Evaluation of Sleep-Disordered Breathing in Children

Abstract

OBJECTIVE: We evaluated changes in disease-specific quality of life (QOL) for children with sleep-disordered breathing (SDB). PATIENTS, DESIGN, AND SETTING: We conducted a cohort study in 69 children (age range, 6 months to 13 years; median age, 6.1 years) from a hospital-based pediatric otolaryngology practice in a metropolitan area. We used the OSA-18, an 18-item QOL survey with known test-retest reliability, internal consistency, and construct validity. Survey domains included sleep disturbance, physical suffering, emotional distress, daytime problems, and caregiver concerns. INTERVENTION: Tonsillectomy or adenoidectomy was performed as part of routine clinical care. The OSA-18 was completed at entry by the child's caregiver and again at least 4 weeks after surgery. MAIN OUTCOME MEASURES: The validity of the OSA-18 change score was assessed by comparison with multiple external constructs, including a validated measure of longitudinal change (OSD-6 survey). Responsiveness was assessed by the standardized response mean (SRM). RESULTS: The mean baseline OSA-18 survey score was 3.1 (SD, 0.9) of a maximum 7.0, with higher values indicating poorer QOL. Change scores were available for all children, with a mean interval between preoperative and postoperative surveys of 61 days (range, 42 to 92 days). The mean OSA-18 change score of 1.14 (SD, 0.71) showed significant correlation with tonsil size ( r = 0.40), adenoid size ( r = 0.31), OSD-6 change scores ( r = 0.71), and the direct caregiver estimates of change ( r = 0.34). OSA-18 change scores showed large responsiveness to change (SRM 1.44; 95% confidence interval, 1.16 to 69), with the most responsive domains being sleep disturbance, physical suffering, and care-giver concerns. Significant responsiveness was also demonstrated for the domains of daytime problems and emotional distress. CONCLUSIONS: The OSA-18 is a valid, reliable, and responsive QOL measure that combines the advantages of a discriminative and evaluative survey in a single instrument. The OSA-18 is a useful measure of patient-based outcomes for clinical trials, health services research, and routine clinical care.