Intra-rater and Inter-rater consistency of drug induced sleep endoscopy

Abstract

Objective: Drug induced sleep endoscopy (DISE) is a valuable tool which is used in the diagnosis of obstructive sleep apnea (OUA). The aim of this study is to evaluate inter-rater and intra-rater consistency of DISE.

Methods: 36 OSA patients with Apnea-hypopne index>5 included in this study. DISE was performed and recorded digitally for all patients, by the first author (OA1). VOTE scores were noted to procedure report in patients’ charts. Video records of DISE were blindly evaluated six months after the last procedure, by observer 1 for the second time (OA2) and by observer 2 (OB) for the first time. DISE was evaluated by using VOTE classification. OA1 and OA2 scores were compared to determine intra-rater reliability and OA2 and OB scores were compared to determine inter-rater reliability.

Results: Inter-rater consistency of DISE was poor to good. Highest consistency rate was found in velum at anteroposterior configuration, while the lowest was found in the same level at lateral configuration. Intra-rater consistency of DISE was moderate to excellent. Highest consistency rate was found in epiglottis at lateral configuration, while the lowest was found in oropharynx level.

Conclusion: OSA is condition with possible serious complications. DISE is a tool that could change the course of treatment in OSA. The validity of DISE is quite acceptable although a golden standard classification tool could enable us to “speak the exact same language” and will surely increase the diagnostic success of DISE.

Keywords

• Obstructive sleep apnea,drug-Induced abnormalities,endoscopy

References

1. 1. Guilleminault C, Hill MW, Simmons FB, Dement WC. Obstructive sleep apnea:electromyographic and fiberoptic studies. Exp Neurol 1978;62:48-67.
2. 2. Sullivan C, Berthon-Jones M, Issa F, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981;1:862-5.
3. 3. Grote L, Hedner J, Grunstein R, Kraiczi H. Therapy with nCPAP: incomplete elimination of sleep related breathing disorder. Eur Respir J 2000;16:921-7.
4. 4. Ravesloot M, de Vries N, Stuck BA. Treatment adherence should be taken into account when reporting treatment outcomes in obstructive sleep apnea. Laryngoscope 2014;124:344-5.
5. 5. DeVito A, Llatas MC, Vanni A, et al. European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 2014;18:453-65.
6. 6. Croft C, Pringle M. Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci 1991;16:504-9.
7. 7. Kezirian EJ. Nonresponders to pharyngeal surgery for obstructive sleep apnea: Insights from drug-induced sleep endoscopy. Laryngoscope 2011;121:1320-6.
8. 8. Koutsourelakis I, Safiruddin F, Ravesloot M, Zakynthinos S, de Vries N. Surgery for obstructive sleep apnea: sleep endoscopy determinants of outcome. Laryngoscope 2012;122:2587-91.

9. 9. Amos JM, Durr ML, Nardone HC, Baldassari CM, Duggins A, Ishman SL. Systematic review of drug-induced sleep endoscopy scoring systems. Otolaryngol Head and Neck Surg 2018;158:240-8.
10. 10. Kezirian EJ, White DP, Malhotra A, Ma W, McCulloch CE, Goldberg AN. Inter rater reliability of drug-induced sleep endoscopy. Arch Otolaryngol Head Neck Surg 2010;136:393-7.
11. 11. Vroegop AV, Vanderveken OM, Wouters K, et al. Observer variation in drug-induced sleep endoscopy: experienced versus nonexperienced ear, nose, and throat surgeons. Sleep 2013;36:947-53.
12. 12. Carrasco-LlatasM, Zerpa-Zerpa V, Dalmau-Galofre J. Reliability of drug-induced sedation endoscopy: interobserver agreement. Sleep and Breath 2017;21:173-9.
13. 13. Altintas A, Yegin Y, Çelik M, Kaya KH, Koç AK, Kayhan FT. Interobserver Consistency of Drug-Induced Sleep Endoscopy in Diagnosing Obstructive Sleep Apnea Using a VOTE Classification System. J Craniofac Surg 2018;29:140-3.
14. 14. KezirianEJ, Hohenhorst W, de Vries N. Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 2011;268:1233-6.
15. 15. Dijemeni E, D’Amone G, Gbati I. Drug-induced sedation endoscopy (DISE) classification systems: a systematic review and meta-analysis. Sleep Breath 2017;21:983-94.
16. 16. Nzekwu C, Dijemeni E. Drug-induced sleep endoscopy (DISE) scoring systems:ideal DISE scoring system and comparability properties. Otolaryngol Head Neck Surg 2018;158:777.
17. 17. Gillespie MB, Reddy RP, White DR, Discolo CM, Overdyk FJ, Nguyen SA. A trial of drug-induced sleep endoscopy in the surgical management of sleep-disordered breathing. Laryngoscope 2013;123:277-82.
18. 18. Rodriguez-BrunoK, Goldberg AN, McCulloch CE, Kezirian EJ. Test-retest reliabilityof drug-induced sleep endoscopy. Otolaryngol Head Neck Surg 2009;140:646-51.