Manual scoring of polysomnograms is labor-intensive and time-consuming. The objective of this topic is to introduce the history of the AASM Scoring Manual, 2 international inter-scorer reliability studies and the reliability of Somté PSG system for scoring respiratory events.
Apnea-hypopnea index (AHI), Apnea type and hypopnea agreement measured in an international study were reported by Magalang and colleagues in 2013. The intraclass correlation coefficient (ICC) for AHI was 0.95. However, this value fell to 0.73 for all apneas and 0.80 for hypopneas. The agreement on classification of apnea type was much less robust.
Another widely cited study of The American Academy of Sleep Medicine (AASM) Inter-scorer Reliability Program was published in 2014. The agreement for some type of event was good with a value of 88.4% (κ = 0.77), but disagreements in scoring of apnea vs. hypopnea and type of apnea were common. The agreement for epochs scored as obstructive apnea by the majority was 77.1% (κ = 0.71). The agreement for hypopnea was 65.4% (κ = 0.57). The agreement for central apnea and mixed apnea was also much less robust.
A random sample of 6 records was manually scored by an experinced technologist at Shihji Cathay General Hospital. To perform automatic analysis with optimized settings of respiratory parameters for the same sample. To calculate the average agreement of these records for the reliability of automatic scoring. The agreement for AHI was 92.6%. The agreement for epochs scored as obstructive apnea was 84.43% and as hypopnea was 89.41%. The value fell to 79.95% for mixed apnea and 71% for central apnea.
Automatic scoring may yield results that were similar to those obtained by an experinced technologist. In light of the burden associated with manual scoring, automatic scoring should be performed and supplemented with manual editing to increase laboratory efficiency and improve inter-scorer reliability.
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