Pediatric Sleep Questionnaire (PSQ): validity and reliability of
scales for sleep-disordered breathing, snoring, sleepiness, and
Ronald D. Chervin
, Kristen Hedger
, James E. Dillon
, Kenneth J. Pituch
Department of Neurology, University of Michigan, Ann Arbor, MI, USA
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
Received 25 August 1999; received in revised form 4 October 1999; accepted 4 October 1999
Objective: To develop and validate questionnaire scales that can be used in research to investigate the presence of childhood
SRBDs and prominent symptom complexes, including snoring, daytime sleepiness, and related behavioral disturbances.
Background: Obstructive sleep-related breathing disorders (SRBDs) are common but usually undiagnosed among children.
Methods to help identify SRBDs without the expense of polysomnography could greatly facilitate clinical and epidemiological
Methods: Subjects were children aged 2±18 years who had polysomnographically-con®rmed SRBDs (n 54) or appoint-
ments at either of two general pediatrics clinics (n 108). Parents completed a Pediatric Sleep Questionnaire which contained
items under consideration for inclusion in desired scales.
Results: Item reduction, based on data from a randomly selected 50% of the subjects (group A), produced a 22-item SRBD
score that was strongly associated with diagnosis of an SRBD (P , 0:0001) in a logistic regression model that accounted for
age and gender. Diagnosis was also strongly associated with subscores for snoring (four items, P , 0:0001), sleepiness (four
items, P 0:0003), and behavior (six items, P , 0:0001) among group A subjects. The scales performed similarly well among
group B subjects, and among subjects of different ages and gender. In group A and B subjects, respectively, a selected criterion
SRBD score produced a sensitivity of 0.85 and 0.81; a speci®city of 0.87 and 0.87; and a correct classi®cation for 86 and 85% of
subjects. The scales showed good internal consistency and, in a separate sample (n 21), good test-retest stability.
Conclusions: These scales for childhood SRBDs, snoring, sleepiness, and behavior are valid and reliable instruments that can
be used to identify SRBDs or associated symptom-constructs in clinical research when polysomnography is not feasible.
q 2000 Elsevier Science B.V. All rights reserved.
Keywords: Children; Pediatric sleep questionnaire; Scales; Obstructive sleep apnea; Snoring; Sleep disorders; Sleepiness; Polysomnography;
Obstructive sleep apnea affects 0.7±3.0% of chil-
dren and can produce excessive daytime sleepiness,
behavioral problems, learning disabilities, right-sided
heart failure, growth retardation, or failure to thrive
Sleep Medicine 1 (2000) 21±32
1389-9457/00/$ - see front matter q 2000 Elsevier Science B.V. All rights reserved.
Presented in part as an abstract at the annual meeting of the
Association of Professional Sleep Societies, Orlando, FL, June 1999.
* Corresponding author. Sleep Disorders Center, University
Hospital 8D8702, P.O. Box 0117, 1500 E. Medical Center Dr.,
Ann Arbor, MI 48109-0117, USA. Tel.: 11-734-647-9064; fax:
E-mail address: firstname.lastname@example.org (R.D. Chervin)