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Validation of the Pediatric Narcolepsy Screening Questionnaire (PNSQ): A cross-sectional, observational study
Susan Morris1, Giuseppe Plazzi2, Christine de la Loge3
1Formerly Jazz Pharmaceuticals, Palo Alto, CA, USA.
Insights
The Pediatric Narcolepsy Screening Questionnaire (PNSQ) shows strong psychometric properties for identifying pediatric narcolepsy. This tool effectively distinguishes narcolepsy from other sleep problems and healthy controls in children.
Area of Science:
- Pediatric Sleep Medicine
- Neuroscience
- Psychometrics
Background:
- Pediatric narcolepsy diagnosis is challenging.
- The Pediatric Narcolepsy Screening Questionnaire (PNSQ) was developed to aid identification.
- Initial versions were refined based on parent feedback.
Purpose of the Study:
- To evaluate the psychometric properties of the updated PNSQ.
- To assess the questionnaire's ability to differentiate between narcolepsy, other sleep problems (OSP), and controls in children.
- To establish reliable scoring and classification criteria for the PNSQ.
Main Methods:
- Caregivers of children with confirmed narcolepsy, OSP, or no sleep problems completed the 11-item PNSQ.
- Psychometric properties including construct validity, unidimensionality, and item discriminative power were analyzed.
- Analysis of variance (ANOVA) compared mean PNSQ Total Scores (TS) across groups.
- Internal consistency reliability was assessed using Cronbach's alpha.
Main Results:
- The study included 158 participants (49 narcolepsy, 55 OSP, 54 controls).
- The PNSQ demonstrated good construct validity and unidimensionality.
- The questionnaire effectively discriminated between narcolepsy and control groups, with lower discrimination for narcolepsy vs. OSP.
- The final 10-item PNSQ showed high internal consistency (Cronbach's alpha = 0.88).
- Mean PNSQ TS differed significantly across groups (P < 0.0001), with distinct cut-off scores proposed for classification.
Conclusions:
- The PNSQ exhibits robust psychometric properties for pediatric narcolepsy screening.
- The questionnaire performs excellently in distinguishing narcolepsy from OSP and control groups.
- The PNSQ provides a reliable and valid tool for identifying children who may have narcolepsy.
Objective/Background:
This study evaluated psychometric properties of the Pediatric Narcolepsy Screening Questionnaire (PNSQ), developed in response to the difficulty of identifying pediatric narcolepsy.
Patients/Methods:
The initial PNSQ was updated following debriefing interviews with parents of children with suspected/diagnosed narcolepsy. Subsequently, newly recruited caregivers were categorized into groups: clinician-confirmed narcolepsy, other sleep problems (OSP), and no sleep problems (controls). Caregivers completed the 11-item PNSQ assessing narcolepsy symptomatology. PNSQ psychometric properties were evaluated; mean PNSQ Total Score (TS) was compared inter-group using analysis of variance.
Results:
The analysis population (N = 158) included patients with narcolepsy (n = 49), OSP (n = 55), and controls (n = 54); mean ± SD age was 13.8 ± 2.8, 10.2 ± 4.3, and 10.0 ± 3.8 years, respectively. Inter-item Pearson correlations (range, 0.22-0.75) indicated good construct validity. Principal component analysis confirmed unidimensionality. Item discriminative power was high for narcolepsy vs control (range, 0.693-0.936) and lower for narcolepsy vs OSP (range, 0.584-0.729). The latent trait was well covered (separation index = 0.868). Item 7 (vivid dreams/nightmares), having low discriminative power and specificity, was removed. Cronbach's alpha (final PNSQ) indicated high internal consistency reliability (raw alpha = 0.88). Mean ± SD PNSQ TS (range, 0-50) in the narcolepsy, OSP, and control groups were 34.98 ± 7.98, 25.20 ± 9.43, and 9.54 ± 9.38, respectively (nominal P < 0.0001). Classification by PNSQ TS was defined: PNSQ+ (likely narcolepsy, TS ≥ 29), PNSQ 0 (likely OSP, TS 19-28), and PNSQ- (narcolepsy unlikely, TS ≤ 18); patients with narcolepsy were classified as PNSQ+ (79.6%), PNSQ 0 (18.4%), and PNSQ- (2.0%).
Conclusions:
The PNSQ demonstrated good psychometric properties and excellent performance discriminating narcolepsy, OSP, and control groups.
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