Poor interexaminer agreement on Friedman tongue position

Abstract

Conclusion: The Friedman tongue position demonstrated only a slight inter-examiner agreement among 15 medical doctors, indicating that the method is difficult to perform and could be an uncertain method to select patients for uvulopalatopharyngoplasty.

Objective: The Friedman staging system is a clinical tool for selecting patients with obstructive sleep apnea who are appropriate for uvulopalatopharyngoplasty. The objective of this study was to evaluate the staging system by determining the inter-examiner agreement of one of its key components, the Friedman tongue position.

Methods: Eleven residents and four specialists in Otorhinolaryngology were recruited from a course in surgical management of obstructive sleep apnea. They examined each other’s tongue positions, resulting in a total of 210 evaluations. Cohen’s kappa analysis was performed to assess the inter-examiner agreement. The range of kappa is usually between 0–1, where 0 is complete disagreement and 1 is complete agreement.

Results: The median kappa was 0.36 (1st and 3rd quartile, 0.23 and 0.42), corresponding to only a slight agreement.

Keywords:

• Uvulopalatopharyngoplasty
• obstructive sleep apnea
• patient selection
• inter-rater reliability
• Cohen kappa

Disclosure statement

The authors reports no conflicts of interest. The authors alone are responsible for the content and writing of the paper.