Measuring quality of life in children with obstructive sleep disorders

Objective: To validate a disease-specific health-related quality of life (HRQOL) instrument for children with obstructive sleep disorders (OSDs). Design: Prospective cohort study using a 6-item health-related instrument (OSD-6). Subjects: One hundred caregivers of patients with OSDs secondary to adenotonsillar hypertrophy (age range, 2-12 years) from 2 tertiary care, pediatric otolaryngology practices. Intervention: The OSD-6 was administered on initial presentation and 4 to 5 weeks after adenotonsillectomy. A subset of patients repeated the OSD-6 within 3 weeks after presentation to assess test-retest reliability. Main Outcome Measures: Test-retest reliability, internal consistency, construct validity, and responsiveness to clinical change of the OSD-6 score. Results: Test-retest reliability was good (intraclass correlation coefficient=0.74). Median OSD-6 score was 4.5 (0- to 6-point scale) with higher scores indicating poorer quality of life (QOL). Construct validity was demonstrated by the moderate correlation between OSD-6 score and global adenoid and tonsil-related QOL (R=-0.62), strong correlation between the OSD-6 change score and change in global adenoid and tonsil-related QOL (R=-0.63), and the moderate correlation between the change score and parent estimate of clinical change (R=0.40). The mean change in OSD-6 score after adenotonsillectomy was 3.0 (95% confidence interval, 2.7-3.4). The mean standardized response was 2.3 (95% confidence interval, 1.9-2.7) indicating the instrument's large responsiveness to clinical change. The change score was very reliable (R=0.85). Conclusions: The OSD-6 is a reliable, responsive, easily administered instrument. It is valid for detecting change after adenotonsillectomy in children with OSDs.