Domain Classification and Content Validation of FAirEST-15 for Pediatric Sleep-Disordered Breathing: A Tool Structuring Study for Dental Screening

Background: Sleep-Disordered Breathing (SDB) in children affects craniofacial growth, behavior, and general health but remains underdiagnosed.The FAirEST-15 (Functional Airway Evaluation Screening Tool) includes 15 observable features to help clinicians identify SDB risk.However, the tool lacks a domain-wise structure and risk stratification system, limiting its broader application.Aim: To develop a domain-level classification system for the FAirEST-15 tool through expert consensus and evaluate its content validity and inter-rater agreement.Methods: A cross-sectional methodological study was conducted involving nine subject-matter experts-three each from pediatric dentistry, orthodontics, and pediatric ENT.Experts independently reviewed and assigned each FAirEST-15 item to a relevant domain.A modified Delphi method was used to reach consensus, resulting in a seven-domain classification: Craniofacial Morphology, Orofacial Functional Profile, Orofacial Muscle Tone/Function, Oropharyngeal Airway Evaluation, Transverse Skeletal Development, Sleep Behavior, and Nasal/Respiratory Function.Validity was assessed using Item level Content Validity Index (I-CVI), Content Validity Ratio (CVR), and Inter-Rater Agreement (IRA).Results: Nine of the 15 items achieved perfect I-CVI (1.00), CVR (1.00), and IRA (≥0.89).Most other items showed acceptable agreement (I-CVI and CVR ≥0.78; IRA ≥0.75).Only one item-Maxillary Intercanine Distance-showed lower indices, suggesting the need for future re-evaluation.Conclusions: This study presents a validated domain-wise classification for FAirEST-15, enhancing its clinical interpretability and supporting its integration into structured pediatric SDB screening.The findings enable more targeted assessment and facilitate interdisciplinary collaboration in early identification and management