International Journal of Pediatric Otorhinolaryngology
Translation and cross-cultural adaptation of the Pediatric Sleep Questionnaire into Portuguese language
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)
- et al.
Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems
Sleep Med.
(2000) Clinical and therapeutic aspects of obstructive sleep apnea syndrome in infants and children
Sleep
(1992)- et al.
Clinical assessment of pediatric obstructive sleep apnea
Pediatrics
(2004) - et al.
Applying principles of good practice for translation and cross-cultural adaptation of sleep-screening instruments in children
Behav. Sleep Med.
(2010) - et al.
Issues in the development of cross-cultural assessments of speech and language for children
Int. J. Lang. Commun. Disord.
(2005)
Cited by (31)
Translation and validation of the Arabic version of the sleep-related breathing disorder scale of the pediatric sleep questionnaire (PSQ-SRBD)
2023, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryTranslation and cross-cultural adaptation of the pediatric sleep questionnaire (PSQ*) into Brazilian Portuguese
2022, Brazilian Journal of OtorhinolaryngologyCitation Excerpt :This demonstrates that children with PSQ values up to 9 have a low probability of having OSA. Also noteworthy is the high reliability of the Brazilian version of the questionnaire, evidenced by the Cronbach's alpha value of 0.86, corroborating the findings of the original version and other versions, such as the French and Portuguese versions.15,16,18 Regarding the test stability, the subdomains showed almost perfect reliability, with ICC values of 0.89 for the Snoring subdomain; 0.93 for Drowsiness; and 0.86 for Behavior.
Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020)
2021, World Journal of Otorhinolaryngology - Head and Neck SurgeryCitation Excerpt :In terms of the questionnaires that have been scientifically validated and widely used in China, this recommendation mainly advocates the use of two questionnaires, PSQ and OSA-18. The PSQ has been translated into Portuguese,35 Spanish,36 Chinese,37,38 and other versions; its reliability and validity have been confirmed. As a current approach to investigate the quality of life in children with OSA, the OSA-18 has been widely used; this questionnaire covers five dimensions (18 items): sleep disorder, physical symptoms, emotional distress, daytime conditions, and the degree of influence on guardians.