Abstract
BackgroundChildren with obstructive sleep apnea are at high risk for perioperative airway obstruction. Many “at risk” children may remain unrecognized. The aim of this study is to find a clinically practicable test to identify obstructive sleep apnea in childhood.MethodsIn this pilot study, we prospectively compared four parental questionnaires with the respective findings of subsequent sleep laboratory testing in children. Right before sleep laboratory testing, children’s parents answered both the Pediatric Sleep Questionnaire, a subscale of the Sleep Related Breathing Disorder questionnaire (PSQ-SRBD-Subscale), and an eight-item questionnaire derived from it. Finally, we condensed the eight-item questionnaire to three core issues: Does your child regularly snore at night? Does your child demonstrate labored breathing during sleep? Does your child have breathing pauses during sleep? With it, two similar questionnaires were generated that differed in the formation of the resulting score. One questionnaire was built by a quotient comparable to the abovementioned questionnaires and a second as quick test that functioned as a simple sum score. Both sensitivity and specificity were determined by using a Receiver Operating Characteristic analysis.ResultsIn total, 53 children were included in the study. Both the PSQ-SRBD-questionnaire and self-derived eight-item questionnaire failed to reach statistically significant results in detecting obstructive sleep apnea. The set of three core questions with a score built by a quotient was statistically significant and provided sensitivity and a moderate specificity of 0.944 and 0.543, respectively. This could be slightly optimized by creating a simple sum-score (specificity of 0.571).ConclusionsThe use of three core-questions may facilitate the detection of pediatric obstructive sleep apnea within the scope of the anesthesia survey. While the study has some limitations, future studies with both unselective collectives and older children might prove this ultra-short questionnaire to be advantageous in detecting pediatric OSA in clinical practices.Trial registrationGerman Clinical Trial Register (DRKS00010408, https://www.drks.de); date of registration 26.07.2016
Highlights
Children with obstructive sleep apnea are at high risk for perioperative airway obstruction
OSAsq3 and obstructive sleep apnea (OSA) quick test (OSA3/8) First, the OSA-short questionnaire 3 (OSAsq3) was subsequently condensed from the OSA-short questionnaire-8 (OSAsq8) and summarizes the first three key questions (Table 1): Does your child regularly snore at night? Does your child demonstrate labored breathing during sleep? Does your child have breathing pauses during sleep? Answers are either “yes”, “no,” or “don’t know.”
Compared with the group of children without OSA (AHI 0,45 ± 0,9), we found less boys (p = 0,019) in the group of pediatric OSA (AHI 14 ± 13,4, Table 2)
Summary
Children with obstructive sleep apnea are at high risk for perioperative airway obstruction. Children with obstructive sleep apnea (OSA) face a higher risk for perioperative airway obstruction and, many “at risk” children may remain unrecognized at the time of pre-anesthetic assessment [2]. While both the ASA and the STOP-BANG questionnaire demonstrate a reliable sensitivity and specificity in adults, those questionnaires are often of limited usefulness in childhood due to the complex nature of pediatric OSA [3,4,5,6]. A reliable “quick-test” on pediatric OSA is needed for a pre-anesthetic assessment in order to detect a hidden disease that may lead to serious respiratory sequels
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