Diagnostic Properties Modi(cid:976)ied OSA-18 Questionnaire in
Children with Severe Obstructive Sleep Apnea
Panchanok Kaewkul MD1, Wish Banhiran MD1, Kitirat Ungkanont MD1, Archwin Tanphaichitr MD1,
Cheerasook Chongkolwatana MD1, Vannipa Vathanophas MD1
Affiliation :
1 Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To determine the diagnostic properties of OSA-18 and its modi(cid:976)ied version for detection of severe obstructive sleep
apnea [OSA] in snoring children.
Materials and Methods : The present cross-sectional study was conducted in 123 patients (82 boys and 41 girls), aged younger than
12 years, who had snoring problems and performed polysomnography [PSG] at Siriraj Hospital. Those with incomplete questionnaires
and inadequate PSG data were excluded. The patients were divided into two groups, non-severe OSA (apnea-hypopnea index [AHI]
lower than 10) and severe OSA (AHI of 10 and above). The scores of OSA-18 questionnaires were compared between the two
groups. Five most important questions (one from each domain) were selected to develop a modi(cid:976)ied shorter version of OSA-18.
Results : There was no statistically signi(cid:976)icant difference in total scores of OSA-18 between severe OSA and non-severe OSA groups.
The optimal cut-off score (65) was selected from receiver operating characteristic [ROC]. The original OSA-18 had the speci(cid:976)icity of
76%, the sensitivity of 40%, positive predictive value [PPV] of 40%, negative predictive value [NPV] of 76%, accuracy of 66%, and
area under the curve [AUC] of 0.59. Meanwhile, at the optimal cut-off score (21), the modi(cid:976)ied OSA-18 had the speci(cid:976)icity of 92%,
the sensitivity of 34.3%, PPV of 63.2%, NPV of 77.9%, the accuracy of 76%, and AUC of 0.67, which was better than its original.
Conclusion : The modi(cid:976)ied shorter version of OSA-18 questionnaire with the optimal cut-off score of 21 is more useful, based on
its high speci(cid:976)icity, to enable physicians to quickly identify patients who require urgent treatment. Nevertheless, further studies of
this newer version in different populations is recommended.
Keywords : OSA-18, Children, Screening, Severe obstructive sleep apnea
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