Utility of Screening for Obstructive Sleep Apnea with the Pediatric Sleep Questionnaire (PSQ) in Children with Craniofacial Anomalies

Objective To determine the accuracy of the Pediatric Sleep Questionnaire (PSQ) as a screening tool for obstructive sleep apnea in children with craniofacial anomalies. Design Retrospective cohort study. Setting Multidisciplinary cleft and craniofacial clinic at a tertiary care center. Patients Children with craniofacial anomalies 2 to <= 18 years of age who both completed a PSQ screen and underwent polysomnography (PSG) without interval surgery. Main outcome measures Sensitivity and specificity of the PSQ in detecting an obstructive apnea-hypopnea index (AHI) >= 5 events/hour. Results Fifty children met study criteria, with 66% (n = 33) having an associated syndrome. Mean patient age at time of PSQ was 9.6 + 4.0 years. Overall, 33 (64%) screened positive on the PSQ, while 20 (40%) had an AHI >= 5. The sensitivity and specificity for identifying AHI >= 5 was 70% and 40%, respectively. With subgroup analysis, the sensitivity and specificity were higher (100% and 50%) in children with non-syndromic palatal clefting but lower (65% and 31%) in children with a syndrome or chromosomal anomaly. There was no correlation detected between PSQ score and AHI severity (p = 0.25). The mean obstructive AHI in the study population was 10.1 +/- 22.7 despite 44% (n = 22) undergoing prior adenotonsillectomy. Conclusions The PSQ was less sensitive and specific in detecting an AHI >= 5 in children with craniofacial anomalies than in a general population, and particularly poor in for children with syndrome-associated craniofacial conditions. Given the high prevalence of OSA in this patient population, a craniofacial-specific validated screening tool would be beneficial.