Figure 1.

Severity hierarchy of respiratory complaints in children for the clinical AHI cutoff groups. Q1: shake child to breathe. Q2: apnea during sleep. Q3: struggle breathing when asleep. Q4: breathing concerns while asleep. Q5: loudness of snoring. Q6: snoring during sleep. Daytime mouth breathing (excluded by Mokken Scale Analysis). With a high score on a question it is likely that previous questions within the hierarchy will be scored high as well; also, the higher the mean score the more severe the complaints. The lines depict the mean score per question for each AHI cutoff group when the proposed hierarchy is preserved; hence, they can be a clinical rule of thumb. Visually, the disparities among the lines of severity hierarchy further suggest the closeness and distinctiveness of AHI cutoff groups based on the applied questionnaire. The lower x-axis applies for AHI_G4-6 (or AHI > 3). AHI = apnea-hypopnea index.