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Original Research: Sleep Disorders |

Screening of Pediatric Sleep-Disordered BreathingPediatric Sleep-Disordered Breathing Complaints: A Proposed Unbiased Discriminative Set of Questions Using Clinical Severity Scales

Karen Spruyt, PhD; David Gozal, MD, FCCP
Author and Funding Information

From the Department of Pediatrics and Comer Children’s Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, IL.

Correspondence to: David Gozal, MD, FCCP, Department of Pediatrics and Comer Children’s Hospital, The University of Chicago, 5721 S Maryland Ave, MC 8000, Ste K-160, Chicago, IL 60637; e-mail: dgozal@uchicago.edu


Funding/Support: This study was supported by the National Institutes of Health [Grant HL65270].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(6):1508-1515. doi:10.1378/chest.11-3164
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Background:  Identification of sleep-disordered breathing (SDB) using questionnaires is critical from a clinical and research perspective. However, which questions to use and how well such questionnaires perform has thus far been fraught with substantial uncertainty. We aimed at delineating the usefulness of a set of questions for identifying pediatric SDB.

Methods:  Random prospective sampling of urban 5- to 9-year-old children from the community and enriched for habitual snoring underwent overnight sleep study. Subjective indicators or questions were evaluated to further characterize and discriminate SDB.

Results:  Of 1,133 subjects, 52.8% were habitual snorers. This sample was analyzed based on a clinical grouping (ie, established apnea-hypopnea index cutoffs). Several statistical steps were performed and indicated that complaints can be ranked according to a severity hierarchy: shake child to breathe, apnea during sleep, struggle breathing when asleep, and breathing concerns while asleep, followed by loudness of snoring and snoring while asleep. With a posteriori cutoff, a predictive score > 2.72 on the severity scale was found (ie, area under the curve, 0.79 ± 0.03; sensitivity, 59.03%; specificity, 82.85%; positive predictive value, 35.4; negative predictive value, 92.7), making this cutoff applicable for confirmatory purposes.

Conclusions:  As a result, the set of six hierarchically arranged questions will aid the screening of children at high risk for SDB but cannot be used as the sole diagnostic approach.

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