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World J Otorhinolaryngol Head Neck Surg. 2017 Jun 9;3(2):92-96. doi: 10.1016/j.wjorl.2017.05.014. eCollection 2017 Jun.

Application of drug-induced sleep endoscopy in patients treated with upper airway stimulation therapy.

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Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Otorhinolaryngology-Head and Neck Surgery, Saint Lucas Andreas Hospital, Amsterdam, The Netherlands.
Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
Department of Otolaryngology-Head and Neck Surgery, University of Tennessee-Memphis, USA.



To determine the level of agreement among experienced operators of candidacy for upper airway stimulation (UAS) based on evaluation of drug-induced sleep endoscopy (DISE).


The trial was designed as a single-blinded cross-sectional study. Four otolaryngologists with extensive DISE experience were given 63 video clips from the STAR trial video library. These videos were graded using the VOTE classification. Percentage agreement and Cohen's κ (for inter-rater reliability) were calculated between pairs of reviewers, assessing palatal complete concentric collapse (CCC) and determining UAS eligibility. Subjects were also grouped based on collapse severity for each reviewer.


The reviewers had excellent (approximately 90%) agreement on findings at the level of the soft palate and tongue base. The inter-rater reliability for palatal CCC ranged from moderate to substantial. The agreement on determining the criteria for UAS implantation ranged from poor to moderate. All 4 upper airway structures as classified by the criteria of the VOTE were graded by all the reviewers as contributing to obstruction in a majority of subjects who were performed via application of DISE.


Application of DISE remains a subjective examination, even among those experienced operators, therefore more studies need to be performed for evaluation of improvement in inter-rater reliability after implantation of training videos.


Drug-induced sedation endoscopy; Drug-induced sleep endoscopy; Inter-rater reliability; Obstructive sleep apnea; Sleep-disordered breathing; Upper airway stimulation

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