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Utility of Screening for Obstructive Sleep Apnea Syndrome in Children with Craniofacial Disorders

Cielo, Christopher M. D.O.; Silvestre, Jason B.S.; Paliga, J. Thomas B.A.; Maguire, Meg C.P.N.P.; Gallagher, Paul R. M.A.; Marcus, Carole L. M.B.B.Ch.; Taylor, Jesse A. M.D.

Plastic and Reconstructive Surgery: September 2014 - Volume 134 - Issue 3 - p 434e–441e
doi: 10.1097/PRS.0000000000000484
Pediatric/Craniofacial: Original Articles
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Background: Children with craniofacial disorders are at increased risk for obstructive sleep apnea syndrome. Methods for diagnosing obstructive sleep apnea syndrome in this population remain controversial. Sleep studies are the criterion standard but are impractical for all patients. The utility of obstructive sleep apnea syndrome questionnaires such as the Pediatric Sleep Questionnaire is unknown in children with craniofacial disorders. The authors hypothesized that the Pediatric Sleep Questionnaire would be a sensitive tool for detecting obstructive sleep apnea syndrome in children with craniofacial abnormalities.

Methods: A retrospective review of consecutive children with diagnosed craniofacial disorders who both completed the Pediatric Sleep Questionnaire and underwent polysomnography was performed. Demographics, Pediatric Sleep Questionnaire score, and polysomnographic data were recorded. Statistical analysis included calculation of sensitivity, specificity, positive predictive value, and negative predictive value for the Pediatric Sleep Questionnaire.

Results: Eighty-three children aged 2 to 18 years were included in the study. Of these, 44 (53.0 percent) screened positive on the Pediatric Sleep Questionnaire and 23 (27.7 percent) had polysomnographic evidence of obstructive sleep apnea syndrome, but the sensitivity of the Pediatric Sleep Questionnaire for detecting obstructive sleep apnea syndrome in this sample was only 0.57 and the specificity was 0.48. Positive predictive value and negative predictive value were 0.30 and 0.74, respectively. The correlation between the apnea hypopnea index and Pediatric Sleep Questionnaire score was 0.152 (p = 0.17).

Conclusions: A substantial portion of craniofacial patients referred for polysomnography was found to have obstructive sleep apnea syndrome. However, the Pediatric Sleep Questionnaire is not a good screening tool for obstructive sleep apnea syndrome in children with craniofacial conditions. More research is needed to determine which patients with craniofacial disorders should be evaluated for obstructive sleep apnea syndrome by polysomnography or other means.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

Supplemental Digital Content is available in the text.

Philadelphia, Pa.

From the Divisions of Pulmonary Medicine and Plastic and Reconstructive Surgery, the Clinical and Translational Research Center, and the Sleep Center, The Children’s Hospital of Philadelphia; and the Perelman School of Medicine at the University of Pennsylvania.

Received for publication November 18, 2013; accepted January 9, 2014.

Preliminary data from this study were presented in poster presentation format at the American Thoracic Society 2013 International Conference, in Philadelphia, Pennsylvania, May 17 through 22, 2013.

Disclosures: The authors have no financial interest to declare in relation to the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s Web site (www.PRSJournal.com).

Jesse A Taylor, M.D., Colket Translational Research Building, Ninth Floor, 3501 Civic Center Boulevard, Philadelphia, Pa. 19104, jataylor@gmail.com

©2014American Society of Plastic Surgeons