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Prediction of Sleep Apnea and Outcomes

Ronald D. Chervin, MD, MS; Robert A. Weatherly, MD; Susan L. Garetz, MD; Deborah L. Ruzicka, RN, PhD; Bruno J. Giordani, PhD; Elise K. Hodges, PhD; James E. Dillon, MD; Kenneth E. Guire, MS

Arch Otolaryngol Head Neck Surg. 2007;133(3):216-222.

Objectives  To further validate a questionnaire about symptoms of childhood obstructive sleep apnea (OSA) and to compare the questionnaire with polysomnography in their ability to predict outcomes of adenotonsillectomy.

Design  Retrospective analysis of data from a longitudinal study.

Setting  University-based sleep disorders laboratory.

Participants  The Washtenaw County Adenotonsillectomy Cohort, comprising 105 children aged 5.0 to 12.9 years at entry.

Intervention  Parents completed the 22-item Sleep-Related Breathing Disorder (SRBD) scale of the Pediatric Sleep Questionnaire, and children underwent polysomnography before and 1 year after clinically indicated adenotonsillectomy (n = 78, usually for suspected OSA) or unrelated surgical care (n = 27).

Main Outcome Measures  Findings from commonly used hyperactivity ratings, attention tests, and sleepiness tests.

Results  At baseline, a high SRBD scale score (1 SD above the mean) predicted an approximately 3-fold increased risk of OSA on polysomnography (odds ratio, 2.80; 95% confidence interval, 1.68-4.68). One year later, OSA and symptoms had largely resolved, but a high SRBD score still predicted an approximately 2-fold increased risk of residual OSA on polysomnography (odds ratio, 1.89; 95% confidence interval, 1.13-3.18). Compared with several standard polysomnographic measures of OSA, the baseline SRBD scale better predicted initial hyperactivity ratings and 1-year improvement, similarly predicted sleepiness and its improvement, and similarly failed to predict attention deficit or its improvement.

Conclusions  The SRBD scale predicts polysomnographic results to an extent useful for research but not reliable enough for most individual patients. However, the SRBD scale may predict OSA-related neurobehavioral morbidity and its response to adenotonsillectomy as well or better than does polysomnography.

Author Affiliations: Sleep Disorders Center, Department of Neurology (Drs Chervin and Ruzicka), Division of Pediatric Otolaryngology, Department of Otolaryngology (Dr Garetz), Neuropsychology Section, Department of Psychiatry (Drs Giordani and Hodges), Division of Child and Adolescent Psychiatry, Department of Psychiatry (Dr Dillon), and Department of Biostatistics, School of Public Health (Mr Guire), University of Michigan, Ann Arbor; and Division of Pediatric Otolaryngology, Department of Otolaryngology, University of Kansas, Kansas City (Dr Weatherly).