Pediatric Sleep Questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems

Objective: To develop and validate questionnaire scales that can be used in research to investigate the presence of childhood SRBDs and prominent symptom complexes, including snoring, daytime sleepiness, and related behavioral disturbances. Background: Obstructive sleep-related breathing disorders (SRBDs) are common but usually undiagnosed among children. Methods to help identify SRBDs without the expense of polysomnography could greatly facilitate clinical and epidemiological research. Methods: Subjects were children aged 2-18 years who had polysomnographically-confirmed SRBDs (n = 54) or appointments at either of two general pediatrics clinics (n = 108). Parents completed a Pediatric Sleep Questionnaire which contained items under consideration for inclusion in desired scales. Results: Item reduction, based on data from a randomly selected 50% of the subjects (group A), produced a 22-item SRBD score that was strongly associated with diagnosis of an SRBD (P < 0.0001) in a logistic regression model that accounted for age and gender. Diagnosis was also strongly associated with subscores for snoring (four items, P < 0.0001), sleepiness (four items, P = 0.0003), and behavior (six items, P < 0.0001) among group A subjects. The scales performed similarly well among group B subjects, and among subjects of different ages and gender. In group A and B subjects, respectively, a selected criterion SRBD score produced a sensitivity of 0.85 and 0.81; a specificity of 0.87 and 0.87; and a correct classification for 86 and 85% of subjects. The scales showed good internal consistency and, in a separate sample (n = 21), good test-retest stability. Conclusions: These scales for childhood SRBDs, snoring, sleepiness, and behavior are valid and reliable instruments that can be used to identify SRBDs or associated symptom-constructs in clinical research when polysomnography is not feasible. (C) 2000 Elsevier Science B. V. All rights reserved.