Soh Han Jie, Rowe Katherine, Davey Margot J, Horne Rosemary S C, Nixon Gillian M
The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Australia.
Department of General Medicine, Royal Children's Hospital, Melbourne, Australia.
Int J Pediatr Otorhinolaryngol. 2018 Oct;113:62-66. doi: 10.1016/j.ijporl.2018.07.029. Epub 2018 Jul 19.
To develop and test a screening tool based on the OSA-18 questionnaire for triage of referrals for sleep-disordered breathing (SDB) in children.
Consecutive children aged >2y without major comorbidities referred for polysomnography (PSG) or overnight oximetry for suspected obstructive sleep apnea (OSA) between 11 January and 31 May 2017 were included. OSA was defined by an obstructive apnea/hypopnea index (OAHI) >1event/h on PSG or an abnormal overnight oximetry (McGill Oximetry Score 2-4). An 11-item questionnaire derived from a previous validation study of the OSA-18 underwent exploratory factor analysis (EFA) with varimax rotation. ANOVA identified questions associated with the presence of OSA. This informed a 5-question, 4-category instrument, scored 0-15 (the OSA-5), that was tested prospectively on 112 children having PSG.
420 children (2.0-17.9y, 43% female) met the inclusion criteria, including 366 complete questionnaires. EFA resulted in a 3-factor structure. ANOVA identified 5 questions from one factor that were independently associated with a diagnosis of OSA: snoring, breath holding, choking, mouth breathing and parental concern. Mean OSA-5 scores with and without OSA were 7.7 vs 4.5 (p < 0.001). Thirty-four percent (60/178) had a total score <5/15, with a sensitivity at this threshold for OSA of 82% and negative predictive value (NPV) of 70%. Similar results were obtained when tested prospectively, including a sensitivity of 82% and NPV of 81% for the presence of moderate/severe OSA (OAHI>5/h).
The OSA-5 is a simple questionnaire that performs well as a triage screening tool to identify those children at risk of OSA among large numbers of referrals for SDB.
基于OSA - 18问卷开发并测试一种用于儿童睡眠呼吸障碍（SDB）转诊分流的筛查工具。
纳入2017年1月11日至5月31日期间连续转诊进行多导睡眠图（PSG）检查或夜间血氧饱和度测定以评估疑似阻塞性睡眠呼吸暂停（OSA）的2岁以上无重大合并症的儿童。OSA的定义为PSG检查时阻塞性呼吸暂停/低通气指数（OAHI）>1次/小时或夜间血氧饱和度测定异常（麦吉尔血氧饱和度评分2 - 4）。从先前对OSA - 18的验证研究中得出的一份11项问卷进行了主成分分析（EFA）并采用方差最大化旋转。方差分析确定了与OSA存在相关的问题。据此形成了一个5个问题、4个类别的工具，评分范围为0 - 15分（OSA - 5），并对112名进行PSG检查的儿童进行了前瞻性测试。
420名儿童（2.0 - 17.9岁，43%为女性）符合纳入标准，包括366份完整问卷。主成分分析得出一个三因素结构。方差分析从一个因素中确定了5个与OSA诊断独立相关的问题：打鼾、屏气、窒息、口呼吸和家长关注。有OSA和无OSA儿童的OSA - 5平均得分分别为7.7分和4.5分（p<0.001）。34%（60/178）的儿童总分<5/15，在此阈值下OSA的敏感度为82%，阴性预测值（NPV）为70%。前瞻性测试时也获得了类似结果，包括中度/重度OSA（OAHI>5/小时）存在时的敏感度为82%，NPV为81%。
OSA - 5是一种简单的问卷，作为一种分流筛查工具，在大量SDB转诊儿童中识别有OSA风险的儿童时表现良好。
