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Psychometric Properties and Predictive Value of a Screening Questionnaire for Obstructive Sleep Apnea in Young
Sarah Grantham-Hill1, Hazel J Evans1,2, Catherine Tuffrey3
1Faculty of Medicine, School of Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom.
Insights
A new screening questionnaire for obstructive sleep apnea (OSA) in children with Down syndrome (DS) showed limited predictive value. Objective sleep studies are recommended for accurate OSA screening in this population.
Area of Science:
- Pediatric Pulmonology
- Genetics and Genetic Diseases
- Sleep Medicine
Background:
- Obstructive sleep apnea (OSA) is prevalent in children with Down syndrome (DS), impacting health and cognition.
- Current clinical assessments are poor predictors of OSA, necessitating regular screening.
- Sleep studies are the recommended screening method but face accessibility and cost barriers.
Purpose of the Study:
- To evaluate the psychometric properties and predictive accuracy of a novel OSA screening questionnaire for children with DS.
- To determine if a questionnaire can reliably identify moderate to severe OSA in this vulnerable population.
Main Methods:
- A cohort of 202 children with DS (aged 6 months to 6 years) underwent cardio-respiratory sleep studies to determine the obstructive apnea hypopnea index (OAHI).
- Parents completed a 14-item Down syndrome OSA screening questionnaire.
- Factor analysis, internal consistency (Cronbach's alpha), and receiver operator characteristic (ROC) curves were used to assess validity.
Main Results:
- 15.4% of the 188 children completing sleep studies had moderate to severe OSA (OAHI ≥5/h).
- A four-factor solution was identified in the questionnaire, with breathing-related symptoms being a key factor (Cronbach's alpha = 0.87).
- The total score yielded an area under the curve (AUC) of 0.497, and the breathing subscale an AUC of 0.603 for predicting moderate to severe OSA.
Conclusions:
- Despite good psychometric properties, the developed questionnaire demonstrated limited predictive value for moderate to severe OSA in young children with DS.
- Routine use of this screening questionnaire is not recommended for OSA detection in children with DS.
- Objective sleep study measures remain essential for accurate OSA screening in children with Down syndrome.
Study Objectives:
Obstructive sleep apnea (OSA) is common in children with Down syndrome (DS) and is associated with adverse health and cognitive outcomes. Daytime clinical assessment is poorly predictive of OSA, so regular screening with sleep studies is recommended. However, sleep studies are costly and not available to all children worldwide. We aimed to evaluate the psychometric properties and predictive value of a newly developed screening questionnaire for OSA in this population.
Methods:
202 children aged 6 months to 6th birthday with DS were recruited, of whom 188 completed cardio-respiratory sleep studies to generate an obstructive apnea hypopnea index (OAHI). Parents completed the 14-item Down syndrome OSA screening questionnaire. Responses were screened, a factor analysis undertaken, internal consistency calculated and receiver operator characteristic (ROC) curves drawn to generate an area under the curve (AUC) to assess criterion related validity.
Results:
Of 188 children who completed cardiorespiratory sleep studies; parents completed the screening questionnaire for 186. Of this study population 15.4% had moderate to severe OSA defined by an OAHI of ≥5/h. Sixty-three (33.9%) participants were excluded due to "unsure" responses or where questions were not answered. Using the remaining 123 questionnaires a four-factor solution was found, with the 1st factor representing breathing related symptoms, explaining a high proportion of the variance. Internal consistency was acceptable with a Cronbach alpha of 0.87. ROC curves for the total score generated an AUC statistic of 0.497 and for the breathing subscale an AUC of 0.603 for moderate to severe OSA.
Conclusion:
A well designed questionnaire with good psychometric properties had limited predictive value to screen for moderate to severe OSA in young children with DS. The use of a screening questionnaire is not recommended. Screening for OSA in this population requires objective sleep study measures.
