Interrater Reliability of Drug-Induced Sleep Endoscopy
Interrater Reliability of Drug-Induced Sleep Endoscopy
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DOI：
10.1001/archoto.2010.26
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发表时间：
2010-04-01
影响因子：
--
通讯作者：
Goldberg, Andrew N.
中科院分区：
文献类型：
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作者：
Kezirian, Eric J.;White, David P.;Goldberg, Andrew N.
目的：确定药物诱导睡眠内窥镜检查(DISE)的评价者间可靠性。设计：前瞻性队列；盲法对照。设置：学术参考中心。参与者：无法耐受正压治疗的阻塞性睡眠呼吸暂停患者。干预：药物诱导睡眠内窥镜检查采用静脉注射异丙酚以达到镇静，视频内窥镜检查记录由两名独立的评价者评估。主要观察指标：测量以下结果：对腭锚下咽阻塞的总体评估；腭部和下咽的阻塞程度；以及个体结构(腭部、扁桃体、舌部、会厌和咽侧壁)对阻塞的影响。结果：共108名受试者接受了DISE检查。诊断性睡眠研究显示平均(SD)呼吸暂停-低呼吸指数为39.6(24.0)。四分之三的受试者在腭部和下咽部表现出多平面的呼吸道阻塞，不同的个体结构导致了阻塞。对于腭部和下咽部是否存在梗阻，评价者之间的可信度(kappa值分别为0.76和0.79)高于梗阻程度(加权kappa值分别为0.60和0.44)。评价者之间评估导致腭部和下咽部阻塞的主要结构的可靠性(0.70和0.86)高于单个结构的可靠性(kappa值，0.42-0.71)。DISE对下咽结构评价的评定者间信度高于上颌区。结论：DISE评定者间信度为中等到较高。
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.