The Generalizability of the Clinical Assessment Score-15 for Pediatric Sleep-Disordered Breathing

Laryngoscope. 2020 Sep;130(9):2256-2262. doi: 10.1002/lary.28428. Epub 2019 Nov 29.

Abstract

Objective: The Clinical Assessment Score-15 (CAS-15) has been validated as an office-based assessment for pediatric sleep-disordered breathing in otherwise healthy children. Our objective was to determine the generalizability of the CAS-15 in a multi-institutional fashion.

Methods: Five hundred and thirty children from 13 sites with suspected sleep-disordered breathing were recruited, and the investigators completed the CAS-15. Based on decisions made in the course of clinical care, investigators recommended overnight polysomnography, observation, medical therapy, and/or surgery. Two hundred and forty-seven subjects had a follow-up CAS-15.

Results: Mean age was 5.1 (2.6) years; 54.2% were male; 39.1% were white; and 37.0% were African American. Initial mean (standard deviation [SD]) CAS-15 was 37.3 (12.7), n = 508. Spearman correlation between the initial CAS-15 and the initial apnea-hypopnea index (AHI) was 0.41 (95% confidence interval [CI], 0.29, 0.51), n = 212, P < .001. A receiver-operating characteristic curve predicting positive polysomnography (AHI > 2) had an area under the curve of 0.71 (95% CI, 0.63, 0.80). A score ≥ 32 had a sensitivity of 69.0% (95% CI, 61.7, 75.5), a specificity of 63.4% (95% CI, 47.9, 76.6), a positive predictive value of 88.7% (95% CI, 82.1, 93.1), and a negative predictive value of 32.9% (95% CI, 23.5, 44.0) in predicting positive polysomnography. Among children who underwent surgery, the mean change (SD) score was 30.5 (12.6), n = 201, t = 36.85, P < .001, effect size = 3.1.

Conclusion: This study establishes the generalizability of the CAS-15 as a useful office tool for the evaluation of pediatric sleep-disordered breathing.

Level of evidence: 2B Laryngoscope, 130:2256-2262, 2020.

Keywords: Sleep-disordered breathing; diagnosis; obstructive sleep apnea; pediatric; polysomnography.

Publication types

  • Multicenter Study
  • Validation Study

MeSH terms

  • Child
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Polysomnography / methods
  • Polysomnography / statistics & numerical data*
  • Predictive Value of Tests
  • ROC Curve
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Severity of Illness Index*
  • Sleep Apnea Syndromes / diagnosis*
  • Statistics, Nonparametric
  • Symptom Assessment / methods
  • Symptom Assessment / statistics & numerical data*