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Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Assessment of pediatric obstructive sleep apnea using a drug-induced sleep endoscopy rating scale
Derek J Lam1, Edward M Weaver2, Carol J Macarthur1
1Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.
Insights
The Sleep Endoscopy Rating Scale (SERS) reliably assesses pediatric obstructive sleep apnea (OSA) severity. A SERS score of 6 or higher accurately predicts severe OSA in children.
Area of Science:
- Otolaryngology
- Pediatric Sleep Medicine
- Respiratory Medicine
Background:
- Obstructive sleep apnea (OSA) is a common respiratory disorder in children.
- Accurate assessment of OSA severity is crucial for effective treatment planning.
Purpose of the Study:
- To evaluate the reliability of the Sleep Endoscopy Rating Scale (SERS) in pediatric patients.
- To determine the correlation between SERS scores and the severity of pediatric OSA.
- To assess the SERS's ability to predict severe OSA.
Main Methods:
- Retrospective case series of pediatric patients undergoing drug-induced sleep endoscopy (DISE).
- Three blinded otolaryngologists scored obstruction at six anatomical levels using the SERS.
- Reliability was assessed using κ statistic; correlation with apnea-hypopnea index (OAHI) was analyzed using Spearman correlation.
- Receiver operating characteristic (ROC) analysis determined the predictive ability of SERS for severe OSA.
Main Results:
- Intrarater and inter-rater reliability for SERS were substantial-to-excellent (κ = 0.61-0.83) and fair-to-substantial (κ = 0.33-0.76), respectively.
- SERS total scores and oropharyngeal/hypopharyngeal ratings showed significant correlation with OAHI (r = 0.75, P = .002 for total score).
- A SERS total score ≥6 demonstrated 81.8% sensitivity and 87.5% specificity for predicting severe OSA, correctly classifying 84% of patients.
Conclusions:
- The SERS is a reliable tool for assessing pediatric patients during DISE for OSA.
- SERS ratings, particularly for the oropharynx, hypopharynx, and overall score, correlate significantly with OSA severity.
- A SERS total score of 6 or higher accurately predicts severe pediatric OSA.
Objectives/Hypothesis:
Assess the reliability of a Sleep Endoscopy Rating Scale (SERS) and its relationship with pediatric obstructive sleep apnea (OSA) severity.
Study Design:
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.
Methods:
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).
Results:
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.
Conclusions:
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.
Level Of Evidence:
4. Laryngoscope, 126:1492-1498, 2016.
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