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Screening for sleep-disordered breathing with Pediatric Sleep Questionnaire in children with underlying conditions

Rishi Pabary1,2, Christophe Goubau1,3, Kylie Russo1

  • 1Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK.

Journal of Sleep Research
|March 9, 2019
PubMed

Insights

The Pediatric Sleep Questionnaire is not reliable for screening sleep-disordered breathing in children with chronic conditions. Cardiorespiratory polygraphy is essential for accurate diagnosis in these complex cases.

Area of Science:

  • Pediatric Sleep Medicine
  • Respiratory Medicine
  • Clinical Diagnostics

Background:

  • The Pediatric Sleep Questionnaire (PSQ) was initially validated for children with obstructive sleep apnea syndrome (OSAS) without comorbidities.
  • Chronic medical conditions can alter the presentation and diagnosis of sleep-disordered breathing (SDB) in children.
  • Assessing the PSQ's utility in pediatric populations with complex underlying health issues is crucial for accurate SDB screening.

Purpose of the Study:

  • To evaluate the applicability and diagnostic accuracy of the PSQ in children with chronic medical conditions.
  • To compare the PSQ's sensitivity and specificity against cardiorespiratory polygraphy (CRP) in diverse pediatric patient groups.
  • To determine if the PSQ can serve as a reliable screening tool for SDB in children with neuromuscular disorders, craniofacial anomalies, or Trisomy 21.

Main Methods:

  • A prospective study involving 561 children aged 2-18 years undergoing diagnostic sleep studies.
  • Parents completed the PSQ, and results were correlated with CRP findings.
  • Sensitivity and specificity were calculated using different apnea-hypopnea index (AHI) cut-off values (≥5 and ≥1).

Main Results:

  • The PSQ showed reduced sensitivity for SDB in children with neuromuscular disorders (25%) and Trisomy 21 (36.7%) when using an AHI ≥5.
  • Sensitivity for OSAS remained relatively high (76.5%) with AHI ≥5.
  • Using an AHI ≥1 improved PSQ sensitivity for neuromuscular disorders (36.7%) and Trisomy 21 (84%), but overall diagnostic utility remained limited in complex cases.

Conclusions:

  • The PSQ is not a suitable screening tool for OSAS in children with complex chronic conditions when using an AHI cut-off of ≥5.
  • The PSQ cannot replace CRP for definitive diagnosis of SDB in these vulnerable pediatric populations.
  • Clinical judgment and objective sleep study data (CRP) are paramount for diagnosing SDB in children with underlying medical complexities.

Keywords:
Trisomy 21craniofacialneuromuscularpaediatricssleep apnea syndromessurveys and questionnaires

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