Analysis of risk factors in pediatric obstructive sleep apnea questionnaires: a 20 year review.

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.