Chest
Volume 142, Issue 6, December 2012, Pages 1508-1515
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Original Research
Sleep Disorders
Screening of Pediatric Sleep-Disordered Breathing: A Proposed Unbiased Discriminative Set of Questions Using Clinical Severity Scales

https://doi.org/10.1378/chest.11-3164Get rights and content

Background

Identification of sleep-disordered breathing (SDB) using questionnaires is critical from a clinical and research perspective. However, which questions to use and how well such questionnaires perform has thus far been fraught with substantial uncertainty. We aimed at delineating the usefulness of a set of questions for identifying pediatric SDB.

Methods

Random prospective sampling of urban 5- to 9-year-old children from the community and enriched for habitual snoring underwent overnight sleep study. Subjective indicators or questions were evaluated to further characterize and discriminate SDB.

Results

Of 1,133 subjects, 52.8% were habitual snorers. This sample was analyzed based on a clinical grouping (ie, established apnea-hypopnea index cutoffs). Several statistical steps were performed and indicated that complaints can be ranked according to a severity hierarchy: shake child to breathe, apnea during sleep, struggle breathing when asleep, and breathing concerns while asleep, followed by loudness of snoring and snoring while asleep. With a posteriori cutoff, a predictive score > 2.72 on the severity scale was found (ie, area under the curve, 0.79 ± 0.03; sensitivity, 59.03%; specificity, 82.85%; positive predictive value, 35.4; negative predictive value, 92.7), making this cutoff applicable for confirmatory purposes.

Conclusions

As a result, the set of six hierarchically arranged questions will aid the screening of children at high risk for SDB but cannot be used as the sole diagnostic approach.

Section snippets

Materials and Methods

Data collection was approved by the University of Louisville Human Research Committee (protocol #474.99), and the Institutional Review Boards of Jefferson County Public Schools and Archdiocese of Louisville Catholic Schools. Informed consent was obtained from the legal caregiver of each participant, with assent being obtained from children > 7 years of age.

Results

We focused on the distributions of the 11 sleep questions that were significantly different across AHI groups: breathing concerns while asleep (Question [Q]4) (Kruskal-Wallis test H[5,N = 1,036] = 128.8, P = .0001), apnea during sleep (Q2) (H[5,N = 994] = 121.2, P < .00001), snoring during sleep (Q6) (H[5,N = 1,051] = 103.1, P < .00001), loudness of snoring (Q5) (H[5,N = 856] = 89.7, P < .00001), struggle breathing when asleep (Q3) (H[5,N = 1,019] = 85.9, P < .00001), shake child to breath (Q1)

Discussion

Based on commonly used subjective respiratory symptoms, a severity hierarchy of parental reported complaints has now been delineated. More specifically, a set of six ordered questions allows for fair discrimination along the SDB spectrum. Snoring and loudness of snoring are potentially valuable screening items; however, their specificity remains low to moderate across the spectrum. A high score on breathing concerns while asleep appears to be discriminative, affording a high probability of

Acknowledgments

Author contributions: Dr Spruyt: contributed to performing the analyses of the database and drafting the manuscript and approved the final version of the manuscript.

Dr Gozal: contributed to conception and design, securing the funding for the project, analysis and interpretation of data, drafting the manuscript, and revising it critically for important intellectual content, and gave final approval of the version to be published.

Financial/nonfinancial disclosures: The authors have reported to

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    Funding/Support: This study was supported by the National Institutes of Health [Grant HL65270].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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