Optimizing Pediatric Sleep-Disordered Breathing Screening: Key Predictive Questions Identified From CHAT and PATS...

To identify a concise set of screening questions that effectively predict severe obstructive sleep apnea (OSA).

Secondary analysis of prospectively collected data from two large pediatric clinical trials.

Children ages 5 to 9 from the Pediatric Adenotonsillectomy Trial for Snoring (June 2016 to January 2021) and the Childhood Adenotonsillectomy Trial (October 2007 to June 2012).

Screening questions and tonsil size were analyzed against polysomnography (PSG) markers, including the apnea-hypopnea index (AHI), obstructive AHI (OAHI), and respiratory disturbance index (RDI). Positive predictive values (PPVs) for severe OSA and negative predictive values (NPVs) for lack of severe OSA were calculated for various question combinations. The top combinations with a PPV of 100% and the highest NPV were identified.

The top four three-question combinations, consistently among the highest NPV sets across all outcomes, achieved NPVs of 95.97% to 96.64% and PPVs of 100%. These combinations assessed the following key factors: breath-holding spells, choking/gasping, mouth breathing, aggressive/hyperactive behavior, discipline problems, and growth delays. In univariate analysis, larger tonsils were more common in children with moderate or severe OSA, but tonsil size was not an independent predictor of severe disease in multivariable models.

This study demonstrates that SDB can be effectively predicted or ruled out using just three key screening questions. Incorporating these into preoperative evaluations, alongside history, physical examination, and tonsil size, may improve efficiency in clinical practice, guide PSG referral, and inform perioperative decisions such as the need for inpatient admission and the optimal surgical setting.