title: The efficacy of the OSA-18 as a waiting list triage tool for OSA in children.
abstract: OBJECTIVE
  Sleep disordered breathing (SDB) is common in children, resulting in extensive waiting lists for specialist clinics. There is an urgent need for a valid method of triaging patients and the OSA-18, a disease-specific tool, is an attractive candidate for this role. We aimed to examine the OSA-18 as a measurement tool in detail and to determine whether the score or aspects of it could be used as a screening tool for SDB in children.
  
  
  METHODS
  Retrospective analysis of 582 children (6 months to 16.4 years)-216 underwent overnight PSG and 366 overnight oximetry. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were conducted. Receiver operating characteristic curve analysis assessed the diagnostic accuracy of the factors for the presence of OSA. Rasch analysis was used to assess the structure of the items (1-18) and categories of response (Likert scale).
  
  
  RESULTS
  The CFA with a forced five-factor structure, revealed three factors with Eigenvalues >1, and explained 73.7 % of the variance. EFA resulted in a two-factor structure, explaining 60.3 % of the variance. Assessment of sensitivity and specificity showed a high false-positive rate, irrespective of the factor structure tested. Rasch analysis showed poor discrimination between adjacent categories on the Likert scale.
  
  
  CONCLUSIONS
  This study confirmed that the predictive value of the OSA-18 for SDB severity is weak. Some questions perform better than others statistically, and the seven categories of response introduce significant statistical noise, raising the possibility that modification of the OSA-18 may improve its performance in the prediction of OSA severity.
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research Melbourne, Level 5 Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia. lisa.walter@hudson.org.au.|Department of Paediatrics, Monash University, Melbourne, Australia. lisa.walter@hudson.org.au.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Walter
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research Melbourne, Level 5 Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia.|Department of Paediatrics, Monash University, Melbourne, Australia.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Biggs
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research Melbourne, Level 5 Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia.
authors.forename: Natascha
authors.initials: N
authors.lastname: Cikor
authors.affiliation: Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia.|Department of General Medicine, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Kathy
authors.initials: K
authors.lastname: Rowe
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research Melbourne, Level 5 Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia.|Department of Paediatrics, Monash University, Melbourne, Australia.|Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia.
authors.forename: Margot J
authors.initials: MJ
authors.lastname: Davey
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research Melbourne, Level 5 Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia.|Department of Paediatrics, Monash University, Melbourne, Australia.
authors.forename: Rosemary S C
authors.initials: RS
authors.lastname: Horne
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research Melbourne, Level 5 Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia.|Department of Paediatrics, Monash University, Melbourne, Australia.|Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia.
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Nixon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017286:Polysomnography; D011594:Psychometrics / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000145:classification / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D014218:Triage / Q000379:methods*; D014850:Waiting Lists
keywords: Obstructive sleep apnea; Pediatric; Quality of life