Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Baselland, Liestal, Switzerland.
Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Freiburgstrasse 20, Bern, 3010, Switzerland.
Sleep Breath. 2024 Nov 29;29(1):27. doi: 10.1007/s11325-024-03190-2.
To explore the interobserver reliability of drug-induced sleep endoscopy (DISE) for patients with obstructive sleep apnea syndrome (OSAS) of two classification systems.
DISE examinations were recorded digitally for all patients and were evaluated independently by five examiners blinded to all patient data. Areas of obstruction were rated using VOTE (velum, oropharynx lateral wall, tongue base, epiglottis) classification and PTLTbE (palate, tonsils, lateral pharyngeal wall, tongue base, epiglottis) classification. Additionally, palatal coupling was assessed during the jaw thrust maneuver. Interobserver reliability was evaluated with Fleiss' kappa for categorical data and linearly weighted kappa for ordinal data.
In total, 123 patients were included in this study, 92 males and 31 females, with a mean (SD) age of 50.7 (12.1) years and a body mass index (BMI) of 28.3 (5.0) kg/m2. The mean apnea-hypopnea index was 22.2 (18) per hour, and the Epworth Sleepiness Scale was 7.3 (2.3). In our cohort, the interobserver reliability for the VOTE classification ranged from 0.32 to 0.59 and for the PTLTbE classification from 0.23 to 0.49 over all assessed levels, indicating fair to moderate interobserver reliability. The weighted kappa for palatal coupling was 0.37. In the VOTE classification, the level with the best agreement was the velum, while in PTLTbE, the best agreement was observed for tonsillar obstruction.
The interrater agreement was fair to moderate for both classifications, with no clear superiority for one classification. The large variability shows the need to objectively quantify upper airway collapse during DISE and natural sleep endoscopy.
探讨两种分类系统在阻塞性睡眠呼吸暂停综合征（OSAS）患者药物诱导睡眠内镜（DISE）中的观察者间可靠性。
对所有患者的 DISE 检查均进行数字记录，并由 5 名对所有患者数据均不知情的观察者进行独立评估。使用 VOTE（软腭、口咽侧壁、舌根、会厌）分类和 PTLTbE（腭、扁桃体、咽侧壁、舌根、会厌）分类评估阻塞部位。此外，在颏部推挤试验期间评估腭部耦合。使用 Fleiss'kappa 评估分类数据的观察者间可靠性，使用线性加权 kappa 评估有序数据的观察者间可靠性。
本研究共纳入 123 例患者，男 92 例，女 31 例，平均（SD）年龄为 50.7（12.1）岁，体重指数（BMI）为 28.3（5.0）kg/m2。平均呼吸暂停低通气指数为 22.2（18）/小时，Epworth 嗜睡量表评分为 7.3（2.3）。在我们的队列中，VOTE 分类的观察者间可靠性在所有评估水平上为 0.32 至 0.59，PTLTbE 分类的观察者间可靠性为 0.23 至 0.49，表明观察者间可靠性为中等至良好。腭部耦合的加权 kappa 值为 0.37。在 VOTE 分类中，一致性最好的是软腭，而在 PTLTbE 中，扁桃体阻塞的一致性最好。
两种分类的观察者间一致性为中等至良好，没有一种分类具有明显优势。较大的变异性表明需要在 DISE 和自然睡眠内镜检查期间客观地量化上气道塌陷。
