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Predicting obstructive sleep apnea severity in children referred for polysomnography: use of the Pediatric Sleep Questionnaire and Subscales

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

This study evaluated the role of the Pediatric Sleep Questionnaire (PSQ) and associated subscales in predicting the severity of obstructive sleep apnea (OSA) in children referred for attended polysomnography (PSG).

Methods

This is a retrospective study of children (0–18 years) who completed PSQs the night of their initial diagnostic PSG (2019–2020). We excluded children with previous PSG, positive airway pressure titrations, or underlying genetic or craniofacial syndromes. Area under the receiver operating characteristic curve (AUC [95%CIs]) were estimated for prediction of varying severities of obstructive apnea–hypopnea index (oAHI > 2, 5, 10, and 25/h) by the PSQ’s sleep-related breathing disorders (SRBD) scale and subscales.

Results

Of 477 children, median (IQR) age at PSG was 5.7 (4.3); 60% of children were male, 21% were obese, and 4% had oAHI > 25/h. SRBD score did not improve discrimination of OSA cases at any oAHI threshold, with AUC CI that crossed 50% at all severities. Snoring subscale scores were predictive at oAHI > 2/h (AUC = 64.5% [59.5–69.5%]), oAHI > 5/h (AUC = 64.3% [59.6–69.0%]), and oAHI > 10 (AUC = 67.2% [62.0–72.4%]) thresholds, but were not predictive at oAHI > 25/h. The addition of demographic data (age and gender) improved the classification of the SRBD scale.

Conclusions

When utilized in children referred for attended PSG due to concerns for an underlying sleep disorder, the PSQ snoring subscale was more predictive of OSA at varying thresholds than the SRBD scale. While the original intent of the PSQ was not for the purpose of predicting severity in children referred for PSG, future directions include augmenting the questionnaire with additional clinical variables.

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Data availability

The data that support the findings of this study are available on request from the corresponding author [MB]. The data are not publicly available due to restrictions from the Kaiser Permanente Division of Research.

Abbreviations

AHI:

Apnea–hypopnea index

oAHI:

Obstructive apnea–hypopnea index

OSA:

Obstructive sleep apnea

PSG:

Polysomnogram

PSQ:

Pediatric Sleep Questionnaire

SRBD:

Sleep-related breathing disorder

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Acknowledgements

We would like to thank the staff of the Kaiser Permanente Martinez Sleep Lab, as well as the patients and families we had the privilege of caring for. We would also like to thank Adam Boroian for assisting with manuscript submission.

Funding

This study was funded by The Permanente Medical Group Division of Research, Delivery Science Grant.

Author information

Authors and Affiliations

  1. Pediatric Pulmonology & Sleep Medicine, Kaiser Permanente Santa Clara, 710 Lawrence Expressway Department 190, Santa Clara, CA, USA

    Mustafa Bseikri

  2. Kaiser Permanente Northern California Division of Research, Oakland, CA, USA

    Jie Zhang, Jocelyn Kirley, Catherine Lee, Adrienne Castillo & Elizabeth M. Cespedes Feliciano

Authors
  1. Mustafa Bseikri
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  2. Jie Zhang
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  3. Jocelyn Kirley
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  4. Catherine Lee
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  5. Adrienne Castillo
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  6. Elizabeth M. Cespedes Feliciano
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Corresponding author

Correspondence to Mustafa Bseikri.

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Ethics approval

This retrospective study was approved with a waiver of informed consent by the Kaiser Permanente Northern California Institutional Review Board.

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

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Brief Summary

Current Knowledge/Study Rationale: Questionnaire responses have demonstrated variable predictive values for the identification of obstructive sleep apnea in children. We aim to assess the predictive value of the Pediatric Sleep Questionnaire and subscales among children referred for attended polysomnography.

Study Impact: Our study demonstrates that snoring subscales are the most predictive of the PSQ subscales across all severities. It also highlights the need to explore augmentation of questionnaire responses with other variables to improve the predictive value in this population.

Supplementary Information

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Bseikri, M., Zhang, J., Kirley, J. et al. Predicting obstructive sleep apnea severity in children referred for polysomnography: use of the Pediatric Sleep Questionnaire and Subscales. Sleep Breath 27, 545–552 (2023). https://doi.org/10.1007/s11325-022-02647-6

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  • DOI: https://doi.org/10.1007/s11325-022-02647-6

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