Reliability and Validity of a Pediatric Drug-Induced Sleep Endoscopy Grading System (PedDISE-8)

Drug-induced sleep endoscopy (DISE) is increasingly being used in children with obstructive sleep apnea (OSA) to identify specific sites of upper airway obstruction and plan surgical interventions. This study aims to test the reliability and validity of a new grading system for pediatric DISE procedures (PedDISE-8).

We conducted a retrospective chart review of children 0 to 18 years old with OSA who underwent DISE. Four independent raters reviewed and graded each video recording twice using the PedDISE-8. Eight upper airway sites were evaluated: inferior turbinates, adenoid, velum, tonsils/lateral pharyngeal walls, lingual tonsils, tongue base, epiglottis, and supra-arytenoid tissue. Intraclass correlation coefficients were calculated to determine inter-rater and intra-rater rating reliability for each site. External validity was assessed by analyzing the correlation between the number of sites with severe obstruction and polysomnographic data.

DISE recordings were reviewed for 86 pediatric patients, 59.5% of whom were male and 26.7% were obese. The median age was 3.5 (IQR 2.4-5.3) years, and the median obstructive apnea-hypopnea index (oAHI) was 5.5 (IQR 3.1-10.4). Moderate to good inter-rater and intra-rater reliability were found for all eight sites (intraclass correlation coefficient 0.67 to 0.88 and 0.71 to 0.87, respectively). The number of sites with severe obstruction correlated positively with the oAHI (τ = 0.119, P = .004).

The PedDISE-8 grading system demonstrated good inter-rater and intra-rater reliability and external validity. It can be used in children undergoing DISE for OSA.