Systematic investigation of childhood sleep-disordered breathing (SDB) in Beijing: validation of survey methodology

Abstract

ObjectiveTo systematically investigate and validate the survey methodology for the epidemiological study of childhood sleep-disordered breathing (SDB) in mainland China using the Mandarin version of the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder (PSQ-SRBD).DesignA cross-sectional study using randomised, stratified, multistage, cluster sampling method.SettingA total of 11 kindergartens, 7 primary schools and 8 middle schools from 7 districts of Beijing, China.ParticipantsA total of 9198 children with valid questionnaires (4736 boys and 4462 girls; age range 3.0–14.4 years) were included.Primary and secondary outcome measuresData on sociodemographic characteristics and PSQ-SRBD were collected. The score on PSQ-SRBD and the included factors were calculated with the effective data after data cleaning. Logistic regression and factor analysis with the principal components method were used to evaluate the validity of the questionnaire; reliability was assessed by retesting 5% of the respondents after 2±4 weeks of the initial test, and the intraclass correlation coefficient was calculated.ResultsThe effective response rate of80.54% matched the sociodemographic characteristics of the respondents with respect to age group ratio and sex ratio in Beijing. With regard to construct validity of the PSQ-SRBD, the item score, except that of ‘delayed growth’, was highly correlated to the SRBD score as assessed by the logistic regression model. The exploratory factor analysis displayed a credible construct validity, with majority of the items grouped as the original dimensions. The test–retest reliability coefficient of each dimension’s score ranged from 0.758 to 0.901, with an SRBD score of 0.730 indicating significant retest reliability.ConclusionsThis study conducted and validated a successful survey methodology for investigation of childhood SDB in Beijing, China. The questionnaire demonstrated credible construct validity and retest reliability, thereby supporting the applicability and generalisability of the PSQ-SRBD in a large epidemiological survey of childhood SDB in China.

Relationship between Poorly Controlled Asthma and Sleep-Related Breathing Disorders in Children with Asthma: A Two-Center Study

“…The PSQ was used to assess the scale of SRBD. The PSQ identifies children with SRBD with a sensitivity of 83% and a specificity of 87%; its applicability and generalizability in assessing childhood SRBD in China has been confirmed [ 24 ]. This multipage questionnaire consists of 22 questions on snoring, sleepiness, and behavioral problems and has been used frequently for sleep-associated respiratory research studies [ 15 , 16 , 24 – 31 ].…”

“…The PSQ identifies children with SRBD with a sensitivity of 83% and a specificity of 87%; its applicability and generalizability in assessing childhood SRBD in China has been confirmed [ 24 ]. This multipage questionnaire consists of 22 questions on snoring, sleepiness, and behavioral problems and has been used frequently for sleep-associated respiratory research studies [ 15 , 16 , 24 – 31 ]. The three possible responses to each question are “yes = 1,” “no = 0,” and “do not know = missing.” The number of symptom items endorsed positively (“yes”) is divided by the number of items answered positively or negatively; the denominator therefore excludes items with missing responses, i.e., items answered with “do not know.” Scores >0.33 are considered positive and suggestive of a high risk of having SRBD.…”

Characteristics and risk factors of children with sleep-disordered breathing in Wuxi, China

“…The Paediatric Sleep Questionnaire (PSQ), developed by Chervin et al [17], has a low cost and a precise cut-off score (> 0.33), and identifies children with OSAS with a sensitivity of 83% and a specificity of 87%. Li et al confirmed that the PSQ was a successful methodology for the investigation of childhood SDB in Beijing, China, thereby supporting the applicability and generalizability of the PSQ in a large epidemiological survey of childhood SDB in China [18].…”

“…The respondents were recruited from 9 kindergartens, 10 primary schools, and 9 middle schools, and encompassed children aged 3-14 years. Base on the sample size of each group and school scale, the selection of the school and each grade among the same educational institutions was based on computer-generated random numbers [18].…”

“…The PSQ is a multi-page questionnaire that consists of closed question-items and several queries on pediatric sleep disorder symptoms. This questionnaire has frequently been used for research [1,11,12,14,16,18,[22][23][24][25]. It comprises 22 questions on snoring, sleepiness, and behavioral problems.…”