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

Nira A. Goldstein; Norman R. Friedman; Heather C. Nardone; Abdullah Aljasser; Allison B.J. Tobey; Debra Don; Fuad M. Baroody; Derek J. Lam; Steven Goudy; Stacey L. Ishman; Jill M. Arganbright; Cristina Baldassari; J. B.S. Schreinemakers; Todd M. Wine; Nicole J. Ruszkay; Ahmed Alammar; Amber D. Shaffer; Jeffrey A. Koempel; Jeremy Weedon

doi:10.1002/lary.28428

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

Nira A. Goldstein, Norman R. Friedman, Heather C. Nardone, Abdullah Aljasser, Allison B.J. Tobey, Debra Don, Fuad M. Baroody, Derek J. Lam, Steven Goudy, Stacey L. Ishman, Jill M. Arganbright, Cristina Baldassari, J. B.S. Schreinemakers, Todd M. Wine, Nicole J. Ruszkay, Ahmed Alammar, Amber D. Shaffer, Jeffrey A. Koempel, Jeremy Weedon

Otolaryngology

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

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.

Original language	English (US)
Pages (from-to)	2256-2262
Number of pages	7
Journal	Laryngoscope
Volume	130
Issue number	9
DOIs	https://doi.org/10.1002/lary.28428
State	Published - Sep 1 2020

Keywords

Sleep-disordered breathing
diagnosis
obstructive sleep apnea
pediatric
polysomnography

ASJC Scopus subject areas

Otorhinolaryngology

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10.1002/lary.28428

Cite this

Goldstein, N. A., Friedman, N. R., Nardone, H. C., Aljasser, A., Tobey, A. B. J., Don, D., Baroody, F. M., Lam, D. J., Goudy, S., Ishman, S. L., Arganbright, J. M., Baldassari, C., Schreinemakers, J. B. S., Wine, T. M., Ruszkay, N. J., Alammar, A., Shaffer, A. D., Koempel, J. A., & Weedon, J. (2020). The Generalizability of the Clinical Assessment Score-15 for Pediatric Sleep-Disordered Breathing. Laryngoscope, 130(9), 2256-2262. https://doi.org/10.1002/lary.28428

Goldstein, NA, Friedman, NR, Nardone, HC, Aljasser, A, Tobey, ABJ, Don, D, Baroody, FM, Lam, DJ, Goudy, S, Ishman, SL, Arganbright, JM, Baldassari, C, Schreinemakers, JBS, Wine, TM, Ruszkay, NJ, Alammar, A, Shaffer, AD, Koempel, JA & Weedon, J 2020, 'The Generalizability of the Clinical Assessment Score-15 for Pediatric Sleep-Disordered Breathing', Laryngoscope, vol. 130, no. 9, pp. 2256-2262. https://doi.org/10.1002/lary.28428

@article{9dc811ebc1514a7a9c2bb92a15436ef2,

title = "The Generalizability of the Clinical Assessment Score-15 for Pediatric Sleep-Disordered Breathing",

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",

author = "Goldstein, {Nira A.} and Friedman, {Norman R.} and Nardone, {Heather C.} and Abdullah Aljasser and Tobey, {Allison B.J.} and Debra Don and Baroody, {Fuad M.} and Lam, {Derek J.} and Steven Goudy and Ishman, {Stacey L.} and Arganbright, {Jill M.} and Cristina Baldassari and Schreinemakers, {J. B.S.} and Wine, {Todd M.} and Ruszkay, {Nicole J.} and Ahmed Alammar and Shaffer, {Amber D.} and Koempel, {Jeffrey A.} and Jeremy Weedon",

note = "Publisher Copyright: {\textcopyright} 2019 The American Laryngological, Rhinological and Otological Society, Inc.",

year = "2020",

month = sep,

day = "1",

doi = "10.1002/lary.28428",

language = "English (US)",

volume = "130",

pages = "2256--2262",

journal = "Laryngoscope",

issn = "0023-852X",

publisher = "John Wiley and Sons Inc.",

number = "9",

}

TY - JOUR

T1 - The Generalizability of the Clinical Assessment Score-15 for Pediatric Sleep-Disordered Breathing

AU - Goldstein, Nira A.

AU - Friedman, Norman R.

AU - Nardone, Heather C.

AU - Aljasser, Abdullah

AU - Tobey, Allison B.J.

AU - Don, Debra

AU - Baroody, Fuad M.

AU - Lam, Derek J.

AU - Goudy, Steven

AU - Ishman, Stacey L.

AU - Arganbright, Jill M.

AU - Baldassari, Cristina

AU - Schreinemakers, J. B.S.

AU - Wine, Todd M.

AU - Ruszkay, Nicole J.

AU - Alammar, Ahmed

AU - Shaffer, Amber D.

AU - Koempel, Jeffrey A.

AU - Weedon, Jeremy

PY - 2020/9/1

Y1 - 2020/9/1

N2 - 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.

AB - 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.

KW - Sleep-disordered breathing

KW - diagnosis

KW - obstructive sleep apnea

KW - pediatric

KW - polysomnography

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

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Keywords

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