Interrater reliability of sleep videofluoroscopy for airway obstruction in obstructive sleep apnea

Objectives/Hypothesis Sleep videofluoroscopy (SVF) has been introduced to identify upper airway obstruction. This study was aimed to determine the interrater reliability of SVF in patients with obstructive sleep apnea (OSA). Study Design A retrospective analysis. Methods On the basis of apnea-hypopnea index in full-night attended polysomnography, 374 consecutive OSA patients who underwent SVF were enrolled in this study. The SVF was evaluated by three independent reviewers. Interrater reliabilities were assessed by evaluating agreement of the obstructive anatomic structures (soft palate, tongue base, tonsils, and epiglottis) and airway levels (velopharynx, oropharynx, and hypopharynx) between the reviewers. Results In a comparison between an unblinded and a blinded well-experienced sleep surgeons, the interrater reliability for the presence of obstruction was the highest for the soft palate at the level of the velopharynx (Cohen's kappa value, 0.919) and the lowest for the soft palate at the level of the oropharynx (Cohen's kappa value, 0.757). In a blind comparison between a well-experienced and less-experienced sleep surgeons, the interrater reliability for the presence of obstruction was also the highest for the soft palate at the level of the velopharynx (Cohen's kappa value, 0.938) and the lowest for the palatine tonsils at the level of the oropharynx (Cohen's kappa value, 0.635). Conclusion This study showed that SVF was a diagnostic modality that can be used to evaluate upper airway obstruction without significant interrater disagreements. Level of Evidence 4. Laryngoscope, 124:1267-1271, 2014