Sleep and Breathing

, Volume 20, Issue 4, pp 1263–1268 | Cite as

Inter-examiner agreement of the systematic physical examination in patients with obstructive sleep disorders

  • Danilo Anunciatto Sguillar
  • Tatiana de Aguiar Vidigal
  • João Paulo Mangussi
  • Lia Bittencourt
  • Luiz Carlos Gregório
  • Sergio Tufik
  • Fernanda Louise Martinho Haddad
Sleep Breathing Physiology and Disorders • Original Article



The goal of this study was to investigate the agreement between examiners who were or were not trained in the physical examination of the upper airway (UA) and the craniofacial skeleton of individuals with obstructive sleep disorders (OSD).


A systematic assessment of the UA and craniofacial skeleton was performed on 55 individuals with OSD. The participants were consecutively assessed by three otorhinolaryngologists who specialized in sleep medicine for at least 1 year (trained examiners) and two doctors who were attending a residency program in otorhinolaryngology (untrained examiners).


When analyzing all of the parameters assessed, the concordance was better in the trained group (k = 0.694, which is considered “good”) compared to the untrained group (k = 0.475, “fair”) (p < 0.001). The inter-examiner agreement was also better in the trained compared to the untrained group, as follows: craniofacial (k = 0.643 vs. 0.349), nasal (k = 0.657 vs. 0.614), and pharyngeal (k = 0.729 vs. 0.276) abnormalities (p < 0.05).


The overall concordance of the physical examination of the UA and craniofacial skeleton was “good” among the trained specialists and “fair” among examiners without appropriate training, despite its subjectivity.


Physical examination Upper airway Obstructive sleep apnea Snoring Reproducibility 


Compliance with ethical standards


The authors declare that they have no funding.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

The study was approved by the institutional research ethics committee—Brazil Platform, ruling no. 226,524.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Danilo Anunciatto Sguillar
    • 1
    • 2
  • Tatiana de Aguiar Vidigal
    • 1
  • João Paulo Mangussi
    • 1
  • Lia Bittencourt
    • 3
  • Luiz Carlos Gregório
    • 1
  • Sergio Tufik
    • 3
  • Fernanda Louise Martinho Haddad
    • 4
  1. 1.Department of Otorhinolaryngology and Head and Neck SurgeryFederal University of São Paulo—UNIFESPSão PauloBrazil
  2. 2.São PauloBrazil
  3. 3.Discipline of Sleep Medicine and Biology, Department of PsychobiologyFederal University of São Paulo—UNIFESPSão PauloBrazil
  4. 4.Department of Psychobiology, Department of Otorhinolaryngology and Head and Neck SurgeryFederal University of São Paulo—UNIFESPSão PauloBrazil

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