0809 Development and validation of a questionnaire to assess toddler sleep

Abstract

Abstract Introduction Few sleep questionnaires focus on toddlers, whose sleep is unique from both infants and older children. Fewer include both medical and behavioral items, or have been externally validated against polysomnograms (PSGs). Methods Caregivers of children 12 to 36 months old were recruited through social media, flyers in common hospital spaces, general pediatrics clinics, a pediatric neurology clinic, and at the sleep lab. A questionnaire using a 5-point Likert scale was developed. Questionnaire items pertained to behavioral issues, restless legs syndrome, sleep-disordered breathing, dysautonomia, feeding, attitudes toward sleep, and comorbidities. Factor analysis was used to determine which items represent distinct dimensions of toddler sleep. A diagnosis of sleep apnea was not included in the generation of the factors. Cronbach’s alpha was calculated to evaluate internal consistency within the derived factors. Sleep apnea was defined as the presence of either obstructive or central sleep apnea diagnosed by PSG. We used receiver operating characteristic (ROC) curves to determine which factors most closely estimate sleep apnea. Concordance of factors with the presence of sleep apnea was determined by measuring the area under the ROC curve (AUC). Results Responses from 720 caregivers of toddlers were used to generate the factors. External validation was performed using the PSG data of 35 children. One distinct factor emerged which had good concordance with a diagnosis of sleep apnea (AUC≥0.70). The factor was comprised of the following items: “My child has noisy breathing during sleep”, “My child snorts and gasps during sleep”, “My child snores”, “My child's breathing is heavy during sleep”, “My child breathes through their mouth while sleeping”, “My child breathes through their mouth during the day”, “My child "belly breathes" during sleep”; Cronbach’s alpha=0.83; AUC=0.70). Factors associated with daytime behavior, behavioral insomnia of childhood, and excessive daytime sleepiness were not associated with sleep apnea. Conclusion Obstructive features are most associated with sleep apnea, whereas daytime and bedtime behavioral characteristics, and excessive daytime sleepiness are not, unlike in studies of older children. This may reflect the natural history of sleep apnea in children. Further study with a larger sample size is required to confirm this finding. Support (if any) NIH 2T32HL110952-06