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

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


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 languageEnglish (US)
Pages (from-to)2256-2262
Number of pages7
Issue number9
StatePublished - Sep 1 2020


  • Sleep-disordered breathing
  • diagnosis
  • obstructive sleep apnea
  • pediatric
  • polysomnography

ASJC Scopus subject areas

  • Otorhinolaryngology


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