The AASM Scoring Manual Four Years Later

Abstract

lent and incident blood pressure; 6,7 (2) lower neurocognitive test scores; 8 and (3) automobile crashes due to sleepiness. 9 The respiratory review paper also provided suffi cient evidence for scoring hypopneas which caused as little as ≥ 20% to 30% fall in airfl ow and/or ≥ 2% or ≥ 3% desaturations. [10][11][12] However, the AASM wanted rules for scoring hypopneas which had substantial or excellent interscorer reliability. Interrater reliability (IRR) as it relates to scoring sleep in a PSG measures how closely individuals score the same sleep study. IRR when scoring a PSG depends upon the: (1) skill, experience, and training of scorer; (2) technical quality of study; (3) clarity and simplicity of scoring rules; (4) diligence with which scoring rules are applied; and (5) degree of physiological ambiguity of the sleep/wake patterns. 13 When two or more individuals score a stage of sleep or an event in a PSG differently, it can introduce enough variability to lead to a false positive or false negative for a particular diagnosis.The IRR for scoring respiratory events in a PSG is particularly affected by the: (1) duration of the event; (2) degree of reduction in the amplitude of the measured signal(s); (3) level of the oxyhemoglobin desaturation associated with it; and (4) presence and duration of arousal which accompanies it. Ayappa et al. found the percent scoring agreement for scoring apneas using a nasal pressure sensor was excellent (0.91) but only moderate for hypopneas (0.69) or fl ow limitation events (0.64).14 The more subtle the reduction in airfl ow, the more diffi cult to achieve good interscorer agreement: one scorer identifi ed 35% more fl ow limitation events than the other. Whitney et al. found a hypopnea associated with 2% to 5% desaturations could be scored with IRR of 0.90, but scoring agreement inPurpose of Review: Review published studies and critiques which evaluate the impact and effects of the American Academy of Sleep Medicine (AASM) Sleep Scoring Manual in the four years since its publication. Findings: Using the AASM Manual rules to score sleep and events in a polysomnogram (PSG) results in: (1) very large differences in apnea-hypopnea indexes (AHI) when using the recommended and alternative rule for scoring hypopneas in adults; (2) increases in NREM 1 and sleep stage shifts with compensatory decreases in NREM 2 in children and adults when following rule 5.C.b. for ending NREM 2 sleep; (3) increases in NREM 3 in adults scoring slow wave activity in the frontal EEG derivations; (4) improved interscorer reliability; and (5) successfully identifi ed fragmented sleep in children with obstructive sleep apnea (OSA) from primary snorers or normal controls because they had more NREM 1 and stage shifts using rule 5.C.b. Criticism of the Manual most often cited: (1) two rules for scoring hypopneas; (2) alternative EEG montage cancellation effects; (3) scoring stages 3 and 4 as NREM 3; and (4) too few rules for scoring arousals and REM sleep without atonia. Summary: Four years have passed since the...

Sleep Apnea Is Associated with Hearing Impairment: The Hispanic Community Health Study/Study of Latinos

“…Several prior studies that have assessed the association between snoring and HI have found mixed results. 29,30 In the current study, we found that self-reported snoring was not associated with HI, nor did adjustment for self-reported snoring appreciably change the association between SA and HI. In one of the earliest studies of hearing loss among snorers, Prazic 37 reported varying degrees of hearing loss in 17 snorers although this study lacked information on SA.…”

“…We required events to be linked to a ≥ 3% desaturation in accordance with current recommended hypopnea scoring criteria from the American Academy of Sleep Medicine. 28,29 We defined SA as AHI ≥ 15 events/h. SA severity was defined as: mild or no SA (0 ≤ AHI < 15), moderate SA (15 ≤ AHI < 30), and severe SA (AHI ≥ 30).…”

The American Academy of Sleep Medicine Inter-scorer Reliability Program: Sleep Stage Scoring

“…Grigg-Damberger, in a recent review, 3 noted that there have been few complaints about the new scoring system. Moser and colleagues 4 found signifi cant differences in stage scores with the AASM Manual.…”

Obstrüktif Uyku Apne Semptomları ile Uyku Laboratuvarına Başvuran Hastalarda Hastane Anksiyete Depresyon Skorlarının Semptomlar ve Polisomnografik Bulgular ile İlişkisi

“…Sertrifikalı teknisyenler tarafından 6 kanal elektroensefalografi (F4-M1, C4-M1, O2-M1, F3-M2, C3-M2, O1-M2), elektrookülografi (E1-M2, E2-M2), bilateral tibia ve çene elektromiyografi, elektrokardiyografi, horlama sensörü, solunumsal olayların kaydı için nazal flow, oro-nazal termistör, respiratuvar indüktans pletismografi bağlanarak tüm gece kayıt alındı. Skorlama, sertifikalı uzman hekim tarafından Amerikan Uyku Tıbbı Akademisi (AASM) 2007 ve 2012 kurallarına göre yapıldı (18,19). OUAS hastalık sınıflaması AASM 2014 Uluslararası Uyku Bozuklukları Sınıflaması'na göre yapıldı (20).…”