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Refining screening questionnaires for prediction of sleep apnea severity in children
Amal Isaiah1, Meryam Shikara2, Kevin D Pereira2
1Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA. aisaiah@som.umaryland.edu.
Insights
Removing redundant questions from pediatric obstructive sleep apnea (OSA) screening tools significantly improves their accuracy in predicting OSA severity. This helps in better diagnosis for children with suspected sleep apnea.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Clinical Diagnostics
Background:
- Screening questionnaires are currently used to assess the risk of pediatric obstructive sleep apnea (OSA).
- However, their effectiveness in predicting the severity of OSA is limited.
- Redundant features within these instruments may contribute to their poor predictive performance.
Purpose of the Study:
- To improve the predictive performance of screening instruments for pediatric obstructive sleep apnea (OSA) severity.
- To identify and eliminate redundant features from existing screening questionnaires.
- To evaluate the efficacy of selected features in predicting OSA severity.
Main Methods:
- Utilized baseline data from the Childhood Adenotonsillectomy Trial (CHAT) involving three pediatric OSA screening questionnaires: modified Epworth Sleepiness Scale (ESS), Pediatric Sleep Questionnaire (PSQ), and Obstructive Sleep Apnea-18 (OSA-18).
- Employed variable selection methods to identify key features from the questionnaires.
- Assessed the predictive ability of selected features (SF) for the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI), including thresholds of >5 and >10.
Main Results:
- Data from 453 children aged 5-10 years were analyzed.
- Overall questionnaire scores showed poor prediction of AHI and ODI.
- A four-item selected feature (SF) set, including apneic pauses, growth problems, mouth breathing, and obesity, significantly outperformed individual questionnaires in predicting AHI and ODI.
- SF also demonstrated superior prediction for AHI and ODI at thresholds of >5 and >10 compared to the original questionnaires.
Conclusions:
- Eliminating redundant items from screening questionnaires enhances their predictive accuracy for OSA severity in children.
- This approach is particularly beneficial for children with a high pre-test probability of OSA.
- Optimized screening tools can lead to more accurate identification of severe cases.
Purpose:
Screening instruments are poor predictors of the severity of pediatric obstructive sleep apnea (OSA). We hypothesized that their performance could be improved by identifying and eliminating redundant features.
Methods:
Baseline scores from three screening questionnaires for pediatric OSA were obtained from the Childhood Adenotonsillectomy Trial (CHAT). The questionnaires included the (i) modified Epworth sleepiness scale (ESS), (ii) the sleep-related breathing disorders subscale of the pediatric sleep questionnaire (PSQ), and the (iii) obstructive sleep apnea-18 (OSA-18) scale. Key features from each questionnaire were identified using variable selection methods. These selected features (SF) were then assessed for their ability to predict the severity of OSA, measured by the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). In addition, prediction performance of SF was also calculated for AHI > 5 and > 10 and ODI > 5 and > 10, respectively.
Results:
Four hundred fifty-three children aged 5-10 years were included. The majority of the pairwise correlations among the items within the 3 screening questionnaires were statistically significant. The prediction of AHI and ODI by overall questionnaire scores was poor. Four-item SF, comprising apneic pauses, growth problems, mouth breathing, and obesity predicted AHI and ODI significantly better than each of the individual questionnaires. Furthermore, SF also predicted AHI > 5 and > 10, as well as ODI > 5 and > 10 significantly better than the original questionnaires.
Conclusions:
Elimination of redundant items in screening questionnaires improves their prediction performance for OSA severity in children with high pre-test probability for the condition.
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