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European Archives of Oto-Rhino-Laryngology

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Open Access 01-06-2018 | Laryngology

Low inter-examiner agreement of the Friedman staging system indicating limited value in patient selection

Authors: Joar Sundman, Johan Fehrm, Danielle Friberg

Published in: European Archives of Oto-Rhino-Laryngology | Issue 6/2018

Abstract

Purpose

The Friedman staging system is a clinical method for selecting patients with obstructive sleep apnoea who are likely to benefit from uvulopalatopharyngoplasty. The objective of this study was to evaluate the system by determining its inter-examiner agreement.

Methods

Twelve patients with obstructive sleep apnoea were examined by 14 doctors. The Friedman stage was derived from tonsil size and tongue position, and a Cohen’s kappa analysis was performed to assess inter-examiner agreement.

Results

One hundred and sixty-eight ratings were performed. The median kappa for tongue position was 0.32 (first and third quartiles: 0.21 and 0.44) and was 0.62 (0.50 and 0.63) for tonsil size. The median kappa for the Friedman stage was 0.38 (0.24 and 0.55), which corresponds to only a slight or fair agreement.

Conclusion

The Friedman staging system demonstrated a low inter-examiner agreement, indicating that the system is an uncertain method for selecting patients for uvulopalatopharyngoplasty.

Level of evidence

2B.

Friedman M, Ibrahim H, Bass L (2002) Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg 127(1):13–21. https://doi.org/10.1067/mhn.2002.126477 CrossRefPubMed

Li H-Y, Wang P-C, Lee L-A, Chen N-H, Fang T-J (2006) Prediction of uvulopalatopharyngoplasty outcome: anatomy-based staging system versus severity-based staging system. Sleep 29(12):1537–1541CrossRefPubMed

Browaldh N, Nerfeldt P, Lysdahl M, Bring J, Friberg D (2013) SKUP3 randomised controlled trial: polysomnographic results after uvulopalatopharyngoplasty in selected patients with obstructive sleep apnoea. Thorax 68(9):846–853CrossRefPubMed

Browaldh N, Bring J, Friberg D (2017) SKUP3: 6 and 24 months follow-up of changes in respiration and sleepiness after modified UPPP. Laryngoscope 1–7. https://doi.org/10.1002/lary.26835

Friedman M, Soans R, Gurpinar B, Lin HC, Joseph NJ (2008) Interexaminer agreement of Friedman tongue positions for staging of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 139(3):372–377CrossRefPubMed

Ingram DG, Ruiz A, Friedman NR (2015) Friedman tongue position: age distribution and relationship to sleep-disordered breathing. Int J Pediatr Otorhinolaryngol 79(5):666–670CrossRefPubMed

Sundman J, Bring J, Friberg D (2017) Poor interexaminer agreement on Friedman tongue position. Acta Otolaryngol 137(5):554–556CrossRefPubMed

Byrt T (1996) How good is that agreement? Epidemiology 7(5):561CrossRefPubMed

Ashby D (1991) Practical statistics for medical research. Douglas G. Altman, Chapman and Hall, London

10.

R Core Team (2017) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

11.

Rodenstein DO, Stănescu DC (1986) The soft palate and breathing. Am Rev Respir Dis 134(2):311–325PubMed

12.

Friedman M, Salapatas AM, Bonzelaar LB (2017) Updated friedman staging system for obstructive sleep apnea. Adv Otorhinolaryngol 80:41–48PubMed

13.

Certal VF, Pratas R, Guimarães L et al (2015) Awake examination versus DISE for surgical decision making in patients with OSA: a systematic review. Laryngoscope 126(10):1–7

14.

Huntley C, Chou D, Doghramji K, Boon M (2017) Preoperative drug induced sleep endoscopy improves the surgical approach to treatment of obstructive sleep apnea. Ann Otol Rhinol Laryngol 126(6):478–482CrossRefPubMed

15.

Vanderveken OM, Maurer JT, Hohenhorst W et al (2013) Evaluation of drug-induced sleep endoscopy as a patient selection tool for implanted upper airway stimulation for obstructive sleep apnea. J Clin Sleep Med 9(5):433–438PubMedPubMedCentral

Title: Low inter-examiner agreement of the Friedman staging system indicating limited value in patient selection
Authors: Joar Sundman
Johan Fehrm
Danielle Friberg
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 6/2018
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-018-4970-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Low inter-examiner agreement of the Friedman staging system indicating limited value in patient selection

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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