Validation of Sleep Nasopharyngoscopy (SNP) in Children with Snoring/Sleep-Disordered Breathing

Abstract

Objectives:

Propose and validate a scoring system of the findings of sleep nasopharyngoscopy (SNP) for children with sleep disordered breathing (SBD).

Methods:

We conducted an inter- and intra-rater agreement study on video documentations of SNP performed on children (non-syndromic or dysmorphic) presenting with SDB. Videos used represented different types of pharyngeal findings including normal, collapse, mixed picture, or obstruction. Three “non-expert” raters at various stages in their otolaryngological career rated the videos twice and independently. One calculation assumed equal spacing between categories, the second assumed unequal spacing between the first and the second two based on need for surgical intervention.

Results:

Sixty-three videos were rated by each observer (2 weeks apart). None were syndromic or dysmorphic patients. Intra-observer agreement was 0.6442 ± 0.0835 (95%CI 0.4806-0.8078), 0.7373 ± 0.0718 (95%CI 0.5965-0.8781), 0.5853 ± 0.0789 (95%CI 0.4306-0.74), for raters 1, 2, and 3. Weighted kappa was 0.593 ± 0.1864 (95%CI 0.2277-0.9583), 0.85 ± 0.0884 (95%CI 0.6848-1), 0.79 ± 0.0772 (95%CI 0.6458-0.9506), respectively. Inter-rater agreements between raters 1 and 2, 2 and 3, 3 and 4 were 0.8304 ± 0.0604 (95%CI 0.7119-0.9489), 0.5168 ± 0.0827 (95%CI 0.3546-0.697), and 0.5306 ± 0.0829 (95%CI 0.368-0.693), respectively. Weighted kappa was 0.81 ± 0.1504 (95%CI 0.5231-1), 0.72 ± 0.1147 (95%CI 0.5-0.95), and 0.6658 ± 0.052 (95%CI 0.5253-0.8), respectively.

Conclusions:

This is the first proposed scoring method for SNP in children. It is based on a generic interpretation of SNP into four types. Overall reproducibility among the three raters and their agreement was good.