Reliability of SNIP test and optimal number of maneuvers in 6-11 years healthy children

BACKGROUND AND PURPOSE: Sniff nasal inspiratory pressure (SNIP) is a voluntary inspiratory maneuver measured through a plug occluding one nostril. The investigation of the number of maneuvers necessary to reach the highest peak of SNIP in pediatric populations has been inconsistent. Thus, this study aimed to assess the reliability of SNIP in healthy children aged 6 to 11 years according to sex and age group, and to determine the optimal number of SNIP maneuvers for this age group. METHODS: This cross-sectional study included healthy children with normal pulmonary function. We performed 12 to 20 SNIP maneuvers, with a 30 s rest between each maneuver. The reliability was tested using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman analysis for agreement. RESULTS: A total of 121 healthy children (62 girls [51%]) were included in this study. The ICC and corresponding confidence interval (CI) between the highest measure and the first reproducible maneuver were 0.752 (0.656–0.824), SEM = 10.37 cmH(2)O, and MDC = 28.74 cmH(2)O. For children aged 6 to 7 years, the ICC was 0.669 (0.427–0.822), SEM = 10.76 cmH(2)O and MDC = 29.82 cmH(2)O; for children aged 8 to 11 years, the ICC was 0.774 (0.662–0.852), SEM = 9.74 cmH(2)O, and MDC = 26.05 cmH(2)O. For girls, the ICC was 0.817 (0.706–0.889), SEM = 9.40 cmH(2)O and MDC = 26.05 cmH(2)O; for boys, the ICC was 0.671 (0.487–0.798), SEM = 11.51 cmH(2)O, and MDC = 31.90 cmH(2)O. Approximately 80% of the total sample reached the highest SNIP before the 10(th) maneuver. CONCLUSIONS: SNIP demonstrated moderate reliability between the maneuvers in children aged 6 to 11 years; older children and girls reached the SNIP peak faster. Finally, results indicated that 12 maneuvers were sufficient for healthy children aged 6 to 11 years to achieve the highest SNIP peak.