Publication:

Screening for sleep related breathing disorders and assessing the risk of obstructive sleep apnea in 2-18 years of children using paediatric sleep questionnaire: an observational study

Background Paediatric obstructive sleep apnea (OSA) is a prevalent yet under-recognised condition associated with significant neurocognitive, behavioural, and cardiovascular morbidity. Polysomnography, the diagnostic gold standard, remains inaccessible in many resource-limited settings. The paediatric sleep questionnaire (PSQ) offers a validated, non-invasive alternative for outpatient screening. Objectives were to screen children aged 2-18 years for sleep-related breathing disorders (SRBD) and assess the risk of OSA using the PSQ, along with associated clinical risk factors.

Methods An observational study was conducted at a tertiary care paediatric outpatient department. Children presenting with at least one sign or symptom of SDB were enrolled using a validated structured checklist. The 22-item PSQ (Chervin et al) was administered via caregiver interview. A PSQ score≥0.33 defined high OSA risk. Associations with clinical variables were assessed by chi-square test.

Results Of 386 children enrolled (65.5% male; majority aged 6-10 years), 235 (60.9%) had PSQ ≥0.33. Neurobehavioural daytime symptoms-hyperactivity, attention deficit, aggressive behaviour, poor school performance, and difficulty in arousing-were significantly associated with high PSQ score (all p<0.05). Nighttime symptoms including snoring, mouth breathing, restless sleep, frequent awakenings, enuresis, increased work of breathing, and diaphoresis showed significant associations (all p<0.05). Physical signs significantly associated with high PSQ score included hypertrophied nasal turbinate, tonsillar hypertrophy, adenoid facies, and obesity (all p<0.05). Among children with confirmed adenoid enlargement on lateral nasopharyngeal radiograph (n=112), higher grades of adenoid hypertrophy were significantly associated with higher PSQ score categories (p=0.001).

Conclusions A substantial proportion (60.9%) of symptomatic children in an outpatient setting were at high OSA risk. The PSQ is a practical, validated screening tool enabling early identification of at-risk children, particularly in resource-limited settings where polysomnography is unavailable.