. ANOVA identified questions associated with the presence of OSA. This informed a 5-question, 4-category instrument, scored 0-15 (the OSA-5), that was tested prospectively on 112 children having PSG.
Results:
420 children (2.0-17.9y, 43% female) met the inclusion criteria, including 366 complete questionnaires. EFA resulted in a 3-factor structure. ANOVA identified 5 questions from one factor that were independently associated with a diagnosis of OSA: snoring, breath holding, choking, mouth breathing and parental concern. Mean OSA-5 scores with and without OSA were 7.7 vs 4.5 (p < 0.001). Thirty-four percent (60/178) had a total score <5/15, with a sensitivity at this threshold for OSA of 82% and negative predictive value (NPV) of 70%. Similar results were obtained when tested prospectively, including a sensitivity of 82% and NPV of 81% for the presence of moderate/severe OSA (OAHI>5/h).
Conclusion:
The OSA-5 is a simple questionnaire that performs well as a triage screening tool to identify those children at risk of OSA among large numbers of referrals for SDB.
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