Review of Sleep Questionnaires in Children with Down Syndrome

Introduction: Despite the high prevalence of obstructive sleep apnea (OSA) in children with Down syndrome (DS), very few subjective pediatric assessments have been evaluated in this population. The Sleep-Related Breathing Disorder subscale of the Pediatric Sleep Questionnaire (SRBD-PSQ) and Obstructive Sleep Apnea-18 Quality-of-Life Questionnaire (OSA-18) are two sleep-related questionnaires previously validated for the general pediatric population. Our aim was to assess the performance of these questionnaires in our DS population. Methods: We performed a retrospective case series of patients with DS, ages 2-18 years, seen in our tertiary care DS clinic between May 1, 2009 and October 1, 2018. We included those who returned complete sleep questionnaires and had polysomnography testing within the same year. Patients were excluded for history of OSA or lack of questionnaire data. A Student’s t-test was used to compare mean SRBD-PSQ total score to published norms. Spearman correlation coefficients were calculated between obstructive apnea-hypopnea index (oAHI) and SRBD-PSQ or OSA-18 total scores, as well as domain scores. Results: SRBD-PSQ (N = 50) and OSA-18 (N = 36) average total scores were 0.46 ± 0.20 and 55.47 ± 22.9, respectively. OSA-18 total score was better correlated with oAHI (rs= 0.46, p < 0.05) than SRBD-PSQ (rs = 0.23, p > 0.05). Questionnaire scores seemed to be most strongly, positively correlated with oAHI in adolescents and negatively correlated in children. Conclusion: The SRBD-PSQ and OSA-18 demonstrated weak to moderate correlations with oAHI, but scores within domains of each questionnaire showed varying strengths of correlation with polysomnography. Further study is needed to better define how these questionnaires should be used and interpreted in the DS population.