Optimizing Pediatric Screening for Severe Sleep Disordered Breathing: Identifying Seven Key Questions

Introduction: Existing screening tools for sleep-disordered breathing (SDB) are lengthy and lack accuracy in diagnosing severe cases. With prolonged wait times and challenges in scheduling polysomnography (PSG), pediatric otolaryngologists often rely on these tools to prioritize patients for surgery. This study aimed to identify a concise set of screening questions to effectively predict severe SDB.

Methods: The study included children aged 5–9 with mild SDB from the Pediatric Adenotonsillectomy Trial for Snoring (PATS, June 2016–January 2021) and participants with obstructive sleep apnea (OSA) from the Childhood Adenotonsillectomy Trial (CHAT, October 2007–June 2012). Screening questions were evaluated against PSG markers, including the Apnea-Hypopnea Index (AHI), Obstructive AHI, and Respiratory Disturbance Index. Positive predictive values (PPV) for severe SDB and negative predictive values (NPV) for the absence of severe SDB were calculated for various question combinations, identifying those with the highest predictive accuracy.

Results: Several three-question combinations achieved a perfect PPV of 1 and an NPV ranging from 0.94 to 0.97. Seven key questions were identified with a PPV of 1, consistently appearing among the top 10 combinations with the highest NPVs across all three outcomes. These questions included snoring more than half the time, daytime mouth breathing, breath-holding spells, choking or gasping sounds, failure to grow at a normal rate at any point since birth, aggressive or hyperactive behavior, and discipline problems.

Conclusions: This study developed a concise set of screening questions with high predictive accuracy for severe SDB. These findings enable providers to streamline the screening process to just seven questions, improving efficiency in prioritizing patients for PSG and surgery.