Interrater Reliability of Drug-Induced Sleep Endoscopy

Objective: To determine the interrater reliability of drug-induced sleep endoscopy (DISE). Design: Prospective cohort; blinded comparison. Setting: Academic referral center. Participants: Subjects with obstructive sleep apnea unable to tolerate positive airway pressure therapy. Interventions: Drug-induced sleep endoscopy was performed with intravenous propofol infusion to achieve sedation, and the videoendoscopy recording was evaluated by 2 independent reviewers. Main Outcome Measures: The following outcomes were measured: a global assessment of obstruction at the palate anchor hypopharynx; the degree of obstruction at the palate and hypopharynx; and the contribution of individual structures (palate, tonsils, tongue, epiglottis, and lateral pharyngeal walls) to obstruction. Results: A total of 108 subjects underwent DISE examination. Diagnostic sleep studies demonstrated a mean (SD) apnea-hypopnea index of 39.6 (24.0). Three-quarters of the subjects demonstrated multilevel airway obstruction at the palate and hypopharynx, with a diversity of individual structures contributing to obstruction. The interrater reliability for the presence of obstruction at the palate and hypopharynx (kappa values, 0.76 and 0.79, respectively) was higher than for the degree of obstruction (weighted kappa values, 0.60 and 0.44). The interrater reliability for the assessment of primary structures contributing to obstruction at the palate and hypopharynx (0.70 and 0.86) was higher than for the contributions of individual structures (kappa values, 0.42-0.71). The interrater reliability for evaluation of the hypopharyngeal structures was higher than for those of the palate region. Conclusion: The interrater reliability of DISE is moderate to substantial.