Paediatric Sleep Questionnaire (PSQ)

The Paediatric Sleep Questionnaire (PSQ) is a parent-reported screening tool used to identify sleep-related problems in children, particularly obstructive sleep apnoea syndrome (OSAS). It was developed as a practical alternative to polysomnography (laboratory-based sleep testing), especially in settings where such resources are unavailable or when prioritising children who should undergo further diagnostic evaluation.

Purpose and clinical use

The PSQ is designed to screen for:

• Obstructive sleep apnoea (OSA/OSAS)

• Habitual snoring and sleep-disordered breathing

• Associated behavioural, attention, and daytime sleepiness problems

It is commonly used in paediatric sleep medicine, ENT clinics, and general practice to detect children at risk of sleep disorders who may benefit from full polysomnographic assessment or specialist referral.

Structure and content

The PSQ consists of 22 questions, answered by parents or guardians, covering three main domains:

1. Snoring and apnoea – frequency and severity of snoring, witnessed apnoeas, breathing pauses.

2. Sleepiness – excessive daytime sleepiness, falling asleep during the day, difficulties staying awake.

3. Behavioural aspects – hyperactivity, attention problems, irritability.

Responses are scored dichotomously (yes/no/don’t know). A higher proportion of “yes” responses indicates a greater likelihood of OSAS or other sleep-disordered breathing.

Scoring and interpretation

• A cut-off score of ≥ 0.33 (i.e., “yes” on more than one third of items) has been suggested to indicate a high risk of OSAS.

• The PSQ is not a diagnostic tool, but it helps identify children who should be prioritised for sleep studies or ENT evaluation.

• Results should always be interpreted in the context of clinical history and examination.

Strengths and limitations

Strengths:

• Easy to administer and complete in less than 10 minutes.

• Non-invasive, cost-effective, and feasible in primary care.

• Provides insight into both nocturnal symptoms and daytime consequences.

Limitations:

• Relies on parent observation and subjective reporting.

• Cannot replace polysomnography as the diagnostic gold standard.

• May overestimate or underestimate severity depending on parental awareness.

Clinical relevance

The PSQ is a validated, reliable, and practical tool for screening paediatric sleep disorders. It is especially useful for:

• Early detection of children with suspected OSAS.

• Research studies on paediatric sleep-disordered breathing.

• Identifying candidates for adenotonsillectomy or other interventions.

• Monitoring symptoms before and after treatment.

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