title: Fiber-optic sleep endoscopy in children with persistent obstructive sleep apnea: inter-observer correlation and comparison with awake endoscopy.
abstract: OBJECTIVE
  Evaluate the inter-observer correlation of sleep endoscopy findings in children with persistent obstructive sleep apnea (OSA) with awake office fiber-optic endoscopy.
  
  
  METHODS
  
  
  
  METHODS
  retrospective case series; blinded review.
  
  
  METHODS
  tertiary care children's hospital.
  
  
  METHODS
  Children with persistent obstructive sleep apnea.
  
  
  METHODS
  Both awake and drug induced sleep endoscopy were performed. Endoscopy video recordings were mixed at random on a DVD. Two pediatric otolaryngologists and two pediatric pulmonologists independently scored each recording using an upper airway endoscopy scoring survey.
  
  
  METHODS
  reviewers scored the following parameters: each structure's contribution (nose, nasopharynx, lateral pharyngeal walls, tongue base, supraglottis) to the obstruction, the main site in which the obstruction occurs, the severity of OSA (mild, moderate, severe), the level of confidence of endoscopy findings (poor, fair, good).
  
  
  RESULTS
  When reviewing sleep endoscopy recordings for the upper airway obstruction site, the highest correlation among the four observers was found for the nasopharynx and the supraglottis (Kappa score: 0.6 and 0.5, respectively). Compared to awake endoscopy, sleep endoscopy demonstrated more cases of airway obstruction caused by collapse of lateral pharyngeal walls and base of tongue (McNemar test for symmetry, P value<0.05). Level of confidence among the four observers was higher in older children and lower in children with severe OSA.
  
  
  CONCLUSIONS
  Sleep endoscopy is a consistently reliable tool for identifying the site of obstruction in children with persistent OSA. Though anesthetic induced sleep is not a perfect model for real sleep, the technique demonstrably guides further therapy better than awake endoscopy.
authors: Pediatric Otolaryngology Unit, Department of Otolaryngology Head and Neck Surgery, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. nognet@gmail.com
authors: Gadi
authors: G
authors: Fishman
authors: Meir
authors: M
authors: Zemel
authors: Ari
authors: A
authors: DeRowe
authors: Efraim
authors: E
authors: Sadot
authors: Yakov
authors: Y
authors: Sivan
authors: Peter J
authors: PJ
authors: Koltai
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D055100:Optical Fibers; D017286:Polysomnography; D012189:Retrospective Studies; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000473:pathology*; D014741:Video Recording; D014851:Wakefulness