Translation and cross-cultural adaptation of the Pediatric Sleep Questionnaire into Portuguese language

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Abstract

Objective

The need for culturally appropriate and linguistically accessible instruments for assessing sleep quality among children has expanded. The Pediatric Sleep Questionnaire (PSQ) is a validated tool for sleep disordered breathing among children. Our aim was to cross-culturally translate and adapt the PSQ into Portuguese language for use in clinical and research settings.

Methods

The PSQ was translated into Portuguese language in accordance with the stages recommended by International Guidelines and reviewed by a panel of experts. The caregivers of 180 children (aged from 4 to 12 years) answered the Portuguese version of PSQ. The reliability of the translated questionnaire was measured by Cronbach α, Pearson correlation and Kappa statistics.

Results

Reliability analysis yielded an overall Cronbach α of 0.781, confirming the survey's consistency. The Cronbach α of the Portuguese PSQ domains ranged between 0.61 and 0.7. Test–retest reliability for all items was robust with correctness of >90.0% in all items, and the Kappa statistic ranged between 0.5 and 0.8.

Conclusion

The Portuguese version of PSQ has sufficient reliability and validity to measure sleep disordered breathing outcomes, and showed to be linguistically accurate and acceptable for use by children in Portugal.

Introduction

Sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) syndrome, is acknowledged to be a cause of morbidity in children. Clinical symptoms of OSA among children include snoring, nocturnal arousals, restlessness during sleep, enuresis, daytime sleepiness, and hyperactivity [1], [2]. As a result of increasing international collaboration in sleep research, the need for culturally appropriate and linguistically accessible instruments for assessing sleep quality among children has expanded [3]. This is particularly true in Portugal, where there are very few of such instruments available. Having these validated tools is very important when evaluating specific sleep treatment outcomes across different countries. Specifically, both methods used by patients and caregivers to describe sleep problems and the assessment of the effects of treatment must be comparable, irrespective of patients’ language and cultural background. Recognizing these needs, the International Paediatric Sleep Education Task Force concluded that testing methodologies and culturally sensitive epidemiologic tools are key components of cross-cultural sleep research [4].

Despite a recent meta-analysis [5] suggesting that clinical evaluations have poor diagnostic accuracy, especially in regard to OSA, this does not mean that they should not be performed. As a result of a lack of paediatric sleep laboratories, sleep history is frequently the only instrument available to clinicians, especially in Portugal. Thus, sleep history should, and must, be part of routine health care visits as an initial screening tool for children at risk of OSA.

Based on this meta-analysis, the Sleep-Related Breathing Disorder scale within the Pediatric Sleep Questionnaire (PSQ) appears to be the only instrument validated by full overnight polysomnography (PSG) [6]. Furthermore, using the same gold standard, the PSQ was also tested by Spronson et al. [7] in the UK. Thus, it is the most reliable questionnaire for sleep apnea screening.

The purpose of the current study was to evaluate a translation of the PSQ in children in Portugal by checking the accuracy of the translation, assessing its content validity, and determining whether or not it could be clearly understood when piloted in a sample of children.

Section snippets

The Pediatric Sleep Questionnaire

The validated PSQ has 22 items documenting the presence or absence of common symptoms such as snoring, observed apneas, breathing difficulty during sleep, daytime sleepiness, and inattentive or hyperactive behaviour. Positive responses are scored as 1 and negative responses as 0. Then, the overall score is divided by 22 to provide a final value. Compared with overnight PSG, the PSQ has been reported to have a sensitivity of between 0.81 and 0.85 and a specificity of 0.87 in detecting OSA. A

Results

The sample consisted of 180 Caucasian children, including 99 males (55%) and 81 females (45%), with a mean age of 5.5 ± 2.0 years (4–12 years). Based on Graffar's socioeconomic classifications [10], 5 children belonged to Class I (3%), 9 to Class II (5%), 117 to Class III (65%), 45 to Class IV (25%) and 4 to Class V (2%). Eighteen caregivers (10%) graduated from university, 11 (6%) graduated from high school or two-year degree programmes, 45 (25%) did not complete high school or two-year degree

Discussion

With the increase in the number of international research projects, the need to adapt health status measures for use in languages other than the source language is of primary importance. The objective of this study was to translate the PSQ from English into Portuguese language by following the international translation guidelines.

Currently, PSG is widely considered to be the gold standard in diagnosing childhood SDB. However, PSG is very expensive, time consuming and not easy to carry out on

Conclusion

In conclusion, the translation of the PSQ was shown to be linguistically accurate and acceptable for use by children in Portugal. This Portuguese version of the PSQ is easy to understand, quickly completed, and will potentially be of interest to the Portuguese medical community.

Conflict of interest

None.

Funding

None.

References (10)

There are more references available in the full text version of this article.

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