title: Inter-examiner agreement of the systematic physical examination in patients with obstructive sleep disorders.
abstract: OBJECTIVE
  The goal of this study was to investigate the agreement between examiners who were or were not trained in the physical examination of the upper airway (UA) and the craniofacial skeleton of individuals with obstructive sleep disorders (OSD).
  
  
  METHODS
  A systematic assessment of the UA and craniofacial skeleton was performed on 55 individuals with OSD. The participants were consecutively assessed by three otorhinolaryngologists who specialized in sleep medicine for at least 1 year (trained examiners) and two doctors who were attending a residency program in otorhinolaryngology (untrained examiners).
  
  
  RESULTS
  When analyzing all of the parameters assessed, the concordance was better in the trained group (k = 0.694, which is considered "good") compared to the untrained group (k = 0.475, "fair") (p < 0.001). The inter-examiner agreement was also better in the trained compared to the untrained group, as follows: craniofacial (k = 0.643 vs. 0.349), nasal (k = 0.657 vs. 0.614), and pharyngeal (k = 0.729 vs. 0.276) abnormalities (p < 0.05).
  
  
  CONCLUSIONS
  The overall concordance of the physical examination of the UA and craniofacial skeleton was "good" among the trained specialists and "fair" among examiners without appropriate training, despite its subjectivity.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo-UNIFESP, São Paulo, Brazil. danilo_sguillar@hotmail.com.|, Rua Maestro Cardim 770, Bela Vista, São Paulo, SP, CEP 01323 001, Brazil. danilo_sguillar@hotmail.com.
authors.forename: Danilo Anunciatto
authors.initials: DA
authors.lastname: Sguillar
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Tatiana
authors.initials: T
authors.lastname: de Aguiar Vidigal
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: João Paulo
authors.identifier: http://orcid.org/0000-0002-9441-1489
authors.initials: JP
authors.lastname: Mangussi
authors.affiliation: Discipline of Sleep Medicine and Biology, Department of Psychobiology, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Lia
authors.initials: L
authors.lastname: Bittencourt
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Gregório
authors.affiliation: Discipline of Sleep Medicine and Biology, Department of Psychobiology, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
authors.affiliation: Department of Psychobiology, Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Fernanda Louise Martinho
authors.initials: FLM
authors.lastname: Haddad
mesh_terms: D000328:Adult; D019465:Craniofacial Abnormalities / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000150:complications* / Q000175:diagnosis*; D009305:Nasopharynx / Q000002:abnormalities*; D015588:Observer Variation; D010036:Otolaryngology / Q000193:education; D010808:Physical Examination / Q000706:statistics & numerical data*; D011446:Prospective Studies; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000209:etiology*
keywords: Obstructive sleep apnea; Physical examination; Reproducibility; Snoring; Upper airway