The STBUR questionnaire for predicting perioperative respiratory adverse events in children at risk for sleep-disordered breathing

Paediatr Anaesth. 2013 Jun;23(6):510-6. doi: 10.1111/pan.12155. Epub 2013 Apr 1.


Background: In the absence of formal polysomnography (PSG), many children with symptoms of sleep-disordered breathing (SDB) go unrecognized and thus may be at risk for perioperative respiratory adverse events (PRAE).

Objectives: To develop a simple practical tool to identify children with symptoms consistent with SDB who may be at risk for PRAE.

Methods: Three-hundred and thirty-seven parents of children scheduled for surgery completed the Sleep-Related Breathing Disorder (SRBD) questionnaire. Data regarding the incidence and severity of PRAE including airway obstruction and laryngospasm, were collected prospectively.

Results: Thirty-two (9.5%) children had a confirmed diagnosis of SDB by PSG and 90 (26.7%) had symptoms consistent with SDB based on the SRBD questionnaire. Principal component analysis identified five symptoms from the SRBD questionnaire that were strongly predictive of PRAE and which were incorporated into the STBUR tool (Snoring, Trouble Breathing, Un-Refreshed). The likelihood of PRAE was increased by threefold (positive likelihood ratio 3.06 [1.64-5.96] in the presence of any 3 STBUR symptoms and by tenfold when all five symptoms were present (9.74 [1.35-201.8]). In comparison, the likelihood of PRAE based on a PSG-confirmed diagnosis of SDB was 2.63 (1.17-6.23).

Conclusions: Children presenting for surgery with symptoms consistent with SDB may be at risk for PRAE. It is important therefore that anesthesia providers identify these individuals prior to surgery to avoid potential complications. The STBUR questionnaire appears promising as a simple, clinically useful tool for identifying children at risk for PRAE. Further studies to validate the STBUR questionnaire as a diagnostic tool may be warranted.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Data Interpretation, Statistical
  • Female
  • Humans
  • Intraoperative Complications / etiology*
  • Likelihood Functions
  • Male
  • Perioperative Period*
  • Polysomnography
  • Postoperative Complications / etiology*
  • Predictive Value of Tests
  • Principal Component Analysis
  • Respiration Disorders / diagnosis*
  • Respiration Disorders / etiology
  • Risk
  • Sample Size
  • Sleep Apnea Syndromes / complications
  • Sleep Apnea Syndromes / diagnosis*
  • Snoring / complications
  • Surveys and Questionnaires*
  • Treatment Outcome