Discrepancy in polysomnography scoring for a patient with obstructive sleep apnea hypopnea syndrome.

Department of Otolaryngology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
The Tohoku Journal of Experimental Medicine (Impact Factor: 1.28). 09/2005; 206(4):353-60. DOI: 10.1620/tjem.206.353
Source: PubMed

ABSTRACT Overnight polysomnography (PSG) is indispensable for diagnosis of obstructive sleep apnea hypopnea syndrome. However, studies on interscorer agreement on PSG scoring between laboratories are few. The purpose of this study was to examine the reliability of interscorer agreement on PSG scoring among 16 sleep laboratories in Japan. We found a relatively moderate interscorer reliability of the index of oxygen desaturation and arousal during sleep, but a relatively low reliability of the index of transient reduction in and complete cessation of breathing (apnea hypopnea index). The median rate of interscorer coincidence of sleep staging was the lowest for slow wave (deep) sleep (23.5%), followed by those for Stage 1 (59.8%), Wake (73.2%) and Stage 2 (74.2%) in this order, and rapid eye movement was the most reliably identified stage (91.3%). The median rate of interscorer coincidence for all stages was 71.8%. The present study demonstrates that scorers tend to analyze PSG data according to a relatively empirical decision as opposed to a rule-dependent decision. Further detailed scoring manuals are required to decrease the interscorer discrepancy in PSG scoring.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Summarize recently published studies and critiques evaluating the effects of the American Academy of Sleep Medicine (AASM) Sleep Scoring Manual. Only a few retrospective studies have been published evaluating the new AASM Scoring Manual. These have shown that when scoring polysomnograms (PSGs) using the AASM rules compared to previous standards and guidelines: increased amount and percentage of sleep time in Non-Rapid Eye Movement Sleep (NREM) 1 (N1) and N3 sleep, and decreased NREM 2 (N2) sleep; improved interscorer reliability when scoring sleep stages in adults; large differences in apnea-hypopnea indexes (AHIs) using different hypopnea scoring definitions; and PSGs scored using the 'recommended' hypopnea definition in the new manual identified no significant sleep disordered breathing in 40% of lean individuals with symptomatic OSA (AHI ≥5/h by 1999 'Chicago' criteria) and a favorable response to treatment. Two years have passed since the AASM Scoring Manual was published, garnering less criticism than was feared by those who developed it. The improvement in interscorer reliability using the Manual is heartening since this goal shaped many of the choices made. The alternative hypopnea rule should be endorsed as a recommended option. The AASM Scoring Manual provides a foundation upon which we all can build rules and methods that quantify the complexity of sleep and its disorders. Multicenter validation and refinement of the Manual is encouraged.
    Current opinion in pulmonary medicine 09/2009; 15(6):540-9. · 2.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study aims to compare the manual correction of the automatic analysis of ApneaLink™ between a skilled observer in the interpretation of sleep studies and a subject trained only in the scoring of ApneaLink™ device. Ninety-six subjects performed the ApneaLink™ and polysomnography (PSG) simultaneously in the sleep laboratory. Two blind observers, who were independent from the results of the PSG, performed first the automatic scoring and then the hand correction from the ApneaLink™ device. The scorers of ApneaLink™ represented two physicians with different levels of training (scorer A: 20 years of experience in reading polysomnography plus 3 years of experience in the interpretation of ApneaLink™, scorer B: 1 year of experience in the analysis of ApneaLink™). The interobserver agreement was assessed with the intraclass correlation coefficient (ICC) and kappa statistics. The diagnostic accuracy of the manual analysis ApneaLink™ device was evaluated by the area under the receiver operator curve (AUC-ROC). Ninety patients were included (69 men; mean age, 49.6; median RDI, 13.9; median BMI, 29.3 Kg/m(2)). The ICC between the manual apnea/hypopnea index from ApneaLink™ and the respiratory disturbance index of the PSG for each observer was similar (scorer A, 0.902; CI 95% 0.80-0.95; vs. scorer B, 0.904; CI 95% 0.86-0.94; p = 0.9). The agreement between the observers on the presence or absence of obstructive sleep apnea syndrome (OSAS) was very good (kappa, 0.83; CI 95% 0.69-0.98). The AUC-ROC was similar between the observers (scorer A, 0.88; CI 95% 0.78-0.98; scorer B, 0.83; CI 95% 0.71-0.95; p = 0.5). The non-expert observer showed a very good agreement with the expert observer on the results of the manual correction of the ApneaLink™ autoscoring. Both observers had similar diagnostic accuracy to identify subjects with OSAS when compared with PSG.
    Sleep And Breathing 05/2011; 16(2):275-9. · 2.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The Sleep Apnea/Hypopnea Syndrome (SAHS) is a very common sleep disorder whose direct consequences include insomnia, daytime somnolence and cardiovascular problems such as high blood pressure, ischemic myocardiopathy and infarction. Diagnosis requires a polysomnographic recording to be made in a hospital sleep unit. In this work we describe a system capable of detecting and classifying apneic events recorded in the polysomnography, to be used as a support tool for clinical decision making in regard to SAHS diagnosis
    4th European Medical and Biomedical Engineering Conference (eMBEC); 11/2008

Full-text (2 Sources)

Available from
May 16, 2014