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Development and validation of a predictive model (CHASE-OSA) for preoperative assessment of moderate-to-severe
Kantarakorn Unchiti1, Artid Samerchua2, Tanyong Pipanmekaporn1
1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Insights
A new CHASE-OSA score can identify children with moderate-to-severe obstructive sleep apnea (OSA) before surgery. This simplified tool aids in risk assessment and optimizing perioperative care for pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Sleep Medicine
- Medical Informatics
Background:
- Undetected obstructive sleep apnea (OSA) in children poses significant risks for perioperative respiratory complications.
- Existing screening tools for pediatric OSA are often insensitive or overly complex, hindering effective preoperative assessment.
Purpose of the Study:
- To develop and validate a simplified, user-friendly preoperative predictive model for moderate-to-severe pediatric obstructive sleep apnea (OSA).
Main Methods:
- A cohort of 1,327 children (aged 1-18 years) undergoing polysomnography or nocturnal pulse oximetry were analyzed.
- Multivariable logistic regression identified predictors for OSA, leading to the development of the CHASE-OSA scoring system.
- Internal validation was conducted using bootstrapping procedures.
Main Results:
- The CHASE-OSA model, incorporating factors like craniofacial abnormalities and snoring, achieved an area under the ROC curve of 0.85.
- A score cutoff of 6 effectively identified moderate-to-severe pediatric OSA with 86% sensitivity and 70% specificity.
- The scoring system demonstrated high positive (85%) and negative (71%) predictive values.
Conclusions:
- The CHASE-OSA predictive model offers a concise and practical preoperative screening tool for moderate-to-severe pediatric OSA.
- This tool can improve risk stratification, optimize perioperative management, and guide postoperative care planning.
- Further validation is recommended to confirm the clinical utility of the CHASE-OSA score.
Purpose:
Undetected obstructive sleep apnea (OSA) in children increases the likelihood of perioperative respiratory complications. Current screening tools for OSA often lack sensitivity or are overly complex. This study aimed to develop and validate a simplified preoperative predictive model for moderate-to-severe pediatric OSA.
Methods:
The study included children aged 1 to 18 years who underwent either polysomnography or nocturnal pulse oximetry from January 2013 to December 2020. OSA severity was categorized using these tests, and potential predictors were identified using multivariable logistic regression. The outcomes of the tests were used to create a risk-based scoring system. Internal validation was performed using bootstrapping procedures.
Results:
Out of the 1,327 participants, 882 individuals (66.5%) were diagnosed with moderate-to-severe OSA. Predictors considered for developing the scoring system included Craniofacial abnormalities, adenotonsillar Hypertrophy, Age 1-5 years, Snoring > 5 nights/week, Excessive daytime sleepiness, Obesity, Stopping breathing, and Awakening during sleep (CHASE-OSA). The scoring system developed demonstrated an area under the receiver operating characteristic curve of 0.85 (95% CI: 0.83-0.88). The CHASE-OSA score, ranging from 0 to 14, classified scores < 6 as low-risk and ≥ 6 as high-risk for moderate-to-severe pediatric OSA. This cutoff demonstrated a sensitivity of 86%, specificity of 70%, and positive and negative predictive values of 85% and 71%, respectively.
Conclusion:
The CHASE-OSA predictive model provides a concise and user-friendly preoperative screening tool for identifying moderate-to-severe pediatric OSA. It facilitates risk assessment, enhances perioperative care optimization, and informs postoperative management planning. Further research is needed to comprehensively validate its clinical utility.
