0795 Implementation of the Pediatric Craniofacial Screening Tool for Sleep Disordered Breathing (PCSS): An Observational Pilot Study

Abstract

Abstract Introduction Pediatric sleep-disordered breathing (SDB) is highly prevalent and associated with craniofacial risk factors not routinely assessed. We developed the Pediatric Craniofacial Screening Tool for Sleep (PCSS) to assess which craniofacial risk factors are closely correlated with SDB symptoms in children. Methods Pilot study of children ages 5-12y recruited from eight dental sites across the country to participate in the PCSS screening by dental providers. The primary outcome was SDB measured by the validated PSQ-SRBD questionnaire (22 items, range 0-1, and >0.33 signifying increased SDB risk). The predictors included PCSS total score and individual items comprising of 21 craniofacial features. Neighborhood socioeconomic status (NSES) was characterized by using the Area Deprivation Index (ADI). Correlation and regression analyses modeled the association between PSQ-SRBD and total PCSS score. To assess inter-rater reliability, a subset of subjects had a second PCSS screen by a second dental provider. Results The sample included 97 children (94%-Non-Hispanic-White, 4% Hispanic, 2% other; 49%-female), with a mean age of 8.6±2.2. PSQ-SRBD scores were elevated in 20 (20.6%) participants. Three children were reported to overweight (on item specific question of PSQ-SRBD scale). Children with elevated PSQ-SRBD (>0.33) had lower NSES compared to children with PSQ-SRBD scores < 0.33. PSQ-SRBD was associated with total PCSS score (OR=1.17 CI[1.01-1.36], p=0.033) and individual features including, narrow vaulted palate (OR=3.22, CI[0.94-10.93], p=0.03), forward head posture (OR=3.13, CI[1.11, 9.30], p=0.03), tongue thrust (OR=7.04, CI[1.20, 47.67], p=0.03), tongue tie (OR=7.58, CI[1.88, 33.58], p=0.005) and heart-shaped tongue (OR=11.21, CI[1.81, 98.11], p=0.01) after adjustment with age, sex, race and ethnicity. The correlation between total PCSS score and PSQ-SRBD was low (R=0.39, p= < 0.01), however in subjects with at least one positive craniofacial feature, the correlation between significant PCSS features and PSQ-SRBD was moderate (R=0.54, p= < 0.01). There was high inter-rater reliability (kappa=0.75) in a subset of 53 subjects with second PCSS screens. Conclusion Multiple craniofacial features assessed during routine dental visits were associated with increased risk for pediatric SDB. This study points to the utility of a craniofacial scale to assess SDB risk in children. This pilot study will be expanded to include a more diverse patient population. Support (if any)