Diagnostic accuracy of ‘modified’ Pediatric Sleep Questionnaire (PSQ) for Obstructive Apnea Syndromes in pediatric age

Obstructive sleep apnoea syndrome (OSAS) is a sleep-related breathing disorders (SRBDs) characterized by total or partial collapse of the upper airways during sleep. The Paediatric Sleep Questionnaire (PSQ) is one of the most used and validated screening tools, but it lacks the comprehensive assessment of some determinants of OSAS, specifically anamnestic assessment and sleep quality. This lack with modified PSQ was addressed in a recent study  which however had some limitations such as a small sample.  This study aims to overcome these limitations by involving a larger sample. The modified PSQ was administered via a digital form to the parents of children (age range: 3–18 years) attending schools in Palermo (Sicily-Italy). For each item, added in the original PSQ,  sensitivity and specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. The highest sensitivity (71.4, 95% CI: 29,0; 96,3), in combination with the highest specificity (60.0, 95% IC: 51.9;67.6), was found for the Item 8 ('Does your child sweat at night?'). Furthermore the highest specificity (96.8 95% CI:92.8;98.9), in combination with the highest sensitivity (14.2, 95% CI: 0.3;57.8) was found for the Item 11 ('Does your child have confused awakenings, e.g., the child looks awake but confused, disoriented and sometimes aggressive?'). Compared to the previous study, this study  highlights how other Items related to sleep quality can be essential for the diagnosis of OSAS. Although these results should be validated with clinical diagnoses, they suggest that including the factors discriminating sleep quality could further increase the efficiency and accuracy of PSQ. KEYWORDS: paediatric Sleep-Related Breathing Disorders (SRBD); paediatric Obstructive Sleep Apnoea Syndrome (OSAS); Paediatric Sleep Question (PSQ); Di.Chir.On.S 2021