Author(s)
Michelle Buncke, MD
Rukaya Fareh, BS
Derek Lam, MD, MPH
Affiliation(s)
Oregon Health and Sciences University
Abstract:
Introduction: Test-retest reliability and changes in drug-induced sleep endoscopy (DISE) after surgical treatment in children with OSA has not been well-studied. Our aims were: 1) to evaluate the test-retest reliability of DISE, and 2) compare changes in DISE among children who underwent surgery to those who did not.
Methods: This is a retrospective cohort study of children who underwent multiple DISE procedures. The electronic medical record was reviewed for demographics, comorbidities, and surgical data. DISE findings were scored using the IPSES (International Pediatric Sleep Endoscopy Scale). Linearly weighted kappa analysis was used to determine test-retest reliability in children who had no intervention between DISE procedures (Group 1). Mean changes in IPSES score at each anatomic level were compared using t-tests between Group 1 and children who underwent surgery between DISE exams (Group 2).
Results: n = 48 (23 in Group 1, 25 in Group 2). Children in Group 1 were slightly younger (mean age 7.2 vs 9.4 years, p = 0.002) and had a longer interval between DISE exams, but this was not statistically significant (468 days vs 308 days, p = 0.06). The percentage of comorbidities including down syndrome, neuromuscular disorders, craniofacial abnormalities, and asthma, did not differ significantly between group 1 and group 2. Reliability of repeated DISE exams without intervention (Group 1) was weak at the arytenoids and nasal airway (kappa = 0.17 and 0.06 respectively), moderate at the nasopharynx, velopharynx and base of tongue (kappa = 0.43, 0.36 and 0.40 respectively), and good at the epiglottis and oropharynx (kappa = 0.53 and 0.67 respectively). Mean changes in IPSES ratings at the nasopharynx were significantly greater (–0.48 vs 0.09) in Group 2 compared to Group 1 (p = 0.003).
Conclusion: DISE is most reliable in assessing the epiglottis, oropharynx, nasopharynx, velopharynx and base of tongue, but may not be reliable in assessing the arytenoids and nasal airway. Sleep surgery leads to observable changes in DISE scores.