Grantham-Hill Sarah, Evans Hazel J, Tuffrey Catherine, Sanders Emma, Elphick Heather E, Gringras Paul, Kingshott Ruth N, Martin Jane, Reynolds Janine, Joyce Anna, Hill Catherine M, Spruyt Karen
Faculty of Medicine, School of Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom.
Department of Sleep Medicine, Southampton Children's Hospital, Southampton, United Kingdom.
Front Psychiatry. 2020 Apr 28;11:285. doi: 10.3389/fpsyt.2020.00285. eCollection 2020.
Obstructive sleep apnea (OSA) is common in children with Down syndrome (DS) and is associated with adverse health and cognitive outcomes. Daytime clinical assessment is poorly predictive of OSA, so regular screening with sleep studies is recommended. However, sleep studies are costly and not available to all children worldwide. We aimed to evaluate the psychometric properties and predictive value of a newly developed screening questionnaire for OSA in this population.
202 children aged 6 months to 6 birthday with DS were recruited, of whom 188 completed cardio-respiratory sleep studies to generate an obstructive apnea hypopnea index (OAHI). Parents completed the 14-item Down syndrome OSA screening questionnaire. Responses were screened, a factor analysis undertaken, internal consistency calculated and receiver operator characteristic (ROC) curves drawn to generate an area under the curve (AUC) to assess criterion related validity.
Of 188 children who completed cardiorespiratory sleep studies; parents completed the screening questionnaire for 186. Of this study population 15.4% had moderate to severe OSA defined by an OAHI of ≥5/h. Sixty-three (33.9%) participants were excluded due to "unsure" responses or where questions were not answered. Using the remaining 123 questionnaires a four-factor solution was found, with the 1 factor representing breathing related symptoms, explaining a high proportion of the variance. Internal consistency was acceptable with a Cronbach alpha of 0.87. ROC curves for the total score generated an AUC statistic of 0.497 and for the breathing subscale an AUC of 0.603 for moderate to severe OSA.
A well designed questionnaire with good psychometric properties had limited predictive value to screen for moderate to severe OSA in young children with DS. The use of a screening questionnaire is not recommended. Screening for OSA in this population requires objective sleep study measures.
阻塞性睡眠呼吸暂停（OSA）在唐氏综合征（DS）儿童中很常见，并且与不良健康和认知结果相关。日间临床评估对OSA的预测性较差，因此建议定期进行睡眠研究筛查。然而，睡眠研究成本高昂，并非全球所有儿童都能进行。我们旨在评估一种新开发的针对该人群的OSA筛查问卷的心理测量特性和预测价值。
招募了202名年龄在6个月至6岁的DS儿童，其中188名完成了心肺睡眠研究以生成阻塞性呼吸暂停低通气指数（OAHI）。家长完成了14项唐氏综合征OSA筛查问卷。对回答进行筛选，进行因子分析，计算内部一致性，并绘制受试者操作特征（ROC）曲线以生成曲线下面积（AUC）来评估与标准相关的效度。
在188名完成心肺睡眠研究的儿童中，家长为186名儿童完成了筛查问卷。在该研究人群中，15.4%的儿童OAHI≥5/h，被定义为中度至重度OSA。63名（33.9%）参与者因“不确定”回答或未回答问题而被排除。使用其余123份问卷，发现了一个四因子解决方案，其中1个因子代表与呼吸相关的症状，解释了很大一部分方差。内部一致性可以接受，Cronbach α为0.87。总得分的ROC曲线生成的AUC统计值为0.497，呼吸子量表的AUC为0.603，用于中度至重度OSA。
一份设计良好且具有良好心理测量特性的问卷在筛查DS幼儿中度至重度OSA方面的预测价值有限。不建议使用筛查问卷。对该人群进行OSA筛查需要客观的睡眠研究措施。
