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Analysis of risk factors in pediatric obstructive sleep apnea questionnaires: a 20 year review
Arzu Chaudhry1, Kiana W Yau2, Lily Hp Nguyen3
1Department of Emergency Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Insights
Pediatric obstructive sleep apnea (OSA) screening questionnaires are common but lack consistency. They often miss key risk factors like ethnicity and obesity, limiting their ability to predict OSA severity.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Medicine
- Diagnostic Tools
Background:
- Polysomnography (PSG) is the gold standard for diagnosing pediatric obstructive sleep apnea (OSA) but is resource-intensive and inaccessible.
- Sleep questionnaires are used for OSA screening but have limitations in distinguishing OSA from simple snoring and possess variable diagnostic accuracy.
- Existing questionnaires show significant variability in included items, affecting their reliability.
Purpose of the Study:
- To identify and describe questionnaires used for screening pediatric OSA.
- To determine the prevalence of individual items within these questionnaires and review their scoring methods.
- To analyze the evolution of pediatric OSA screening questionnaires and their components over time.
Main Methods:
- A literature review was conducted to find questionnaires primarily designed for pediatric OSA screening (ages 0-18).
- Searches were performed in PubMed and the Health and Psychosocial Instruments (HaPI) database.
- Additional questionnaires were identified through snowball referencing and existing review articles.
Main Results:
- 36 questionnaires with 56 distinct items were analyzed from 67 identified articles.
- Snoring, observed apnea, and daytime sleepiness were the most common items (83.3% each).
- Ethnicity (5.6%) and body mass index (36.1%) were inconsistently included; 97.2% used quantitative scoring.
Conclusions:
- Multiple questionnaires exist for pediatric OSA screening, but they do not predict OSA severity.
- Known OSA risk factors, such as ethnicity and obesity, are infrequently incorporated into current screening tools.
- Further development is needed to enhance the diagnostic capability and comprehensiveness of pediatric OSA screening questionnaires.
Background:
The diagnostic gold standard for pediatric obstructive sleep apnea (OSA) is polysomnography (PSG), a highly resource-intensive tool with limited accessibility. As such, sleep questionnaires have been proposed as an alternative/adjunct for OSA screening. However, these questionnaires have limitations such as the inability to clearly distinguish between OSA and simple snoring, and their poor diagnostic sensitivity and specificity. Specifically, there is significant variability in the items included within the sleep questionnaires.
Objectives:
To identify and describe questionnaires that screen for pediatric OSA, identify prevalence of individual items, and review scoring methods used; To examine how questionnaires and the specific items have evolved over time.
Methods:
We conducted a literature review to identify questionnaires whose primary goal was to screen for pediatric OSA in children 0-18 years old. We searched PubMed (keywords: sleep disordered breathing, OSA, sleep apnea and risk factor) and the health and psychosocial instruments (HaPI) databases. Snowball referencing technique and two comprehensive reviews were used to identify additional questionnaires.
Results:
Of the 67 articles identified, 36 questionnaires containing 56 different items were included in the analysis. Items most commonly included in questionnaires were snoring (83.3%), observed apnea (83.3%) and daytime sleepiness (83.3%). Ethnicity (5.6%)and body mass index (36.1%) were not consistently included. Thirty-five questionnaires (97.2%) used quantitative scores to identify OSA.
Conclusion:
There are currently several questionnaires that aim to screen children for OSA. However, these questionnaires were not able to predict OSA severity, and rarely included known OSA risk factors, such as ethnicity and obesity.
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