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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
Reliability of a pediatric sleep endoscopy scoring system
Adrian Williamson1, Wei Fang2, Matthew J Kabalan3
1Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA.
Insights
A new scoring system for pediatric Obstructive Sleep Apnea (OSA) using Drug Induced Sleep Endoscopy (DISE) shows reliability comparable to the VOTE system. This novel DISE scoring method may improve surgical decision-making for children with OSA.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Surgical Assessment
Background:
- Obstructive Sleep Apnea (OSA) in children often requires surgical intervention.
- Drug Induced Sleep Endoscopy (DISE) aids surgical planning, but lacks a standardized scoring system for pediatric patients.
- Current systems, like VOTE, may not capture all relevant airway obstruction sites.
Purpose of the Study:
- To compare the reliability and utility of a novel DISE scoring system against the established VOTE system in pediatric OSA.
- To evaluate the performance of both systems in guiding surgical recommendations.
Main Methods:
- Thirty pediatric DISE videos were scored twice by five raters using both VOTE and the novel system.
- Intra-rater and inter-rater reliability were assessed using weighted kappa (WK) and Krippendorff's alpha (KA).
- Surgical intervention recommendations were analyzed for test-retest reliability.
Main Results:
- The novel system demonstrated comparable intra-rater reliability (WK: 0.62-0.87) to the VOTE system (WK: 0.50-1.00).
- Inter-rater reliability (KA) was also similar between the systems.
- While no significant difference was found in WK, the novel system showed a significant difference in percentage agreement (PA) (p=0.01).
Conclusions:
- The novel DISE scoring system exhibits reliable intra-rater and inter-rater performance in pediatric OSA.
- It offers a more comprehensive assessment by including additional sites of obstruction.
- The system shows promise for broader clinical adoption in managing pediatric OSA.
Introduction:
The surgical management of Obstructive Sleep Apnea (OSA) may be guided by Drug Induced Sleep Endoscopy (DISE), but there is no universally accepted scoring system for DISE in children. The purpose of this study is to compare a novel system to the more commonly used VOTE (Velum, Oropharynx, Tongue base, Epiglottis) system.
Methods:
A total of thirty pediatric DISE videos were reviewed and scored twice by 5 raters with a range of experience levels. The videos were scored using both the VOTE and the new scoring systems. The raters were also asked to recommend surgical intervention based on the DISE exam alone. Intra-rater test-retest analysis of the responses was conducted using weighted kappa (WK) statistic and percentage agreement (PA), respectively. Inter-rater reliability analysis of responses was evaluated using Krippendorff's alpha reliability coefficient (KA). Using a proportional odds model, a comparison of the weighted kappa statistic for the VOTE and the novel scoring systems was conducted.
Results:
For the novel scoring system, the intra-rater test-retest WK coefficient was 0.62 and 0.87 and the PA was 64% and 82% at the 25th and 75th percentiles, respectively. For the VOTE system, the intra-rater test-retest WK coefficient was 0.50 and 1.00 and PA was 75% and 100% at the 25th and 75th percentiles, respectively. KA was 0.36 and 0.77 at the 25th and 75th percentiles. In addition, responses to the surgical intervention survey analysis yielded a test-retest WK coefficient of 0.40 and 1.00 and a PA 71%-100% at the 25th and 75th percentiles, respectively. KA was 0.40 and 0.61 at the 25th and 75th percentiles, respectively. There was no significant difference between the 2 scoring systems on the WK statistic (p = .15), but significant difference on PA (p = .01).
Conclusion:
Our novel scoring system demonstrated intra-rater test-retest and inter-rater reliability similar to the VOTE system, includes more sites of potential airway obstruction, and has potential for widespread use.
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