Translation and cross-cultural adaptation of the pediatric sleep questionnaire (PSQ*) into Brazilian Portuguese

Martins, Carlos Alexandre Necchi; Deus, Mayara Moreira de; Abile, Isabela Conti; Garcia, Denny Marcos; Anselmo-Lima, Wilma Terezinha; Miura, Carolina Sponchiado; Valera, Fabiana Cardoso Pereira

doi:10.1016/j.bjorl.2021.03.009

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Brazilian Journal of Otorhinolaryngology

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Sumário

Original article • Braz. j. otorhinolaryngol. 88 (Suppl 1) • 2022 • https://doi.org/10.1016/j.bjorl.2021.03.009 copy

Translation and cross-cultural adaptation of the pediatric sleep questionnaire (PSQ*) into Brazilian Portuguese

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

The Pediatric Sleep Questionnaire (PSQ) is a good screening test for OSA, with good sensitivity and specificity when compared to polysomnography in the countries where it has been validated.

The translation and cross-cultural adaptation of the PSQ into Brazilian Portuguese showed high internal consistency, high agreement in the test-retest and high accuracy.

The value of 9.0 was considered ideal to differentiate between patients with OSA and controls, with a sensitivity of 0.92 and specificity of 1.0.

In places with difficult access to polysomnography, the PSQ can be a useful tool in the diagnostic suspicion and follow-up of children with OSA.

Abstract

Introduction

Obstructive sleep apnea is a frequent entity in childhood that can lead to important consequences for the health and children's quality of live. Polysomnography is the gold-standard exam to diagnose obstructive sleep apnea, but it is expensive, complex, and poorly affordable in Brazil. The pediatric sleep questionnaire has shown to be a valuable screening test for obstructive sleep apnea. It is a simple questionnaire with good sensitivity and specificity compared to polysomnography in the countries where it has been validated.

Objective

Translation and cross-cultural adaptation of the pediatric sleep questionnaire (PSQ), into Brazilian Portuguese.

Methods

The translation of the PSQ into Brazilian Portuguese was carried out in accordance with good practices. The validated and adapted questionnaire was applied to parents/caregivers of 60 children (40 of them with obstructive sleep apnea and 20 controls) aged 2-18 years. Retest was applied to 30 children with obstructive sleep apnea. The following tests were performed: internal consistency, test-retest, validation of questionnaire (the latter by ROC curve).

Results

Brazilian PSQ has shown high internal consistency by Cronbach's alpha (0.86 for the total test, 0.83 for subscale “snoring”, 0.64 for “sleepiness” and 0.65 for “behavior”). Test-retest presented a correlation of 0.89 for subscale “snoring”, 0.93 for “sleepiness” and 0.86 for “behavior”. Accuracy by ROC curve was 0.99. Nine was considered the optimal value to discriminate patients with obstructive sleep apnea from controls, with a sensitivity of 0.92 and specificity of 1.0.

Conclusion

The translation and cross-cultural adaptation of the PSQ into Brazilian Portuguese proved to be successful. In places with difficult access to polysomnography, PSQ can be a useful tool in screening and follow-up of children with obstructive sleep apnea.

Keywords
PSQ; Apnea; Children; Obstructive sleep apnea; Questionnaire

PSQ - versão português Brasil	Sim	Não	Não sei
Durante o sono, seu filho:
A1. ronca mais que a metade do tempo	□	□	□
A2. sempre ronca	□	□	□
A3. ronca alto	□	□	□
A4. tem a respiração profunda ou ruidosa	□	□	□
A5. Tem dificuldade em respirar ou se esforça para respirar?	□	□	□
A6. Você alguma vez já viu seu filho (ou filha) parar de respirar durante o sono?	□	□	□
O seu filho (ou filha):
A7. tende a respirar com a boca aberta durante o dia	□	□	□
A8. acorda com a boca seca	□	□	□
A9. Faz xixi na cama de vez em quando	□	□	□

O seu filho (ou filha):
B1. Acorda cansado de manhã?	□	□	□
B2. em problema de sonolência durante o dia?	□	□	□
B3. Algum(a) professor(a) ou outra pessoa já comentou que seu filho parece sonolento durante o dia?	□	□	□
B4. É difícil acordar seu filho de manhã?	□	□	□
B5. Seu filho acorda com dor de cabeça de manhã?	□	□	□
B6. Seu filho parou de crescer normalmente em algum momento desde o nascimento?	□	□	□
B7. Seu filho está acima do peso?	□	□	□

Seu filho com frequência:
C1. Parece não ouvir quando falam diretamente com ele	□	□	□
C2. Tem dificuldade em organizar tarefas e atividades	□	□	□
C3. É facilmente distraído por estímulos alheios	□	□	□
C4. Fica com as mãos ou pés inquietos ou fica agitado quando sentado	□	□	□
C5. Não para quieto ou frequentemente age como se estivesse ligado na tomada	□	□	□
C6. Interrompe as pessoas ou se intromete em conversas ou brincadeiras	□	□	□

Variables	Number of items	Cronbach’s alpha (95% CI)
Subdomain Snorring	9	0.83 (0.76-0.89)
Subdomain Spleepiness	7	0.64 (0.51-0.78)
Subdomain Behaviour	6	0.65 (0.51-0.79)

Total	22	0.86 (0.82-0.91)

Questão	Kappa	95% CI	p-Valor
A1	0.61	0.23-0.99	0.0004
A2	0.92	0.77-1.00	<0.0001
A3	0.71	0.35-1.00	0.0001
A4	0.61	0.20-1.00	0.0010
A5	0.49	0.19-0.80	0.0043
A6	0.65	0.38-0.93	0.0004
A7	0.66	0.31-1.00	0.0003
A8	0.44	0.03-0.85	0.0171
A9	0.78	0.54-1.00	<0.0001

B1	0.69	0.41-0.97	0.0003
B2	0.66	0.39-0.92	0.0003
B3	0.63	0.30-0.95	0.0006
B4	0.78	0.54-1.00	<0.0001
B5	0.56	0.26-0.87	0.0022
B6	0.65	0.02-1.00	0.0002
B7	0.93	0.79-1.00	<0.0001

C1	0.65	0.37-0.93	0.0005
C2	0.59	0.28-0.90	0.0011
C3	0.71	0.33-1.00	0.0001
C4	0.62	0.29-0.96	0.0008
C5	0.66	0.31-1.00	0.0003
C6	0.85	0.65-1.00	<0.0001

Question	ICC	95% CI	p-value
Subdomain Snorring	0.89	0.77-0.95	<0.0001
Subdomain Spleepiness	0.93	0.85-0.97	<0.0001
Subdomain Behaviour	0.86	0.70-0.94	<0.0001

Question	r-Pearson	95% CI	p-Value
A1.	0.75	0.62-0.85	<0.0001
A2.	0.63	0.44-0.76	<0.0001
A3.	0.57	0.37-0.72	<0.0001
A4.	0.79	0.66-0.87	<0.0001
A5.	0.71	0.56-0.82	<0.0001
A6.	0.58	0.38-0.73	<0.0001
A7.	0.44	0.21-0.63	0.0004
A8.	0.41	0.18-0.61	0.0011
A9.	0.25	−0.01-0.47	0.0588^a a Not significant.

B1.	0.51	0.30-0.68	<0.0001
B2.	0.54	0.33-0.70	<0.0001
B3.	0.51	0.29-0.67	<0.0001
B4.	0.34	0.10-0.55	0.0072
B5.	0.52	0.31-0.69	<0.0001
B6.	0.12	−0.13-0.37	0.3441^a a Not significant.
B7.	0.33	0.08-0.55	0.0102

C1.	0.52	0.31-0.69	<0.0001
C2.	0.65	0.48-0.78	<0.0001
C3.	0.57	0.37-0.72	<0.0001
C4.	0.48	0.25-0.65	0.0001
C5.	0.42	0.19-0.61	0.0008
C6.	0.39	0.15-0.59	0.0020

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
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[1] Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Crvico-Facial.