Obstructive Sleep Apnea-20

Instrument Name: Obstructive Sleep Apnea-20

Abbreviation: OSA-20

Points for Consideration:

None

Description of Tool:

The Obstructive Sleep Apnea-20 (OSA-20) is a 20-item ObsRO developed to determine the impact of OSA on children's health-related quality of life (HRQoL). Parents are asked to describe how often during the previous 4 weeks their child had exhibited specific symptoms. Items are rated on a 7-level scale ranging from 1="None of the time", 2="Hardly any of the time", 3="A little of the time", 4="Some of the time", 5="A good bit of the time", 6="Most of the time", to 7="All of the time". A higher score indicates a poorer disease-specific quality of life.

Other Related Tools (if applicable):

The OSA-18 consists of 18 items to determine the impact of OSA on children's health-related quality of life. This revised version does not include Item 12 (Social problems) and Item 16 (School problems) included in the OSA-20.
The OSA-5 consists of 5 items to help screen and triage children at risk of obstructive sleep apnea among large numbers of referrals for sleep-disordered breathing. This revised version consists of Item 1 (Loud snoring), Item 2 (Breath holding spells or pauses in breathing at night), Item 3 (Choking or gasping sounds while asleep), Item 5 (Mouth breathing because of nasal obstruction) and Item 16 (Breathing problems during sleep that made you worried that they were not getting enough air) included in the OSA-18.

Minimum Qualification Required by COA Administrator: No degree requirement

Comment:

The OSA-20 originally consisted of 20 items assessing the impact of OSA on children's health-related quality of life. During the original psychometric validitation performed by Franco et al., 2000, Item 12 (Social problems) and Item 16 (School problems) were removed due to low relevance and trivial correlation with the 3 validity measures used in the study (i.e., respiratory distress index, tonsil size, adenoid size), resulting in the final COA being renamed OSA-18 and consisting of 18 items.

Year: 1999

Objective of Development:

To determine the impact of OSA on children's health-related quality of life

Population of Development: Age range (therapeutic indication):

Age range: 6 months-12 years old (Sleep-disordered breathing)

Pediatric Population(s) in which COA has been used:

None identified

COA type: ObsRO

Number of Items 20

Mode of Administration: Caregiver-rated

Data Collection Mode: Paper and pen administration

Time for Completion: No information

Response Scales: 7-point scale ranging from 1="None of the time", 2="Hardly any of the time", 3="A little of the time", 4="Some of the time", 5="A good bit of the time", 6="Most of the time", to 7="All of the time"

Summary of Scoring:

Available scores: An overall summary score and additional scores for individual domains can be obtained. The OSA-20 survey score is obtained by summing the scores of all 20 items, ranging from 20 to 140. The summary score
is the average of all 20 items. Domain scores reflect the average of the 4 items within that domain. Summary and domain scores can range from 1.0 to 7.0.

Weighting: No

Score interpretation: Higher scores=Poorer disease-specific quality of life.

Evidence of Literature Review: None identified

Evidence of Instrument Review: None identified

Evidence of Clinical or Expert Input: Yes

Evidence of concept elicitation in target patient population: Yes

Evidence of a Saturation Grid: None identified

Evidence for Selection of Data Collection Method: None identified

Recall/Observation Period: Past 4 weeks

Evidence for Selection of Reponse Options: Yes

Evidence of cognitive interviewing of draft instrument in target patient population: None identified

Evidence of Preliminary Scoring of Items and Domains: None identified

Evidence related to respondent and administrator burden: None identified

Evidence of a Conceptual Framework: None identified

Evidence of an item-tracking matrix: None identified

Evidence related to item selection: None identified

Evidence of re-testing the final version: None identified

Internal consistency (Cronbach's alpha): Yes

Evidence of internal consistency: Franco RA (1999) - Method: Item-total correlation - Results: 0.38-0.86 - Population/Disease: Children aged 6 months-12 years; n=61

Test-retest Reliability (ICC):

Franco RA (1999)
Test-retest reliability
- Spearman rank correlation: Excellent test-retest reliability was obtained for the individual survey items (R > 0.74).
- Was a definition of stability applied to identify stable patients: Not stated
- Time frame between the two administrations: 3 days
- Population/disease: Children aged 6 months-12 years; n=61

Inter-rater/ inter-interviewer reliability (kappa):

None identified

Evidence of test-retest or inter-rater reliability: Yes

Concurrent validity (convergent, divergent):

Franco RA (1999)
Convergent validity
- Correlation coefficient used: Spearman rank correlation coefficient
- Measures: Respiratory distress index (RDI), tonsil size and adenoid size
- Results: Construct validity was suggested by fair-to-good correlation between the sleep disturbance and caregiver concern domain items and the RDI, which were all statistically significant except for item 4, fragmented sleep. This item, however, did show significant correlation with adenoid size. Mouth breathing (item 5) showed an expected correlation with adenoid size, and dysphagia (item 8) had weak correlation with tonsil and adenoid size. Items 6 and 7 had weak correlation with objective measures. The poorest correlations with objective external measures were observed for items in the emotional distress and daytime function domains. Items 12 and 16 were eliminated from the survey because they showed low problem rates (about 70% of caregivers reported no problem for each) and trivial correlation with all 3 validity measures (RDI, tonsil size,adenoid size).
- Population/Disease: Children aged 6 months-12 years; n=61

Known-group validity:

None identified

Evidence of Translatability Assessment: None identified

Evidence related to missing data: None identified

Evidence for Selection of Recall Period: None identified

Evidence of Administration Instructions and Training Provided: None identified

Evidence of concurrent validity: Yes

Evidence of known-groups validity: None identified

Evidence of ability to detect change over time: None identified

Ability to detect change (Responsiveness):

None identified

Responder Thresholds:

None identified

Evidence of responder thresholds: None identified

Franco RA Jr, Rosenfeld RM, Rao M. First place--resident clinical science award 1999. Quality of life for children with obstructive sleep apnea. Otolaryngol Head Neck Surg. 2000 Jul;123(1 Pt 1):9-16. doi: 10.1067/mhn.2000.105254. PMID: 10889473. Full Text Article: https://pubmed.ncbi.nlm.nih.gov/10889473/

Soh HJ, Rowe K, Davey MJ, Horne RSC, Nixon GM. The OSA-5: Development and validation of a brief questionnaire screening tool for obstructive sleep apnea in children. Int J Pediatr Otorhinolaryngol. 2018 Oct;113:62-66. doi: 10.1016/j.ijporl.2018.07.029. Epub 2018 Jul 19. PMID: 30174012. Full Text Article: https://pubmed.ncbi.nlm.nih.gov/30174012/

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Yes

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Authors: Franco RA Jr, Rosenfeld RM, Rao M.

Contact:
Ramon Arturo Franco Jr.
Department of Otolaryngology, SUNY Health Science Center at Brooklyn
Brooklyn, New York

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None identified

https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1067/mhn.2000.105254