A rating scale for DISE has previously been described in an attempt to standardize the reporting of endoscopic findings in adults with OSAS. This rating scale evaluates the degree and pattern of obstruction at four levels of the pharynx: the Velum (soft palate), Oropharynx (including the tonsils), Tongue base, and Epiglottis (VOTE). The VOTE rating scale has been demonstrated to have moderate to substantial inter-rater reliability with kappa values ranging from 0.4-0.8 depending on the specific structures being compared. Other investigators have utilized modified versions of the VOTE rating scale in children, including other levels of the airway such as the nasal airway, nasopharynx, and supraglottis. One recent study demonstrated that sleep endoscopy findings in children were more reliable than during awake endoscopy and noted a strong correlation between polysomnography results and the overall impression of OSA severity during endoscopy.