Interexaminer agreement of Friedman tongue positions for staging of obstructive sleep apnea/hypopnea syndrome.

ABSTRACT

OBJECTIVE: To determine if strong interexaminer agreement exists in identifying Friedman tongue positions (FTPs) for staging of obstructive sleep apnea/hypopnea syndrome (OSAHS). STUDY DESIGN AND METHODS: Twenty-six digital video clips of oropharyngeal examinations were prepared to demonstrate FTPs I through IV. Specific parameters for each FTP were provided to 126 examiners (otolaryngology residents, attendings, and fellows). The video clips were then presented to the examiners to determine the FTP. Kappa statistical analysis was used to evaluate the degree of intergrader agreement or disagreement. RESULTS: A generalized kappa statistic of 0.8 is considered the upper limits of substantial agreement. Thus, the overall kappa value (0.82) as well as all the subgroup kappa values for attendings (0.84), fellows (0.87), and residents (0.84) represented "very good" agreement. CONCLUSION: The strong interexaminer correlation of FTP demonstrated by this study indicates that FTP may be a useful adjunct in describing hypopharyngeal anatomy in patients with OSAHS.