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The efficacy of the OSA-18 as a waiting list triage tool for OSA in children

  • Pediatrics • Original Article
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Abstract

Purpose

Sleep disordered breathing (SDB) is common in children, resulting in extensive waiting lists for specialist clinics. There is an urgent need for a valid method of triaging patients and the OSA-18, a disease-specific tool, is an attractive candidate for this role. We aimed to examine the OSA-18 as a measurement tool in detail and to determine whether the score or aspects of it could be used as a screening tool for SDB in children.

Methods

Retrospective analysis of 582 children (6 months to 16.4 years)—216 underwent overnight PSG and 366 overnight oximetry. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were conducted. Receiver operating characteristic curve analysis assessed the diagnostic accuracy of the factors for the presence of OSA. Rasch analysis was used to assess the structure of the items (1–18) and categories of response (Likert scale).

Results

The CFA with a forced five-factor structure, revealed three factors with Eigenvalues >1, and explained 73.7 % of the variance. EFA resulted in a two-factor structure, explaining 60.3 % of the variance. Assessment of sensitivity and specificity showed a high false-positive rate, irrespective of the factor structure tested. Rasch analysis showed poor discrimination between adjacent categories on the Likert scale.

Conclusion

This study confirmed that the predictive value of the OSA-18 for SDB severity is weak. Some questions perform better than others statistically, and the seven categories of response introduce significant statistical noise, raising the possibility that modification of the OSA-18 may improve its performance in the prediction of OSA severity.

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Acknowledgments

The authors would like to thank the children and families who participated in this study and the staff of the Melbourne Children’s Sleep Centre for their support. The authors thank Andrew Stephanou (Australian Council for Educational Research) for performing the Rasch analysis.

Author information

Authors and Affiliations

  1. The Ritchie Centre, Hudson Institute of Medical Research Melbourne, Level 5 Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia

    Lisa M. Walter, Sarah N. Biggs, Natascha Cikor, Margot J. Davey, Rosemary S. C. Horne & Gillian M. Nixon

  2. Department of Paediatrics, Monash University, Melbourne, Australia

    Lisa M. Walter, Sarah N. Biggs, Margot J. Davey, Rosemary S. C. Horne & Gillian M. Nixon

  3. Murdoch Children’s Research Institute, University of Melbourne, Melbourne, Australia

    Kathy Rowe

  4. Department of General Medicine, Royal Children’s Hospital, Melbourne, Australia

    Kathy Rowe

  5. Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Australia

    Margot J. Davey & Gillian M. Nixon

Authors
  1. Lisa M. Walter
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  2. Sarah N. Biggs
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  3. Natascha Cikor
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  4. Kathy Rowe
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  5. Margot J. Davey
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  6. Rosemary S. C. Horne
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  7. Gillian M. Nixon
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Corresponding author

Correspondence to Lisa M. Walter.

Ethics declarations

Ethical approval for this study was granted by the Monash Health and Monash University Human Research Ethics Committees. Written informed consent was obtained from parents at the time of the clinical testing for use of data pertaining to the diagnostic PSG or home oximetry for research purposes. There was no monetary incentive for participation.

Funding

This study was supported by a National Health and Medical Research Council of Australia project grant (491001 and 1010810) and the Victorian Government’s Operational Infrastructure Support Program.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Additional information

Lisa M. Walter and Sarah N. Biggs are co-first authors.

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Walter, L.M., Biggs, S.N., Cikor, N. et al. The efficacy of the OSA-18 as a waiting list triage tool for OSA in children. Sleep Breath 20, 837–844 (2016). https://doi.org/10.1007/s11325-015-1289-5

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  • DOI: https://doi.org/10.1007/s11325-015-1289-5

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