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Updated: May 12, 2026
Multi-Modal Home Sleep Monitoring in Older Adults
Published on: January 26, 2019
Optimizing Pediatric Sleep-Disordered Breathing Screening: Key Predictive Questions Identified From CHAT and PATS
Hannah Sturm1,2, Patrick Scheffler3,4, Eric A Gantwerker1,3
1Zucker School of Medicine at Northwell/Hofstra, Uniondale, New York, USA.
Insights
Three key screening questions can effectively predict or rule out severe obstructive sleep apnea (OSA) in children. This aids in preoperative evaluations and guides decisions for optimal surgical care.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Health
- Clinical Diagnostics
Background:
- Obstructive sleep apnea (OSA) is a prevalent condition in children, impacting health and behavior.
- Accurate screening is crucial for timely diagnosis and management.
- Current screening methods may lack efficiency in identifying severe cases.
Purpose of the Study:
- To identify a concise set of screening questions for predicting severe pediatric obstructive sleep apnea (OSA).
- To evaluate the diagnostic accuracy of specific question combinations using polysomnography (PSG) data.
- To enhance preoperative assessment efficiency for children undergoing tonsillectomy.
Main Methods:
- Secondary analysis of prospectively collected data from two large pediatric clinical trials.
- Inclusion of children aged 5-9 years with data from the Pediatric Adenotonsillectomy Trial for Snoring and the Childhood Adenotonsillectomy Trial.
- Analysis of screening questions and tonsil size against PSG markers (AHI, OAHI, RDI) to calculate PPVs and NPVs.
Main Results:
- Top three-question combinations achieved 100% positive predictive values (PPVs) for severe OSA.
- Negative predictive values (NPVs) ranged from 95.97% to 96.64%, effectively ruling out severe OSA.
- Key factors identified include breath-holding spells, choking/gasping, mouth breathing, and behavioral issues; tonsil size was not an independent predictor.
Conclusions:
- A brief, three-question screening tool can reliably predict or rule out severe sleep-disordered breathing (SDB) in pediatric patients.
- Integration of these questions into preoperative evaluations can improve clinical practice efficiency.
- This approach can guide polysomnography referrals and inform critical perioperative management decisions.
Objective:
To identify a concise set of screening questions that effectively predict severe obstructive sleep apnea (OSA).
Study Design:
Secondary analysis of prospectively collected data from two large pediatric clinical trials.
Setting:
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).
Methods:
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.
Results:
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.
Conclusion:
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.
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