Pediatric Sleep Questionnaire Research Articles

Risk factors of sleep-disordered breathing and poor asthma control in children with asthma

BackgroundSleep-disordered breathing (SDB) may lead to poor asthma control in children.ObjectiveTo identify risk factors of SDB in children with asthma and assess its impact on asthma control.MethodsIn this cross-sectional study, we collected data of outpatients with asthma at the Children’s Hospital of Chongqing Medical University from June 2020 to August 2021. The Pediatric Sleep Questionnaire—Sleep-Related Breathing Disorder and the age-appropriate asthma control tests Childhood Asthma Control Test and Test for Respiratory and Asthma Control in Kids were completed.ResultsWe enrolled 397 children with a male-to-female ratio of 1.7:1 and a mean age of 5.70 ± 2.53 years. The prevalence of SDB was 21.6%. Allergic rhinitis (odds ratio OR = 3.316), chronic tonsillitis (OR = 2.246), gastroesophageal reflux (OR = 7.518), adenoid hypertrophy (OR = 3.479), recurrent respiratory infections (OR = 2.195), and a family history of snoring (OR = 2.048) were risk factors for the development of combined SDB in children with asthma (p < 0.05). Asthma was poorly controlled in 19.6% of the children. SDB (OR = 2.391) and irregular medication use (OR = 2.571) were risk factors for poor asthma control (p < 0.05).ConclusionsAllergic rhinitis, chronic tonsillitis, gastroesophageal reflux, adenoid hypertrophy, recurrent respiratory infections, and a family history of snoring were independent risk factors for the development of SDB in children with asthma. SDB and irregular medication use were independent risk factors for poor asthma control.

Cross-cultural validity of the Dutch sleep-related breathing disorder scale of the Pediatric Sleep Questionnaire in a general population

BackgroundPediatric sleep-disordered breathing is associated with multiple health problems. Polysomnography is the reference standard for identifying this disorder, but availability is limited. Therefore, an alternative screening tool is needed. Globally, the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ) has proven to be a feasible tool. Consequently, this study aimed to translate and culturally adapt the PSQ into Dutch and then to examine the cultural validity, internal consistency, and test-retest reliability of the Dutch version among a general population visiting oral healthcare centers. MethodsThe translation, review, adaptation, pretest, and documentation approach was used to ensure cross-cultural adaptation of the PSQ. Then, 220 children (2.4–18 years) were sampled for clinimetric evaluation. We estimated the cross-cultural validity by comparing the factor analyses of the original PSQ and the Dutch version. Reliability was assessed using Cronbach's alpha, Spearman's correlation, the intraclass correlation coefficient, the standard error of measurement, and a Bland-Altman plot. ResultsThe factor loading patterns of the Dutch version matched with the original study around the four predetermined factors: breathing, sleepiness, behavior, and other. The internal consistency, with a Cronbach's α of 0.77, was acceptable. The test-retest reliability with an intraclass correlation coefficient and Spearman's correlation of 0.89 and 0.93, respectively, was good to excellent. ConclusionsCultural adaptation was ensured and the results support cross-cultural validity, internal consistency, and test-retest reliability of the Dutch Sleep-Related Breathing Disorder scale of the PSQ. This questionnaire could therefore be a valuable tool for screening disordered breathing in Dutch children.

Outcome of tonsillotomy in children with obstructive sleep-disordered breathing

Objective/BackgroundMost children treated for obstructive sleep disordered breathing (oSDB) are not systematically assessed by polysomnography (PSG) nor by structuredsymptom quantification before surgical treatment. The main objective of this study wasto investigate the effect of adeno-tonsillotomy (ATO) on symptom burden and PSGparameters. MethodsChildren aged 2–10 years with oSDB were selected for ATO based uponclinical findings according to current standards of care in Denmark. Each childunderwent standardized assessment before and 3 months after surgery, including aPSG, tonsil size assessment, and the Pediatric Sleep Questionnaire –Sleep RelatedBreathing Disorder (PSQ) to quantify symptom burden. Obstructive sleep apnea (OSA)was defined as an obstructive apnea-hypopnea index (oAHI) ≥2/h. Successfultreatment was defined as post-surgery oAHI ≤5/h, and complete cure as oAHI ≤2/h. ResultsFifty-two children were included. Mean age was 5.0 years (SD ± 1.76). Thirteen children were identified with baseline oAHI <2/h. Significant improvement inOSA severity was observed in children with moderate-to-severe OSA, in whom oAHI decreased from 15.7/h to 2.6/h (p < 0.001). Treatment success was obtained in 85% and cure was obtained in 42% of children. PSQ-score significantly improved from 0.52 (CI 0.47–0.56) to 0.26 (CI 0.21–0.32) (p < 0.001). Baseline OSA severity was notcorrelated to baseline symptom burden nor to symptom relief after ATO. There were noserious adverse events. ConclusionsAdeno-tonsillotomy significantly reduced symptom burden in otherwise healthy children with oSDB symptoms. Significant improvement in oAHI was observedonly in children with moderate-to-severe OSA. We recommend combining clinicalevaluation with PSQ and oAHI.

Assessment of the Epworth Sleepiness Scale, Pediatric Sleep Questionnaire, and Mallampati Score in Children With Obstructive Sleep Apnea: An Observational Study

Background and Objective Individuals diagnosed with obstructive sleep apnea (OSA) experience recurrent episodes of breathing cessation due to blockage of the upper airway during sleep. This study aimed to assess the Pediatric Sleep Questionnaire (PSQ) scores, Epworth Sleepiness Scale (ESS) scores, and Mallampati score in pediatric patients with OSA, compared with non-OSA.Methods An observational study was conducted on 100 pediatric female patients aged 9-13 years with retrognathic mandible. The participants were subjected to PSQ, ESS, and Mallampati score to assess the size and shape of the patient’s tongue and esophageal airway. Finally, polysomnographic examination was carried out for all the participants and they were divided into two groups: Group 1 (50 patients) who were diagnosed with OSA by polysomnography and Group 2 (50 patients) consisting of non-OSA patients. Chi-square and Mann–Whitney U test were applied to compare scores between the two groups.Results The mean PSQ, ESS, and Mallampati scores of participants were 0.78 ± 0.45, 9.86 ± 2.47, and 2.27 ± 0.98, respectively in Group 1 and 0.24 ± 0.03, 7.27 ± 2.39, and 1.32 ± 0.57, respectively in Group 2, and this difference was statistically significant (p &lt; 0.05). PSQ, ESS, and Mallampati scores had specificity of 100%, 95.5%, and 72.7%, respectively, whereas the sensitivity was 45.5%, 22.7%, and 63.6%, respectively. ESS scores ≥ 10, PSQ scores ≥ 0.3, and Mallampati scores ≥ 2 were indicative of OSA.Conclusions Patients with OSA having retrognathic mandible had higher PSQ, ESS, and Mallampati scores compared to healthy individuals without OSA. Mallampati score can be satisfactorily used for screening OSA patients.

Insights into Pediatric Sleep Disordered Breathing: Exploring Risk Factors, Surgical Interventions, and Physical and Scholastic Performance at Follow-Up.

(1) Background: Sleep-disordered breathing represents a growing public health concern, especially among children and adolescents. The main risk factors for pediatric sleep-disordered breathing in school-age children are tonsillar and adenoid hypertrophy. Adenoidectomy, often in combination with tonsillectomy, is the primary treatment modality for pediatric sleep-disordered breathing. This study aims to comprehensively investigate various risk and protective factors in children with sleep-disordered breathing undergoing adenotonsillar or adenoidal surgeries. We also aim to explore the differences in neuropsychological profiles. (2) Methods: This is an observational, retrospective cohort study. We collected information on adenoidectomy or adenotonsillectomy in children referred to our center. We reviewed the clinical history and preoperative visits and collected data through a telephone questionnaire. The Pediatric Sleep Questionnaire (PSQ) and the Pediatric Quality of Life Inventory (PedsQL) screen sleep-disordered breathing and quality of life, respectively. The data were statistically analyzed using SPSS version 22.0 for Windows (SPSS Inc., Chicago, IL, USA). (3) Results: The study involved 138 patients, but only 100 children participated. A higher percentage of patients with sleep-disordered breathing were observed to have mothers who smoked during pregnancy. A smaller proportion of patients with sleep-disordered breathing habitually used a pacifier. A rise in physical score was associated with a reduced PSQ at follow-up (p = 0.051). An increase in the overall academic score was related to a decrease in the PSQ at follow-up (p < 0.001). A more significant proportion of patients undergoing adenotonsillectomy were observed to have a history of prematurity and cesarean birth. (4) This comprehensive study delves into the intricate interplay of risk and protective factors impacting children with sleep-disordered breathing undergoing adenotonsillectomy and adenoidectomy.

Characteristics of sleep in children with heavy prenatal alcohol exposure.

Sleep plays an important role in neurodevelopment. However, the effects of prenatal alcohol exposure on sleep quality have been understudied, despite reports of sleep disturbance in infants prenatally exposed to alcohol and elevated levels of sleep problems reported by caregivers of children with fetal alcohol spectrum disorders. The current study characterizes sleep in children with prenatal alcohol exposure using both objective (actigraphy) and subjective (questionnaires, sleep diaries) methods. Participants aged 6-10 years, with and without prenatal alcohol exposure, were included in the study (alcohol-exposed [AE]: n = 35; control [CON]: n = 39). Objective sleep was measured via 24-h actigraphy for 2 weeks. Parents completed sleep diaries and sleep questionnaires (Children's Sleep Habits Questionnaire, Pediatric Sleep Questionnaire). Multivariate analysis of variance was used to characterize the sleep profile (objective, subjective) and examine group differences. There were no group differences on actigraphy metrics averaged across 2 weeks. However, the AE group showed significantly greater intraindividual variability on most actigraphy measures, particularly total sleep time, percent sleep, wake after sleep onset, and number of wake bouts. Parents reported significantly more sleep problems in the AE group than in the CON group, primarily driven by night wakings, parasomnias (e.g., sleepwalking), snoring, and daytime sleepiness. These effects were more severe in children >8.5 years of age. Despite similar 2-week average sleep outcomes, children with prenatal alcohol exposure showed greater intraindividual sleep variability and parents reported more sleep problems related to sleep behavior and snoring. These difficulties with sleep may be related to other cognitive and behavioral outcomes. Importantly, sleep is a modifiable behavior, and interventions that focus on variability in sleep, particularly in sleep duration, can impact the quality of life in children with prenatal alcohol exposure and their families.

Neurobehavioral Phenotype of Children With Congenital Myotonic Dystrophy.

To describe the neurobehavioral phenotype of congenital myotonic dystrophy. Congenital myotonic dystrophy (CDM) is the most severe form of myotonic dystrophy, characterized by symptom presentation at birth and later, cognitive impairment, autistic features, and disordered sleep. The neurobehavioral phenotype was assessed in this cross-sectional study by a neuropsychological battery consisting of the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, Weschler Intelligence Scale for Children, Fourth Edition, Vineland Adaptive Behavior Scale, Second Edition (Vineland-II), Behavior Rating Inventory of Executive Function including preschool and teacher reports, Autism Spectrum Screening Questionnaire, Social Communication Scale, and Repetitive Behavior Scale-Revised. Sleep quality was evaluated with the Pediatric Sleep Questionnaire and Pediatric Daytime Sleepiness Scale. Fifty-five children with CDM, ages 5 weeks to 14 years, were enrolled. The mean age and (CTG)n repeats (±SD) were 6.4 ± 3.8 years and 1,263 ± 432, respectively. The mean IQ was 64.1 ± 14.9 on the Weschler scales with 65.6% of participants falling in the extremely low range for IQ. Adaptive functioning was significantly low for 57.1% of participants (n = 20). Caregiver report of executive functioning indicated 23.1% (9/39) of participants had clinically elevated levels of dysfunction, though teacher report was discrepant and indicated 53.3% of participants with CDM fell in this range (8/15). Spearman correlations were strongly positive (p ≤ 0.05) for estimated full scale IQ, overall adaptive functioning and with daily living and socialization domain standard scores on the Vineland-II ranging from r = 0.719 to r = 0.849 for all ages. Aspects of executive function were directly related to features of autism and sleep quality. Social communication was inversely related to all aspects of daily functioning, except communication, and directly related to aspects of autism behavior. Depressed IQ, adaptive skills, and executive functioning, poor sleep quality, and features of autism and altered social functioning individually describe different aspects of the neurobehavioral phenotype in CDM. These neurobehavioral and sleep measures could help quantitatively measure and assess the burden of cognitive impairment in CDM.

A case-control study to investigate the prevalence of obstructive sleep apnea and the utility of the PSQ-SRBD questionnaire in children and young people with epilepsy.

Epilepsy and obstructive sleep apnea syndrome (OSAS) are each relatively common in children. OSAS may affect cognition, such that recognition of OSAS is important for children and young people with epilepsy (CYPWE). Published pilot data reported 55% CYPWE had symptoms suggestive of OSAS, compared with 7% typically developing controls. The primary aim of this study was to ascertain OSAS prevalence by polysomnography (PSG) in CYPWE, with secondary aims being to evaluate the utility of sleep questionnaires in CYPWE. Children and young people with epilepsy and age- and sex-matched typically developing controls were studied. A single night of level I attended PSG was undertaken, along with questionnaires [Pediatric Sleep Questionnaire (PSQ-SRBD), Pittsburgh Sleep Quality Index (PSQI) and the childhood and adolescent Epworth Sleepiness Scale (ESS-CHAD)]. OSAS was defined as obstructive apnea-hypopnea index (oAHI) of ≥ 1 event/h. Polysomnography was performed in 72 children including 48 CYPWE (60% male) and 24 controls (54% male). Mean age (11 years) was similar for CYPWE and controls, p= 0.42; with slightly higher BMI z scores (0.7 v 0.1, p=0.03) noted in CYPWE. Mean oAHI was 0.61 in CYPWE versus 0.42 (controls), p=0.62. Despite higher PSQ-SRBD scores in CYPWE (0.38 v 0.12, p<0.001), no difference in OSAS prevalence (10% vs. 4%, p=0.78) was found. Children and young people with epilepsy had higher ESS-CHAD (6 vs. 3.5, p=0.01) and PSQI (5 vs. 3.3, p=0.02) scores indicating greater levels of daytime sleepiness and poorer sleep quality. The study found no evidence for increased OSAS prevalence in CYPWE, whilst the utility of the PSQ-SRBD in predicting OSAS appears limited for CYPWE. Children and young people with epilepsy are, however demonstrably sleepier with poorer sleep quality. The cause for these findings remains unclear. Investigation of Sleep Quality and Prevalence of Sleep-disordered Breathing in Children and Young People With Epilepsy; https://www.clinicaltrials.gov/study/NCT03103841.

Effect of pediatric adenotonsillectomy on sleep-related breathing disorder as measured by Pediatric Sleep Questionnaire (PSQ) scores and serum highly sensitive C-reactive protein (hsCRP) levels

Effect of pediatric adenotonsillectomy on sleep-related breathing disorder as measured by Pediatric Sleep Questionnaire (PSQ) scores and serum highly sensitive C-reactive protein (hsCRP) levels

Forward and Back is Not Enough: Applying Best Practices for Translation of Pediatric Sleep Questionnaires.

Cultural differences in the experience of sleep warrant consideration in the measurement of sleep across populations. This requires careful attention to both language and culture when translating survey measures. While forward and back translation is the most commonly used approach, it has numerous limitations if used as an isolated method. Best practice guidelines recommend a multi-step team-based approach for translating questionnaires. We present our recent experience applying best practices in a study with both Spanish and English-speaking Mexican American mothers of toddlers. This work is part of a larger project that will measure parental sleep-related beliefs and parenting practices in Mexican American parents of toddlers. We utilized a team-based approach to translation and cultural adaptation, assembling a diverse, bilingual, and bicultural team. The translation process started with items and measures that we had selected, revised as needed, or created. New items were based on constructs identified in semi-structured interviews and focus groups used to explore parental sleep-related beliefs and parenting practices in the target population. Following this, our translation process included forward and back translation, harmonization and decentering, cognitive interviewing, debriefing, adjudication, and proofreading. We outline details of our process and the rationale for each step. We also highlight how each step contributes to ensuring culturally appropriate items with conceptual equivalence across languages. To ensure inclusivity and scientific rigor within the field of sleep research, investigators must utilize best practices for translations and cultural adaptations, building on the foundation of cultural constructs often identified in qualitative work.

Sleep, Anxiety, Somatization, Quality of Life, and Resilience in Pediatric Patients With Eosinophilic Esophagitis.

Emerging evidence suggests a high burden of psychosocial comorbidities in patients with eosinophilic esophagitis (EoE), although factors associated with this burden have not been explored. We aimed to increase understanding of the psychosocial burden of EoE and assess factors that are associated with disease burden. We conducted a cross-sectional study of patients with EoE (n = 87) recruited from a single-center, multidisciplinary pediatric eosinophilic gastrointestinal disorders clinic (2019-2021). Participants (aged 8-18 years) completed validated assessments during routine clinic visit to assess EoE symptoms (Pediatric Eosinophilic Esophagitis Symptom Score version 2.0), quality of life (Pediatric Quality of LIfe- Eosinophilic Esophagitis), anxiety state and trait (State-Trait Anxiety Score for Children), somatization (Child Somatic Symptoms Inventory 24), sleep disordered breathing (Pediatric Sleep Questionnaire) and, in a subset (n = 35), resilience (Connor Davidson Resilience Scale). Clinical and demographic data were collected. Participants were at a mean (SD) age of 12.8 (3.1) years, and 26% (n = 23) were female. Shorter disease duration (6-12 months) was associated with higher symptom burden ( P = 0.03), somatization ( P < 0.01), and anxiety (State-Trait Anxiety Score for Children Trait P < 0.01) scores. Participants with neurodevelopmental comorbidities had higher anxiety trait, somatization, sleep disordered breathing, and lower quality of life ( P < 0.01 for all). Symptom burden was significantly associated with increased somatic symptoms (adjusted β [aβ] = 0.34; 95% confidence interval 0.23-0.45) and decreased quality of life (aβ = -0.42; 95% confidence interval -0.59 to -0.25) but not state anxiety, trait anxiety, or disordered sleep breathing. Pediatric patients with a recent diagnosis of EoE can experience higher EoE symptoms, somatization, and anxiety when compared with those with a longer-standing diagnosis. Patients earlier in their diagnosis and with neurodevelopmental disorders may experience increased somatization and anxiety that may warrant additional support services.

Cross-cultural validation and psychometric properties of the Spanish version of the quality of life in Childhood epilepsy Questionnaire (QOLCE-55)

ObjectiveThe aims of the present study were to translate and validate the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) into Spanish. MethodsA backtranslation procedure was used to translate the English version of QOLCE-55 to Spanish, and subsequently, parents of 88 children (aged four to 12 years), completed the Spanish version of three self-reported questionnaires: the QOLCE-55, the Pediatric Quality-of-Life Inventory (PedsQLTM 4.0), and the Pediatric Sleep Questionnaire (PSQ). Seven to 10 days later, parents completed the questionnaires again under the same conditions. ResultsInternal consistency was between 0.669 and 0.968 for the four subscales: cognitive (CF), emotional (EF), social (SF) and physical functioning (PF); and 0.954 for the total score. The test–retest reliability assessed with the intraclass correlation coefficient obtained values from 0.683 for SF to 0.962 for CF. The standard error of measurement for the total score was 5.776, and the minimal detectable change was 16.01. Spearman correlations between the total score of the Spanish version of the QOLCE-55 with the subscales was 0.760 for the CF, 0.776 for the EF, 0.799 for the SF, and 0.682 for the PF (p < 0.001). Convergent validity of QOLCE-55 with the PedsQLTM 4.0 scale was −0.962 (p < 0.001), and the discriminant validity of the QOLCE-55 with PSQ was 0.154 (p = 0.272). This version presented a correlation with maximum lifetime consumption of anti-epileptic drugs (0.500; p < 0.001), and current consumption (0.448; p < 0.001). ConclusionsThe Spanish version of the QOLCE-55 has demonstrated adequate psychometric properties, indicating that it can be confidently used to measure the health-related quality-of-life (HRQoL) in children with epilepsy in a Spanish-speaking population. These results corroborate the instrument's cross-cultural validity.

The frequency of sleep-disordered breathing in preschool children with asthma and its effects on control of asthma.

The frequency and score of SDB were higher in patients with uncontrolled asthma. Frequency and score of SDB were significantly affected by the severity of asthma. SDB must be evaluated in preschool children with uncontrolled asthma. Sleep-disordered breathing (SDB) is more common in asthmatic patients than in non-asthmatic persons, and SDB affects negatively to control asthma. A limited number of studies are discovered on the effect of SDB in preschool asthmatic children. In this study, we aimed to investigate the prevalence of SDB and its effect on control and severity of asthma in preschool children. A pediatric sleep questionnaire was completed by parents of asthmatic children. Patients who received a score of 0.33 or higher were diagnosed with SDB. Control and severity of asthma was assessed by a pediatric allergy specialist based on the Global Initiative for Asthma (GINA) criteria. The study included 249 patients, with a mean±SD age of 4.37±1.04 (range: 2-5.9) years; 69% were boys; 56.6% children had uncontrolled asthma and 28.7% had SDB. The SDB score was significantly different between controlled and uncontrolled asthma (0.19 vs 0.28; P < 0.001). The frequency of uncontrolled asthma in patients with and without SDB was 74.3% and 49.4%, respectively (P < 0.010). Based on the severity of asthma, the frequency of SDB among patients with mild, moderate, and severe asthma was 23.4%, 35.2%, and 47.4%, respectively (P = 0.010).

Association among craniofacial morphology, ethnicity, and risk of pediatric sleep-related breathing disorders: A multicenter study

Craniofacial morphology and ethnicity may be risk factors for sleep-related breathing disorder (SRBD) in children but have not yet been assessed in an international multicenter study. The objectives of this study were to assess the association among craniofacial features, self-reported ethnicity, and risk of SRBD in children undergoing orthodontic treatment. Children aged 5-18 years who presented for orthodontic evaluation were enrolled in the United States, South Africa, South Korea, Saudi Arabia, and Japan. The risk of SRBD was defined as answering ≥0.33 positive responses to the Pediatric Sleep Questionnaire. Craniofacial features included measurements in sagittal and vertical dimensions to evaluate the cranial base, maxillomandibular and dental relationships, and nasopharyngeal airway dimensions. Logistic regression was performed to assess the association among craniofacial features, ethnicity, age, body mass index, and risk of SRBD. Data were obtained from 602 patients from 5 sites. A total of 76 patients (12.6%) had a risk of SRBD. The mean age was 12.5 years. Male gender (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.0-3.4; P= 0.041), Middle Eastern ethnicity (OR, 10.2; 95% CI, 4.1-25.4; P= 0.001), body mass index (OR, 1.1; 95% CI, 1.04-1.10; P= 0.001), gonial angle (OR, 0.91; 95% CI, 0.85-0.98; P= 0.011), and inferiorly positioned hyoid (OR, 1.1; 95% CI, 1.0-1.2; P= 0.002) were significantly associated with the risk of SRBD. In an ambidirectional cohort study across 5 sites, male gender, Middle Eastern ethnicity, body mass index, gonial angle, and inferiorly positioned hyoid were associated with the risk of SRBD in children undergoing orthodontic treatment.

Changes in behavioral and cognitive abilities after rapid maxillary expansion in children affected by persistent snoring after long-term adenotonsillectomy: A noncontrolled study

The objective of this study was to verify changes in behavioral abilities and cognitive functions after rapid maxillary expansion (RME) in children with refractory sleep-disordered breathing (SDB) in the long term after adenotonsillectomy. A prospective clinical trial study using RME therapy was conducted. Participant inclusion criteria were children who had adenotonsillectomy with maxillary transverse deficiency and persistent SDB (obstructive apnea-hypopnea index ≥1). The study included 24 children aged 5-12 years, and of these 24 children, 13 had primary snoring and 11 had obstructive sleep apnea. The patients underwent laryngeal nasofibroscopy and a complete polysomnography. In addition, patients completed the Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire. Behavioral and neurocognitive tests were also completed before and after RME. The Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life scores showed a statistically significant decrease in both groups (P<0.001) after RME. The results showed that neurocognitive and behavioral parameters (Child Behavior Checklist scale) were similar in primary snoring and obstructive sleep apnea (OSA) groups before RME. In the OSA group, the mean scores of the "Somatic" and "Aggressiveness" domains decreased significantly (P<0.05). The cognitive functions did not register significant differences pre- and post-RME in any of the cognitive functions, except for visuospatial function in the OSA group. The noncontrolled design was a major limitation of our study. The need for treatment for SDB should consider the association of symptoms and behavioral disturbances with the child's obstructive apnea-hypopnea index. RME might prove to be an alternative treatment for children with SDB refractory to adenotonsillectomy, improving quality of life and behavioral aspects. However, a larger sample size with a control group is needed to substantiate these claims.

Validation of the Malay version of Epworth sleepiness scale for children and adolescents (MESS-CHAD)

BackgroundEpworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) is a valid and reliable eight-item self-administered questionnaire for the assessment of excessive daytime sleepiness and is commonly used to screen sleep-disordered breathing for children and adolescents. The cross-sectional study aimed to translate and cross-culturally adapt ESS-CHAD into a Malay version of Epworth Sleepiness Scale for Children and Adolescents (MESS-CHAD) for the Malaysian population, and to assess the validity and reliability of MESS-CHAD.MethodsForward-backward translation method was used to translate and cross-culturally adapt ESS-CHAD. Three linguistic experts and two paediatricians content validated the translated version. Face validity was conducted through audio-recorded semi-structured in-depth interviews with 14 native Malay-speaking children and adolescents followed by thematic analysis. The revised questionnaire was then proofread by a linguistic expert. A total of 40 subjects answered the MESS-CHAD twice, 2 weeks apart, for test-retest reliability and internal consistency. For criterion validity, 148 eligible subjects and their parents answered MESS-CHAD and the Malay version of Sleep-Related Breathing Disorder scale extracted from the Paediatric Sleep Questionnaire (M-PSQ:SRBD) concurrently. Variance Inflation Factor (VIF) and P values of the model’s outer weight and outer loading were analysed using SmartPLS software to assess the indicator’s multicollinearity and significance for formative construct validity.ResultsIntraclass Correlation Coefficient (ICC) ranging from 0.798 to 0.932 and Cronbach’s alpha ranging from 0.813 to 0.932 confirmed good to excellent test-retest reliability and internal consistency, respectively. Spearman Correlation Coefficient value of 0.789 suggested a very strong positive correlation between MESS-CHAD and M-PSQ:SRBD. VIF ranging from 1.109 to 1.455 indicated no collinearity problem. All questionnaire items in MESS-CHAD were retained as the P value of either outer model weight or outer model loading was significant (P < 0.05).ConclusionESS-CHAD has been translated and cross-culturally adapted into Malay version for the Malaysian population, and found to be valid and reliable.

Analysis of Obstructive Sleep Apnoea in Craniofacial Microsomia Based on Polysomnography

Objective This study aimed to investigate the prevalence of obstructive sleep apnoea (OSA) in patients with craniofacial microsomia (CFM) through polysomnography (PSG) and the relationship with the severity of CFM. Methods This study reviewed patients of CFM with pre-operative PSG data between January 2005 and September 2023. Patients were grouped according to the Pruzansky-Kaban classification. OSA was diagnosed and severity was assessed by the obstructive apnea-hypopnea index. The Pediatric Sleep Questionnaire was used to investigate OSA-related signs and symptoms. The χ 2 test and Fisher's exact test were used to compare between groups. Univariate logistic regression was used to identify risk factors associated with OSA. A p-value less than 0.05 was considered statistically significant. Results A total of 121 patients with CFM were included in the study with 3 bilateral and 118 unilateral patients. In total, 86 patients (71.07%) were diagnosed with OSA. The prevalence of OSA in type IIa, type IIb and type III was 72.97%, 78.33%, and 47.62%. There was no statistically significant difference in the prevalence of OSA between type IIa and type IIb ( p &gt; .05). The difference in the prevalence of OSA between type III and type II was statistically significant ( p &lt; .05). Snoring was the most common symptom among the patients of CFM with OSA. Conclusions Patients with CFM have a higher incidence of OSA based on PSG in type II and type III patients. The incidence of OSA did not correlate positively with the severity of CFM, with type III patients having certain particularities.

Validation of the newly developed Sleep Screening Questionnaire Children and Adolescents (SSQ-CA) with objective sleep measures

ObjectivesObjectively validated pediatric sleep questionnaires covering a broader age range and different sleep disturbances are lacking, therefore we developed the Sleep Screening Questionnaire Children and Adolescents (SSQ-CA) and compared it with objective sleep parameters. MethodsThis child-reported questionnaire was developed by a multidisciplinary panel and face validated. In a cross-sectional prospective design, participants aged 6–17, answered the questionnaire twice with 21–28 days in between, wore actigraphy (AG) and kept a sleep diary for seven nights and home-polysomnography (PSG) for one of these nights. Exploratory factor analyses (EFA), reliability and validity assessments were performed. ResultsOf the 139 participants, 128 (F:47.7%, AG: n = 128, PSG: n = 59), were included in the analyses. Mean age: 11.3 years (SD: 2.9). EFA revealed 11 factors and 40 items loading above r = 0.4. Subscale internal consistency: 0.54–0.92. Subscale test-retest reliability: r = 0.71–0.87. Total sleep time (TST) from SSQ-CA on weekdays correlated with PSG (r = 0.48, p = 0.001) and with AG (r = 0.75, p < 0.001). The subscale total score for “Sleep duration and latency” correlated with TST from AG (r = −0.19, p = 0.03) and sleep latency (r = 0.31, p < 0.001), but not for PSG variables. The subscale “Awakenings” showed no correlation with objective measures whereas “Circadian rhythm” correlated to AG-derived mid-sleep time (r = 0.34, p < 0.001). ConclusionsThe SSQ-CA shows adequate reliability for the 6–17-year-olds and acceptable criterion validity for two subscales. It appears to be a useful tool for screening for sleep disturbances in combination with objective tools as the subjective and objective parameters seem to uncover different aspects of sleep.

Initial experiences of using the Paediatric Sleep Questionnaire (PSQ) to screen for obstructive sleep apnoea in a tier-3 paediatric weight management clinic

Initial experiences of using the Paediatric Sleep Questionnaire (PSQ) to screen for obstructive sleep apnoea in a tier-3 paediatric weight management clinic

O005 Deficits in learning and overnight memory consolidation in children with mild sleep disordered breathing

Abstract Objectives Sleep disordered breathing (SDB) is associated with sleep fragmentation that can compromise daytime learning and impact overnight memory consolidation. Yet, research into learning and overnight memory consolidation of children with SDB is very limited. The objective of the current study is to determine if school aged children with SDB show deficits in learning and overnight consolidation of declarative and non-declarative memories compared to healthy control (HC) children. Methods This study included 50 school aged (7-16 years) children (25 SDB, 25 HC) of comparable sex, parental SES, and BMI. Parents completed the paediatric sleep questionnaire (PSQ) for all children. Children with SDB underwent an overnight sleep study. All children completed a cognitive battery, including assessment of IQ and memory. We employed two declarative memory tasks, one verbal and one visual, and one non-declarative memory task. We measured learning and recall at two delays (30 minutes and overnight) on memory tasks. Results On the visual declarative memory task children with SDB performed more poorly in learning, and recalled significantly fewer pictures following a night of sleep, compared to HC. On the non-declarative task learning of children with SDB and HC children was comparable but following a night of sleep accuracy improved less in the SDB group compared to the HC group. Discussion This study provides, to our knowledge for the first time, evidence of impairment of overnight declarative and non-declarative memory consolidation concurrently in school aged children with mild SDB, whose declarative (but not non-declarative) learning was also impaired.