简体中文版儿童睡眠问卷应用于北京地区阻塞性睡眠呼吸暂停综合征儿童筛查的信度和效度评估

摘要

Objective To evaluate the validity and reliability of the simplified Chinese version of pediatric sleep questionnaire (PSQ) used in screening obstructive sleep apnea syndrome (OSAS) of children in Beijing.Methods Children with snoring who presented to the Sleep Center of Beijing Childreng Hospital between August 2014 and July 2015 and healthy children were included in the study.All children underwent PSG and then were divided into OSAS group and control group based on the PSG and their guardians were asked to complete the simplified Chinese version of PSQ that was formed by both translation from PSQ and retroversion to PSQ.Structure validity evaluation included confirmatory factor analysis which used Amos structural equation model and exploratory factor analysis which used principal component analysis.Predictive validity were measured with Logistic regression model.Internal reliability and test-retest reliability were evaluated by Cronbach's alpha coefficient and intra-class correlation coefficient (ICC),respectively.The screening efficiency was evaluated by the receiver operating characteristic curve (ROC).Results The study included 235 children aged 3-16 years old,145 children of them with the age of (5.8 ± 2.1) in OSAS group and 90 children with the age of (7.7 ± 3.3) in control group.Confirmatory factor analysis indicated most items belonging to individual factors with load coefficient ≥ 0.5.Predictive validity analysis revealed 13 items positively related to the diagnosis of OSAS (all OR ＞ 1,all P ＜ 0.05).Cronbach's alpha coefficients were respectively 0.703 (overall reliability),0.767 (breathing factor),0.849 (sleepiness factor) and 0.689 (behavior factor).The test-retest ICC reliability was 0.986 (PSQ),0.991 (breathing factor),0.727 (sleepiness factor),and 0.870 (behavior factor) with P ＜ 0.05.In receiver operating characteristic curve,the area under curve of simplified Chinese version PSQ score was 0.922 with P ＜ 0.05 and the cutoff value of PSQ score was 7 in 22 items with the sensitivity of 0.776,specificity of 0.867,positive predictive value of 0.868 and negative prediction value of 0.774.Conclusions The simplified Chinese version of PSQ is suitable to the screen of OSAS for the children in Beijing area with good reliability and validity.It also has acceptable sensitivity and specificity for screening children with OSAS when the cutoff score is 7 points.%目的 评价简体中文版儿童睡眠问卷(pediatric sleep questionnaire,PSQ)应用于北京地区儿童的效度和信度,并考察其对儿童阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)的临床筛查能力.方法 收集于2014年8月至2015年7月就诊于北京儿童医院睡眠中心的打鼾儿童及社区健康儿童,经多道睡眠监测后分别连续纳入OSAS组和对照组;以原版PSQ问卷为源问卷,经翻译-回译形成简体中文版PSQ,由其监护人完成纸质问卷调查.结构效度评价用Amos结构方程模型进行验证性因子分析,用主成分分析方法进行探索性因子分析;预测效度用Logistic回归模型进行分析;内在信度计算克朗巴赫系数,重测信度计算内部相关系数(intra-class correlation coefficient,ICC);问卷的筛查能力通过受试者工作特征曲线(receiver operating characteristic curve,ROC 曲线)评价.结果 本研究共纳入3 ～ 16岁儿童235例,其中OSAS组145例,年龄(5.8±2.1)岁(x±s,下同),对照组90例,年龄(7.7±3.3)岁.结构效度评价中,多数题项对所在因子的载荷系数≥0.5;预测效度评价提示13个题项与OSAS的临床诊断有正相关关系(OR值均＞1,P值均＜0.05);组内信度评价中,各因子克朗巴赫系数分别为0.703(总体信度)、0.767(Breathing因子)、0.849(Sleepiness因子)、0.689(Behavior因子);各因子ICC分别为0.986(总问卷)、0.991(Breathing 因子)、0.727(Sleepiness因子)、0.870(Behavior因子).ROC曲线中问卷总评分的曲线下面积(area under curve,AUC)为0.922,敏感性、特异性、阳性预测值和阴性预测值分别为0.776、0.867、0.868、0.774;问卷总评分AUC临界值为0.296,即临床评分7分(满分22分).结论简体中文版PSQ可作为实用的儿童OSAS临床筛查工具,其信度和效度均在满意水平,以问卷中7个及以上阳性症状为儿童OSAS的筛查标准,有较好的敏感性及特异性.