Validation of pharyngeal findings on sleep nasopharyngoscopy in children with snoring/sleep disordered breathing

Abstract

ObjectiveTo validate the pharyngeal findings in sleep nasopharyngoscopy (SNP) of children with snoring - sleep disordered breathing (S-SDB).DesignProspective agreement diagnostic study on retrospective data.MethodsWe conducted an inter-and intra-rater agreement study on video documentations of SNP performed on children (non-syndromic, complex, or operated upon) who presented with S-SDB. The videos featured various pharyngeal findings (normal, collapse, mixed or obstruction). Three ‘non-expert’ raters at various stages in their otolaryngological careers rated the videos independently, and on two separate occasions following an instructional session. We calculated both weighted and non-weighted linear kappa.ResultsEach independent observer rated sixty-one videos (2 weeks apart). Intra-observer agreement was 0.64 ± 0.08 (95% CI 0.48-0.81), 0.74 ± 0.07 (95% CI 0.60-0.88), 0.59 ± 0.08 (95% CI 0.43-0.74), for raters 1, two and three. Weighted kappa was 0.6 ± 0.1 (95% CI 0.41-0.79), 0.8 ± 0.06 (95% CI 0.7-0.92), 0.7 ± 0.07 (95% CI 0.57-0.83), respectively. Inter-rater agreements between raters one and two, two and three, three and four were 0.83 ± 0.06 (95% CI 0.71-0.95), 0.52 ± 0.08 (95% CI 0.36-0.70), and 0.53 ± 0.08 (95% CI 0.37-0.69), respectively. Weighted kappa was 0.83 ± 0.073 (95% CI 0.69-0.98), 0.68 ± 0.06 (95% CI 0.56-0.79), and 0.64 ± 0.07 (95% CI 0.49-0.78), respectively.ConclusionsThis is the first validation of pharyngeal findings on SNP in children. It is based on a four types’ classification. Overall reproducibility amongst the three raters and their agreement was moderate to good. Further work should be phase four trials investigating the impact on outcome.

Does drug-induced sleep endoscopy change the surgical decision in surgically naïve non-syndromic children with snoring/sleep disordered breathing from the standard adenotonsillectomy? A retrospective cohort study

“…A consistent combination of remifentanyl (2–2.5 mcg/ml) and propofol (200–350 mcg/kg/min) was used for maintenance. If an inhalational anesthetic was used for induction, the tidal volume was ensured to be zero prior to performing DISE [ 8 ]. Lignocaine (1%) was used to topically anesthetize the nasal mucosa.…”

“…The scoring system used is summarized in Table 1 . This system has been described in previous studies and has been shown to have good intra- and inter-rater reliability [ 8 , 20 , 34 ]. Nasal septal deviation (NSD) was graded on a 3 point scale (1: absent, 2:<50% compromise of nasal patency, 3:≥50% compromise of nasal patency), and the degree of rhinitis was graded according to a 3 point endoscopic rhinitis score (ERS) (Grade1, no obstruction to either side (mild or no rhinitis); grade 2, obstruction to 1 side; and grade 3, bilateral obstruction) [ 34 ].…”

“…Depending on the severity, S/SDB can have detrimental health effects including behavioral issues, learning difficulties, educational underperformance, pulmonary hypertension, cor pulmonale, increased healthcare utilization and overall poor quality of life [ 1 , 3 – 7 ]. In otherwise healthy children, adenotonsillar hypertrophy is widely accepted as the most common cause of S/SDB [ 3 , 8 – 10 ]. Moreover, the American Academy of Pediatrics (AAP) endorses adenotonsillectomy (AT) as the first line treatment in all children with S/SDB in its clinical practice guidelines [ 4 ].…”

The relationship between upper airway collapse and the severity of obstructive sleep apnea syndrome: a chart review

“…It must be noted that because our study involves the subjective evaluations of three different physicians on the degree of upper airway obstruction, there may be inherent inter-observer variation. A recent study by Ramji et al [ 19 ] tested inter- and intra-rater agreement on sixty-one recorded videos of children undergoing a sleep nasopharyngoscopy. The authors concluded that there was validation for this procedure with good inter- and intra-rater agreement.…”

Correlation between gonial angle and dynamic tongue collapse in children with snoring/sleep disordered breathing – an exploratory pilot study

“…On the other hand, there are two patterns of pharyngeal compromise that may occur in SDB, namely pharyngeal obstruction or collapse, and can be identified on drug induced sleep endoscopy (DISE) or imaging [ 17 , 18 ]. The pharynx may exhibit collapse upon inspiration in concentrically, lateral wall to lateral wall, or at the tongue base level [ 17 ]. The significance and associations related to each type of collapse has neither been studied nor determined to date.…”