Health outcome measurements in children with sleep disordered breathing

Readability analysis of pediatric otolaryngology patient-reported outcome measures

OBJECTIVE

(s): Patient-reported outcome measures (PROMs) are tools that allow patients to directly share information about their health with their healthcare provider. Health literacy experts recommend that health information, such as PROMs, be written at a 6th grade level to ensure patients can read and comprehend it. As the readability of PROMs used in pediatric otolaryngology has yet to be studied, our goal was to analyze the readability of these PROMs and assess their compliance with readability recommendations.

METHODS

The Gunning Fog, the Simple Measure of Gobbledygook (SMOG), and the FORCAST readability formulas were used to determine the readability of disease-specific PROMs for pediatric otolaryngology.

RESULTS

Fourteen PROMs were reviewed in the study. Most were intended for caregiver completion (n = 13, 92.9%). Ten PROMs when measured by Gunning Fog (71.4%), 2 PROMs when measured by SMOG (14.3%), and 0 PROMs when measured by FORCAST (0.0%) were at or below the 6th grade reading level.

CONCLUSION

Most PROMs available for use in pediatric otolaryngology are above the recommended 6th grade reading level when measured by FORCAST, the most appropriate metric for assessing questionnaires. The high reading grade level needed to complete these PROMs can contribute to health disparities among underserved and vulnerable populations, such as children. Pediatric otolaryngology PROMs developed in the future should take readability into account in order to ensure equity in the delivery of care.

Structured literature review of patient-reported outcome (PRO) instruments in adult tonsillectomy or tonsillotomy

BACKGROUND

Instruments that measure the patient-reported outcome and quality of life are essential to assess the treatment success of any medical intervention. This review represents valid and reliable outcome assessment instruments for tonsillectomy (TE) and tonsillotomy (TO) in adult patients as TE/TO still belong to one of the most common performed surgical procedures.

METHODS

A systematic review of the literature in the MEDLINE, PubMed, Web of Science and Cochrane Library was conducted. Studies describing reliable and valid patient-reported outcome measures (PROM) in adults with regard to the perioperative as well as postoperative follow-up after TE/TO were examined. Thus, studies without PROMs or PROMs only relating to children as well as studies in non-English/non-German language or without any detailed information were excluded.

RESULTS

Four thousand four hundred forty studies were identified. Thirteen reliable and valid patient-reported outcome assessment instruments presenting the perioperative and postoperative outcome were analysed. Four generic questionnaires are included that are used to measure the outcome after TE/TO in adults. Four disease-specific questionnaires relating to obstructive sleep apnea (OSA) and sleep disordered breathing (SDB) as well as two TE/TO specific questionnaires are validated for adults. With regard to the perioperative outcome including parameters like pain, nausea, vomiting, satisfaction three assessment instruments are analysed.

CONCLUSION

This review describes the currently available, reliable and valid generic and disease-specific instruments assessing the perioperative as well as postoperative outcome to evaluate the treatment success after TE/TO in adult patients. Therefore, this study improves the selection of the appropriate patient-reported outcome assessment instrument to assess the quality of life in adults undergoing TE/TO.

A systematic review of patient-reported outcome measures in paediatric otolaryngology

BACKGROUND

Recently, there has been increased emphasis on the development and application of patient-reported outcome measures. This drive to assess the impact of illness or interventions, from the patient's perspective, has resulted in a greater number of available questionnaires. The importance of selecting an appropriate patient-reported outcome measure is specifically emphasised in the paediatric population. The literature on patient-reported outcome measures used in paediatric otolaryngology was reviewed.

METHODS

A comprehensive literature search was conducted using the databases Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo, using the terms: 'health assessment questionnaire', 'structured questionnaire', 'questionnaire', 'patient reported outcome measures', 'PROM', 'quality of life' or 'survey', and 'children' or 'otolaryngology'. The search was limited to English-language articles published between 1996 and 2016.

RESULTS

The search yielded 656 articles, of which 63 were considered relevant. This included general paediatric patient-reported outcome measures applied to otolaryngology, and paediatric otolaryngology disease-specific patient-reported outcome measures.

CONCLUSION

A large collection of patient-reported outcome measures are described in the paediatric otolaryngology literature. Greater standardisation of the patient-reported outcome measures used in paediatric otolaryngology would assist in pooling of data and increase the validation of tools used.

Sleep disordered breathing in early childhood: quality of life for children and families

OBJECTIVES

To characterize health-related quality of life (QOL) in preschool children with sleep disordered breathing (SDB) and their families compared with nonsnoring control patients in the community. It was hypothesized that children with SDB and their families would have poorer QOL than control children, that a relationship would be found between SDB severity and QOL, and that even children with mild SDB and their families would have reduced QOL.

PARTICIPANTS AND METHODS

A clinical sample of preschool children (3-5 y) with SDB diagnosed by gold standard polysomnography (primary snoring, PS = 56, mild obstructive sleep apnea, OSA = 35, moderate/severe OSA = 24) and control children recruited from the community (n = 38) were studied. Parents completed health-related QOL and parenting stress questionnaires.

RESULTS

Children and families in the PS and mild OSA groups had consistently poorer QOL than control children (both P < 0.05-0.001), based on parent ratings, and parents of children with PS had elevated stress ratings relative to control children (P < 0.05-0.001). The moderate/severe OSA group differed from the control group on select measures of parent and family QOL (worry, P < 0.001 and total family impact, P < 0.05).

CONCLUSIONS

Our findings demonstrate that sleep disordered breathing is associated with reduced quality of life in preschool children and their families. These results support previous quality of life findings in older children and in samples with broader age ranges. Furthermore, clinically referred preschool children with mild forms of sleep disordered breathing may be at greatest risk.

Postnatal depression mediates the relationship between infant and maternal sleep disruption and family dysfunction

BACKGROUND

Previous research has linked family sleep disruption and dysfunction in children; however, the mechanism is unknown.

AIMS

This study examined whether maternal sleep and postnatal depression (PND) mediate the relationship between infant sleep disruption and family dysfunction.

STUDY DESIGN AND PARTICIPANTS

Mothers of infants aged 12 months old (N=111; 48% male) completed infant and parent sleep surveys, the Edinburgh Postnatal Depression Scale and the Family Assessment Device.

RESULTS

Poor infant sleep was related to poor maternal sleep, which was associated with higher PND and higher level of family dysfunction.

CONCLUSIONS

Results are consistent with the proposition that identification of both infant and maternal sleep problems during infancy can be relevant to reduction of PND and improved family functioning.

Quality of life of children with sleep-disordered breathing treated with adenotonsillectomy

Objective:

To assess the quality of life of UK children with sleep-disordered breathing undergoing adenotonsillectomy, by using the Obstructive Sleep Apnoea 18 questionnaire and determining score changes and effect sizes.

Design:

Prospective, longitudinal study.

Setting:

The otolaryngology department of a university teaching hospital in Northern England.

Participants:

Twenty-eight children for whom adenotonsillectomy was planned as treatment for sleep-disordered breathing, and who had either a clinical history consistent with obstructive sleep apnoea or a polysomnographic diagnosis.

Main outcome measure:

The Obstructive Sleep Apnoea 18 questionnaire, a previously validated, disease-specific quality of life assessment tool; changes in questionnaire scores and effect sizes were assessed.

Methods:

The Obstructive Sleep Apnoea 18 questionnaire was administered to each child's parent pre-operatively, then again at the follow-up appointment. Questionnaire scores ranged from 1 to 7. Score changes were analysed using the paired t-test; effect sizes were calculated using 95 per cent confidence intervals.

Results:

Complete data were obtained for 22 children (mean age, 61 months). Ten had undergone pre-operative polysomnography. Twenty-one children underwent adenotonsillectomy (one underwent tonsillectomy). Median follow up was eight weeks (interquartile range, six to 11 weeks). Following surgery, the overall mean score improvement was 2.6 (p < 0.0001) and the mean effect size 2.4 (95 per cent confidence interval 1.9 to 2.8). There were significant improvements in each of the individual questionnaire domains, i.e. sleep disturbance (mean score change 3.9, p < 0.0001), physical suffering (2.2, p < 0.0001), emotional distress (2.0, p = 0.0001), daytime problems (1.8, p = 0.0001) and caregiver concerns (2.6, p < 0.0001).

Conclusion:

In these children with sleep-disordered breathing treated by adenotonsillectomy, Obstructive Sleep Apnoea 18 questionnaire results indicated significantly improved mean score changes and effect sizes across all questionnaire domains, comparing pre- and post-operative data.

Resolution of sleep-disordered breathing in a dialysis-dependent child post-renal transplantation

This case alerts paediatricians and renal physicians to the potential for significant sleep-disordered breathing in children with renal disease, particularly those with end stage kidney disease requiring dialysis. In some cases, management of the underlying renal disease may result in amelioration of the sleep-disordered breathing. Proactive sleep history taking and formal sleep monitoring in experienced centres may be indicated for these children to limit morbidity, especially if respiratory support is indicated.