In which pediatric populations has the Pediatric Sleep Questionnaire (PSQ) been validated?

Pediatric Sleep Questionnaire Validation Populations

Primary Validated Population

The Pediatric Sleep Questionnaire (PSQ) has been primarily validated in general pediatric populations of children aged 2 to 18 years with suspected obstructive sleep apnea, but demonstrates significantly reduced accuracy in children with craniofacial anomalies and syndrome-associated conditions. 1, 2

Specific Populations Where PSQ Has Been Studied

General Pediatric Population

• The PSQ has been validated in clinical and community children aged 2.9 to 16.7 years across 39 studies involving 6,131 children 2
• In general pediatric populations, the PSQ demonstrates 74% sensitivity for detecting mild OSA and 82% sensitivity for moderate OSA 2
• The sleep-related breathing disorders (SRBD) subscale has been evaluated in children aged 0-18 years referred for polysomnography 3

Children with Juvenile Idiopathic Arthritis (JIA)

• The PSQ has been validated in 6- to 11-year-old children with JIA, showing 86% sensitivity and 28% specificity when compared against polysomnography OAHI ≥1.5 4
• In this population, children meeting both PSQ criteria and polysomnography criteria for OSA had the most impaired quality of life and greater fatigue 4

Children with Craniofacial Anomalies (Limited Validation)

• The PSQ performs poorly in children with craniofacial anomalies, showing only 70% sensitivity and 40% specificity for detecting AHI ≥5 1
• In children with non-syndromic palatal clefting, performance improves to 100% sensitivity and 50% specificity 1
• In children with syndrome-associated or chromosomal craniofacial conditions, the PSQ demonstrates markedly reduced accuracy with only 65% sensitivity and 31% specificity 1
• The mean age of children with craniofacial anomalies studied was 9.6 ± 4.0 years 1

Age-Specific Considerations

• The PSQ has been studied across a wide age range from 2 to 18 years 1, 2, 3
• Age significantly moderates the sensitivity and specificity of the PSQ 2
• The questionnaire's performance varies by age group, with demographic data (age and gender) improving classification accuracy 3

Populations Where PSQ Has NOT Been Validated

Pediatric Populations Lacking Validation

• Children under 2 years of age have not been adequately studied with the PSQ 1, 2
• Children with neurodevelopmental disorders lack specific validation studies 5
• Infants younger than 1 year fall outside standard pediatric OSA screening guidelines 6

Important Clinical Caveats

• The PSQ was not designed to predict OSA severity in children already referred for polysomnography; it functions as a screening tool in community or primary care settings 3
• The snoring subscale of the PSQ shows better predictive value (AUC 64-67%) than the full SRBD scale when used in children referred for sleep studies 3
• Gender significantly moderates the PSQ's sensitivity and specificity 2
• Sample size and methodology quality of validation studies significantly affect reported accuracy 2

Comparative Performance

• When polysomnography is unavailable, combined use of PSQ with pulse oximetry is recommended, as pulse oximetry provides superior specificity (86% for mild OSA, 75% for moderate, 83% for severe) compared to PSQ alone 2
• The PSQ exhibits higher sensitivity than pulse oximetry for mild OSA (74% vs lower), but pulse oximetry demonstrates better specificity across all severity levels 2

Critical Limitations in Special Populations

• Given the high prevalence of OSA in children with craniofacial anomalies (40% with AHI ≥5) and the PSQ's poor performance in this group, a craniofacial-specific validated screening tool is needed 1
• 44% of children with craniofacial anomalies in validation studies had already undergone adenotonsillectomy, yet still had a mean obstructive AHI of 10.1 ± 22.7, highlighting the complexity of OSA in this population 1
• No correlation was detected between PSQ score and AHI severity in children with craniofacial anomalies (p = 0.25) 1