Pediatric Sleep Questionnaire
Pediatric Sleep Questionnaire (PSQ) · Also known as: PSQ, PSQ-22
The Pediatric Sleep Questionnaire (PSQ) is a 22–24 item parent-report screening tool for sleep-disordered breathing and associated daytime dysfunction in children ages 2–18 years. Developed by Ronald Chervin at the University of Michigan in 2000, the PSQ measures three domains: symptoms of obstructive sleep apnea (snoring, witnessed apneas, gasping), daytime sleepiness and behavioral consequences, and sleep behavior problems (parasomnias, restlessness). It is widely used in pediatric primary care, ENT, and sleep medicine settings to identify children at risk for clinically significant sleep disorders.
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When to use it
Primary uses: (1) Screening for obstructive sleep apnea (OSA) in pediatric primary care, particularly in children presenting with snoring or behavioral/academic concerns; (2) identifying children whose inattention, hyperactivity, or irritability may be secondary to sleep disorder rather than ADHD or mood disorder; (3) monitoring symptom improvement after adenotonsillectomy or other OSA treatment; (4) research on sleep disorder prevalence and developmental outcomes of untreated sleep-disordered breathing; (5) assessing sleep impact on children with developmental disabilities, obesity, or craniofacial anomalies (higher OSA risk).
Strengths & limitations
- Brief and efficient (22–24 items, <10 minutes); ideal for high-volume primary care settings.
- High sensitivity for obstructive sleep apnea (0.85–0.90); detects most children with OSA when cutoff ≥0.36.
- Parent-based: parents observe sleep symptoms clinicians cannot assess in office (snoring, apneas, restlessness).
- Multidimensional: assesses both breathing symptoms and daytime consequences (sleepiness, behavior), which improves detection of pediatric sleep disorders.
- Extensive validation: >300 published studies; validated in diverse populations (US, Europe, Asia) and disease groups (obesity, syndromic children).
- Free or low-cost; available in 15+ languages.
- Normative data available for different age groups (preschool, school-age, adolescent).
- Specificity lower than sensitivity; 20–30% of children scoring positive may not have confirmed OSA on polysomnography.
- Parent-report bias: some parents over-report snoring due to increased awareness after seeing questionnaire; others minimize due to normalization of childhood snoring in family.
- Does not assess sleep quality or architecture (disrupted sleep stages); polysomnography required for definitive diagnosis.
- Less reliable in very young children (<3 years) who may not snore persistently or whose sleep patterns are less observable.
- Daytime symptoms (inattention, hyperactivity) may be non-specific; overlap with ADHD makes differentiation challenging without polysomnography.
- Does not capture central sleep apnea or hypoventilation, which occur in some children (e.g., neuromuscular disorders).
Frequently asked
My child's PSQ score is 0.40. Does this mean they definitely have sleep apnea?
A PSQ score of 0.40 indicates elevated risk for obstructive sleep apnea and warrants polysomnography (overnight sleep study) for definitive diagnosis. However, PSQ is a screening tool—not all children with PSQ >0.36 have confirmed OSA on sleep study. Approximately 70–80% of high-scoring children do have OSA, while 20–30% may have benign snoring without apnea. Sleep study is needed to confirm.
My child scored high on Daytime Sleepiness. Does that mean my child's ADHD diagnosis is wrong?
Not necessarily. Daytime sleepiness can result from sleep-disordered breathing, but ADHD is a separate condition. Many children have both ADHD and OSA. If your child has both snoring (SDB subscale high) and daytime hyperactivity/inattention, polysomnography can confirm whether sleep disorder is contributing to behavior. Treatment of OSA may improve attention, but ADHD may still require medication or behavioral therapy.
My child snores but PSQ score is 0.25. Should we get a sleep study anyway?
A PSQ score of 0.25 is below the recommended cutoff for immediate polysomnography. However, if your child has other risk factors (obesity, witnessed apneas, daytime sleepiness, growth concerns, familial OSA), discuss with your pediatrician. They may still recommend sleep study based on clinical judgment. Repeat PSQ in 6–12 months to monitor symptom progression.
Can PSQ distinguish between obstructive sleep apnea and other sleep problems like narcolepsy or restless legs?
No. PSQ specifically screens for obstructive sleep apnea and associated daytime dysfunction. It does not identify narcolepsy, restless leg syndrome, insomnia, or circadian rhythm disorders. If PSQ is normal but your child has persistent daytime sleepiness, restlessness, or sleep problems, other sleep disorder investigations (Multiple Sleep Latency Test, actigraphy, detailed sleep history) may be needed.
Sources
- Chervin, R. D., Hedger, K., Dillon, J. E., & Pituch, K. J. (2000). Pediatric sleep questionnaire (PSQ): Validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and sleep behavior. Sleep Medicine, 1(1), 21–32. DOI: 10.1016/S1389-9457(99)00009-X ↗
- Chervin, R. D., Weatherly, R. A., Garetz, S. L., Ruzicka, D. L., Giordani, B. J., Hodges, E. K., . . . Dillon, J. E. (2007). Pediatric sleep questionnaire: Prediction of sleep apnea and outcomes. Archives of Otolaryngology–Head & Neck Surgery, 133(3), 216–222. DOI: 10.1001/archotol.133.3.216 ↗
How to cite this page
ScholarGate. (2026, June 3). Pediatric Sleep Questionnaire (PSQ). ScholarGate. https://scholargate.app/en/child-psychiatry/pediatric-sleep-questionnaire
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