Ong Adrian A, Ayers Christopher M, Kezirian Eric J, Tucker Woodson B, de Vries Nico, Nguyen Shaun A, Boyd Gillespie M
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
World J Otorhinolaryngol Head Neck Surg. 2017 Jun 9;3(2):92-96. doi: 10.1016/j.wjorl.2017.05.014. eCollection 2017 Jun.
To determine the level of agreement among experienced operators of candidacy for upper airway stimulation (UAS) based on evaluation of drug-induced sleep endoscopy (DISE).
The trial was designed as a single-blinded cross-sectional study. Four otolaryngologists with extensive DISE experience were given 63 video clips from the STAR trial video library. These videos were graded using the VOTE classification. Percentage agreement and Cohen's κ (for inter-rater reliability) were calculated between pairs of reviewers, assessing palatal complete concentric collapse (CCC) and determining UAS eligibility. Subjects were also grouped based on collapse severity for each reviewer.
The reviewers had excellent (approximately 90%) agreement on findings at the level of the soft palate and tongue base. The inter-rater reliability for palatal CCC ranged from moderate to substantial. The agreement on determining the criteria for UAS implantation ranged from poor to moderate. All 4 upper airway structures as classified by the criteria of the VOTE were graded by all the reviewers as contributing to obstruction in a majority of subjects who were performed via application of DISE.
Application of DISE remains a subjective examination, even among those experienced operators, therefore more studies need to be performed for evaluation of improvement in inter-rater reliability after implantation of training videos.
基于药物诱导睡眠内镜检查（DISE）评估，确定经验丰富的上气道刺激（UAS）候选操作者之间的一致性水平。
该试验设计为单盲横断面研究。四名具有丰富DISE经验的耳鼻喉科医生观看了来自STAR试验视频库的63个视频片段。这些视频使用VOTE分类法进行分级。计算了成对审阅者之间的百分比一致性和科恩κ系数（用于评估评分者间信度），评估软腭完全同心塌陷（CCC）并确定UAS适用性。每位审阅者还根据塌陷严重程度对受试者进行了分组。
审阅者在软腭和舌根水平的检查结果上具有高度一致性（约90%）。软腭CCC的评分者间信度从中度到高度不等。在确定UAS植入标准方面的一致性从差到中等不等。所有审阅者根据VOTE标准对所有4个上气道结构进行分级，结果显示在大多数接受DISE检查的受试者中，这些结构均导致气道阻塞。
即使在经验丰富的操作者中，DISE的应用仍然是一项主观检查，因此需要进行更多研究以评估培训视频植入后评分者间信度的改善情况。
