Paediatric Sleep Questionnaire (PSQ)

Original Editor - Romy Hageman
Top Contributors - Romy Hageman

Purpose[edit | edit source]

The Paediatric Sleep Questionnaire (PSQ) is a screening tool for sleep problems in children. It increases the pretest probability of obstructive sleep apnea syndrome and can help in the clinical decision making when polysomnography is unavailable[1].
The PSQ is widely used for research and in clinical settings. The questionnaire has 22 questions, comprising three symptom complexes: snoring, excessive daytime sleepiness, and inattentive or hyperactive behaviour.

Intended population[edit | edit source]

Technique[edit | edit source]

  • The PSQ is a parent-reported questionnaire and contains 22 items. Parents must fill in the questions about snoring, apneas, daytime sleepiness, inattentive or hyperactive behaviour, and other features. They must choose the following responses: ''yes'' = 1, ''no''=0, and ''don't know'' = missing.
  • Time to administer: 10-15 minutes[6]
  • Required training: not necessary[6]


The PSQ contains the following questions[7]:

  1. Does he/she snore more than half the night?
  2. Does he/she often snore?
  3. Does he/she snore noisily?
  4. Does he/she breathe loudly or heavily?
  5. Does he/she have trouble breathing, or effort to breathe?
  6. Have you ever seen your child stop breathing?
  7. Does he/she breathe out of his/her mouth during the day?
  8. Does he/she have a dry mouth when awake in the morning?
  9. Does he/she wet the bed?
  10. Does he/she awake in the morning without being refreshed?
  11. Does he/she have trouble with sleepiness in the daytime?
  12. Have a teacher or another supervisor noticed that he/she seems to be asleep during the daytime?
  13. Is he/she difficult to awaken in the morning?
  14. Does he/she awake in the morning with headaches?
  15. Has he/she ceased growing normally since birth?
  16. Is he/she overweight?
  17. He/she doesn't appear to listen when you talk to him/her directly
  18. He/she has trouble organizing duties and activities
  19. He/she is easily distracted by foreign stimulation
  20. He/she violins with hands or feet, or twitching in seating
  21. He/she is ''on the move'' or often acts like he/she is ''powered by an engine''
  22. He/she interrupts/disturbs others

Scoring[edit | edit source]

The total PSQ score can be segmented into four sub-scores: breathing, behaviour, sleepiness, and other. A total score exceeding 0.33 (33% of questions answered positively) suggests the presence of sleep-disordered breathing and demonstrates a sensitivity of 81% and specificity of 87% within the general paediatric population[7].

Psychometric values[edit | edit source]

  • The PSQ is a valid tool for sceening paediatric obstructive sleep apnea syndrome with a satisfactory diagnostic accuracy (sensitivity 0.50 and 0.81)[8][9].
    • The PSQ has a high sensitivity (0.74) in detecting mild paediatric obstructive sleep apnea syndrome[1].
    • The sensitivity of the PSQ in children with asthma is high (76.2 - 81.6), but the specificity is low (13.1 - 14.4)[2].
    • The threshold value of 0.65 demonstrated optimal sensitivity (80%) and specificity (100%) for identifying moderate-to-severe obstructive sleep apnea in children and adolescents with obesity[4].
  • Internal consistency:
    • Snoring scale: α=0.86
    • Daytime sleepiness scale: α=0.66
    • Behaviour scale: α=0.84
  • The PSQ is an easy-to-use screening tool that can aid in the screening for paediatric sleep apnea[10][11].

Resources[edit | edit source]

The PSQ is available free of charge for academic and research use here.

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Wu CR, Tu YK, Chuang LP, Gordon C, Chen NH, Chen PY, Chiu HY. Diagnostic meta-analysis of the Pediatric Sleep Questionnaire, OSA-18, and pulse oximetry in detecting pediatric obstructive sleep apnea syndrome. Sleep Medicine Reviews. 2020; 101355.
  2. ↑ 2.0 2.1 Ehsan Z, Kercsmar CM, Collins J, Simakajornboon N. Validation of the pediatric sleep questionnaire in children with asthma. Pediatric Pulmonology. 2017; 52: 382-389
  3. ↑ Dooley AA, Jackson JH, Gatti ML, Fanous H, Martinez C, Prue DC, Phull G, Richmond M, Weinstein NA, Chorvinsky E, Shukla PJ, Pillai DK. Pediatric sleep questionnaire predicts more severe sleep apnea in children with uncontrolled asthma. Journal of Asthma. 2021; 58(12): 1589-1596
  4. ↑ 4.0 4.1 Umano GR, Rondinelli G, Luciano M, Pennarella A, Aiello F, Mangoni di Santo Stefano GSRC, Di Sessa A, Marzuillo P, Papparella A, Miraglia del Giudice E. Pediatric Sleep Questionnaire Predicts Moderate-to-Severe Obstructive Sleep Apnea in Children and Adolescents with Obesity. Children. 2022; 9(9): 1303
  5. ↑ Ward TM, Chen ML, Landis CA. Congruence between polysomnohraphy obstructive sleep apnea and the pediatric sleep questionnaire: fatigue and health-related quality of life in juvenile idiopathic arthritis. Quality of Life Research: an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 2017; 26(3): 779-788
  6. ↑ 6.0 6.1 Burghard M, Brozek-Madry E, Krzeski A. Sleep disordered breathing in children - Diagnostic questionnaires, comparative analysis. International Journal of Pediatric Otorhinolaryngology. 2019; 120(12): 108-111
  7. ↑ 7.0 7.1 Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleepdisordered breathing, snoring, sleepiness, and behavioral problems. Sleep Medicine. 2000; 1: 21–32.
  8. ↑ Canto GDL, Singh V, Major MP, Witmans M, El-Hakim H, Major PW. Diagnostic capability of questionnaires and clinical examinations to assess sleep-disordered breathing in children: a systematic review and meta-analysis. Journal of the American Dental Association. 2014; 145: 165e78.
  9. ↑ Ferry AM, Wright AE, Ohlstein JF, Khoo K, Pine HS. Efficacy of a Pediatric Sleep Questionnaire for the Diagnosis of Obstructive Sleep Apnea in Children. Cureus. 2020; 12(12): e12244
  10. ↑ Masoud AI, Adavadkar PA, Park C, Gowharji LF, Alwadei AH, Carley DW. Comparing two pediatric sleep questionnaires: The Pediatric Sleep Questionnaire (PSQ) and a set of 6 hierarchically - arranged questions (6Q). Cranio: the Journal of Craniomandibular Practice. 2020; 40(4): 1–10.
  11. ↑ Incerti Parenti S, Fiordelli A, Bartolucci ML, Martina S, D'Antò V, Alessandri-Bonetti G. Diagnostic accuracy of screening questionnaires for obstructive sleep apnea in children: A systematic review and meta-analysis. Sleep Medicine Reviews. 2021; 57: 101464.
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