Is image interpretation in drug-induced sleep endoscopy that reliable?
Previous studies have assessed drug-induced sleep endoscopy (DISE) as an interobserver reliable exam, with a learning curve effect. The objective was to check its assumed interobserver agreement and variability of between two groups of experienced and inexperienced French ENT physicians.
Prospective study. Seventy-six French ENT physicians (69 inexperienced in DISE and seven experienced) observed seven DISE videos. They were asked to determine the level(s), the configuration, and the degree of collapse, according to the VOTE classification. Specific and global agreements using the Fleiss’ Kappa coefficient (k) were calculated.
The interobserver agreement varied from poor to good in determining the level; the best agreement being found for the oropharynx (global agreement = 0.82 and k = 0.6 in the experienced group, global agreement = 0.87 and k = 0.7 in the inexperienced group), followed by the soft palate and the larynx; the worst agreement being found for the tongue base (k = 0.29 in the experienced group and k = 0.38 in the inexperienced group). The agreement for the configuration and the degree of collapse was moderate except for the tongue base where the concordance was poor. In both groups, agreement was at best good without any statistically significant difference between the two levels of experience groups.
Even in a French ENT Sleep Experts group, DISE appears to be a technique with a limited interobserver agreement in the detection of obstructive sites, without any learning curve effect. In its current state, DISE interpretation may not be totally reliable.
KeywordsDrug-induced sleep endoscopy Obstructive sleep apnea Reliability VOTE classification
Continuous positive airway pressure
Drug-induced sleep endoscopy
Ear nose throat
Obstructive sleep apnea
Respiratory Event Index
All the authors thank the participants in the study as well as the office of the French ENT Sleep Association (AFSORL) for the organization of the conference that allowed the study. We thank the physicians that provided the DISE videos: Dr. Olivier Gallet de Santerre, Dr. Xavier Dufour, Dr. Frédéric Chalumeau, Dr. Pierre Jean Monteyrol, and Dr. Laurent Yona. We also thank Ms Elodie Féliot, Biostatistics Department at Lariboisière Hospital, Paris, for her statistical calculations.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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