Interrater reliability of drug-induced sleep endoscopy.
OBJECTIVE
To determine the interrater reliability of drug-induced sleep endoscopy (DISE).


METHODS
Prospective cohort; blinded comparison.


METHODS
Academic referral center.


METHODS
Subjects with obstructive sleep apnea unable to tolerate positive airway pressure therapy.


METHODS
Drug-induced sleep endoscopy was performed with intravenous propofol infusion to achieve sedation, and the videoendoscopy recording was evaluated by 2 independent reviewers.


METHODS
The following outcomes were measured: a global assessment of obstruction at the palate and/or hypopharynx; the degree of obstruction at the palate and hypopharynx; and the contribution of individual structures (palate, tonsils, tongue, epiglottis, and lateral pharyngeal walls) to obstruction.


RESULTS
A total of 108 subjects underwent DISE examination. Diagnostic sleep studies demonstrated a mean (SD) apnea-hypopnea index of 39.6 (24.0). Three-quarters of the subjects demonstrated multilevel airway obstruction at the palate and hypopharynx, with a diversity of individual structures contributing to obstruction. The interrater reliability for the presence of obstruction at the palate and hypopharynx (kappa values, 0.76 and 0.79, respectively) was higher than for the degree of obstruction (weighted kappa values, 0.60 and 0.44). The interrater reliability for the assessment of primary structures contributing to obstruction at the palate and hypopharynx (0.70 and 0.86) was higher than for the contributions of individual structures (kappa values, 0.42-0.71). The interrater reliability for evaluation of the hypopharyngeal structures was higher than for those of the palate region.


CONCLUSIONS
The interrater reliability of DISE is moderate to substantial. Trial Registration clinicaltrials.gov Identifier: NCT00695214.
Kezirian
Eric J
EJ
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, 94115, USA. ekezirian@ohns.ucsf.edu
White
David P
DP
Malhotra
Atul
A
Ma
Wendy
W
McCulloch
Charles E
CE
Goldberg
Andrew N
AN
D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D017286:Polysomnography; D015742:Propofol / Q000627:therapeutic use*; D015203:Reproducibility of Results; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D014741:Video Recording; D055815:Young Adult
D006993:Hypnotics and Sedatives; D015742:Propofol