title: Assessment of pediatric obstructive sleep apnea using a drug-induced sleep endoscopy rating scale.
abstract: Assess the reliability of a Sleep Endoscopy Rating Scale (SERS) and its relationship with pediatric obstructive sleep apnea (OSA) severity.
  
  
  
  Retrospective case series of pediatric patients who underwent drug-induced sleep endoscopy (DISE) at the time of surgery for OSA from January 1, 2013 to May 1, 2014.
  
  
  
  Three blinded otolaryngologists scored obstruction on DISE recordings as absent (0), partial (+1), or complete (+2) at six anatomic levels: nasal airway, nasopharynx, velopharynx, oropharynx, hypopharynx, and arytenoids. Ratings were summed for a SERS total score (range, 0-12). Reliability was calculated using a κ statistic with linear weighting. SERS ratings and obstructive apnea-hypopnea index (OAHI) were compared using Spearman correlation. A receiver operating characteristic (ROC) analysis determined the ability of the SERS total score to predict severe OSA (OAHI >10).
  
  
  
  Thirty-nine patients were included (mean age, 8.3 ± 5.1 years; 36% obese; mean OAHI, 19.1 ± 23.7). Intrarater and inter-rater reliability was substantial-to-excellent (κ = 0.61-0.83) and fair-to-substantial (κ = 0.33-0.76), respectively. Ratings correlated best with OAHI for the oropharynx (r = 0.54, P = .02), hypopharynx (r = 0.48, P = .04), and SERS total score (r = 0.75, P = .002). In ROC analysis, a SERS total score ≥6 demonstrated sensitivity/specificity of 81.8%/87.5%, respectively, and correctly classified 84% of patients.
  
  
  
  The SERS can be applied reliably in children undergoing DISE for OSA. Ratings of the oropharynx, hypopharynx, and SERS total score demonstrated significant correlation with OSA severity. A SERS total score ≥6 was an accurate predictor of severe OSA.
  
  
  
  4. Laryngoscope, 126:1492-1498, 2016.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Lam
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Weaver
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Macarthur
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Milczuk
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.
authors.forename: Eleni
authors.initials: E
authors.lastname: O'Neill
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
authors.affiliation: Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health and Science University, Portland, Oregon.
authors.forename: Thuan
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon, U.S.A.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Shea
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D010614:Pharynx / Q000503:physiopathology; D017286:Polysomnography / Q000379:methods / Q000706:statistics & numerical data*; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D018709:Statistics, Nonparametric; D063189:Symptom Assessment / Q000379:methods / Q000706:statistics & numerical data*
keywords: Pediatric sleep apnea; adenotonsillectomy; drug-induced sleep endoscopy; obstructive sleep apnea