title: A new scoring system for upper airway pediatric sleep endoscopy.
abstract: OBJECTIVE
  Sleep-associated upper-airway obstruction in children is a significant cause of morbidity. Development of a simple, standardized, quantitative technique to assess anatomic causes of sleep-related breathing disorder is important for surgical planning, clinical communication, and research.
  
  
  OBJECTIVE
  To design, implement, and evaluate a scoring system to quantify airway obstruction in pediatric drug-induced sleep endoscopy.
  
  
  METHODS
  This study was a retrospective case series conducted at a tertiary pediatric hospital. The patients were children with sleep-related breathing disorder who underwent polysomnography and drug-induced sleep endoscopy.
  
  
  METHODS
  Flexible fiber-optic laryngoscopy was performed. Endoscopic examinations were recorded on video and assessed by 4 independent raters based on a scoring template.
  
  
  METHODS
  Five locations in the upper aerodigestive tract (adenoid, velum, lateral pharyngeal wall, tongue base, and supraglottis) were evaluated on a 4-point scale for minimum and maximum obstruction. Internal reliability was assessed by calculating interrater and intrarater intraclass correlation coefficients (ICCs). For external validation, aggregate and site-specific scores were correlated with preoperative polysomnographic indices.
  
  
  RESULTS
  Videos recorded of sleep endoscopies from 23 children (mean age, 2.2 years) were reviewed and rated. Children had an average apnea-hypopnea index of 24.8. Seventy percent of interrater and intrarater ICC values (7 of 10 for each set) were above 0.6, demonstrating substantial agreement. Higher total obstructive scores were associated with lower oxygen saturation nadir (P = .04). The scoring system was also used to quantitatively identify children with multilevel airway obstruction, who were found to have significantly worse polysomnographic indices compared with children with single-level obstruction (P = .02).
  
  
  CONCLUSIONS
  The proposed scoring system, which is designed to be easy to use and allow for subjectivity in evaluating obstruction at multiple levels, nonetheless achieves good internal reliability and external validity. Implementing this system will allow for standardization of reporting for sleep endoscopy outcomes, as well as aid the practicing clinician in the interpretation of sleep endoscopy findings to inform site-directed surgical intervention in cases of complicated obstructive sleep apnea.
authors.affiliation: Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.
authors.forename: Dylan K
authors.initials: DK
authors.lastname: Chan
authors.affiliation: Division of Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Liming
authors.affiliation: Division of Pediatric Otolaryngology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle.
authors.forename: David L
authors.initials: DL
authors.lastname: Horn
authors.affiliation: Division of Pediatric Otolaryngology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Parikh
mesh_terms: D000402:Airway Obstruction / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods*; D017286:Polysomnography; D015203:Reproducibility of Results; D012107:Research Design / Q000592:standards; D012189:Retrospective Studies; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D014741:Video Recording