The 2007 AASM Recommendations for EEG Electrode Placement in Polysomnography: Impact on Sleep and Cortical Arousal Scoring

Ruehland, Warren R.; O’Donoghue, Fergal J; Pierce, Robert J; Thornton, Andrew; Singh, Parmjit; Copland, Janet M; Stevens, Bronwyn; Rochford, Peter D.

doi:10.1093/sleep/34.1.73

Cited by 85 publications

(68 citation statements)

References 27 publications

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“…Ruehland found no improvement with the new methodology. 6 The improvement in scoring agreement is more impressive when compared to historical values for R&K scoring, such as the 73% agreement among 5 experts from different centers reported by Norman and colleagues. 7 Our data, like those of other researchers, indicates that the best agreement is achieved with stages W, N2, and R. Disagreement with the scoring of stage N1 includes scoring of stage W and scoring of stage N2 sleep.…”

Section: Discussionmentioning

confidence: 79%

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

Rosenberg

Hout²

2013

Journal of Clinical Sleep Medicine

325

228

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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. Stages N1 and N3 were increased, whereas stage N2 was decreased with the new scoring as compared to the old. Scorers were drawn from a pool of 30 experienced sleep experts. Danker-Hopfe and colleagues found that use of the AASM Manual resulted in slightly improved inter-rater reliability to 82.0% compared to 80.6% using R & K rules. 5 Her study was based on 72 recordings that were scored with both methods by a pool of 7 experienced scorers.The AASM inter-scorer reliability (ISR) program was developed to aid sleep centers in fulfi lling accreditation standards. The standards require that a sample of randomly chosen records be scored by the center director and each of the technologists involved in record scoring. As a means of achieving this standard, the AASM ISR program provides a record each

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Section: Discussionmentioning

confidence: 79%

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

Rosenberg

Hout²

2013

Journal of Clinical Sleep Medicine

325

228

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“…19,20 The protocols of these studies differed from our study in that the study by Moser et al examined AASM criteria compared to R&K, 19 while the study by Ruehland et al examined three EEG derivations versus one EEG derivation using AASM criteria for both derivations. 20 Despite the differences in study protocols, these two studies and our study are comparable with respect to comparisons of slow wave activity. Our finding of no difference in the amounts and proportions of N3 between M rec and M acc are therefore in contrast to these previously published studies.…”

mentioning

confidence: 77%

“…The absolute agreement and hierarchy of staging agreement associated with each stage was consistent with the literature. 20,26 Agreement was lowest in staging N1 sleep, better with stages N2 and N3, and highest with staging wakefulness and REM sleep.The finding that the scoring of EEG arousals was similar for both EEG montages was not really surprising. Since the scoring of EEG arousals has quite poor agreement, it was unlikely that the number of PSGs used in this study would have enough power to find differences between the two EEG montages.…”

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confidence: 89%

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The AASM Recommended and Acceptable EEG Montages are Comparable for the Staging of Sleep and Scoring of EEG Arousals

Duce

Rego

Milosavljevic

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objective: To examine the measurement differences in sleep and EEG arousal statistics between the American Academy of Sleep Medicine (AASM) recommended EEG montage (F4-M1, C4-M1, O2-M1) and acceptable EEG montage (Fz-Cz, C4-M1, Oz-Cz). Design: Prospective, blinded, randomized comparison. Setting: Australian clinical sleep laboratory in a tertiary hospital. Patients or Participants: 50 consecutive patients undertaking polysomnography (PSG) for the clinical suspicion of sleep disordered breathing. Interventions: N/A Measurements and Results: Patient EEGs were recorded using both the AASM recommended and acceptable EEG montages during the PSG. Two scorers were used to examine the difference in PSG statistics using the two EEG montages. The scorers analyzed the 50 studies using the two EEG montages. Ten of the studies were scored twice for each montage by each scorer to calculate intra-scorer and interscorer agreement. No statistically signifi cant differences were observed between the PSG statistics of the recommended and acceptable EEG montages. The recommended EEG montage had greater inter-scorer agreement but no difference in intrascorer agreement. Conclusions: This study demonstrates that the two EEG montages endorsed by the AASM Manual produce similar sleep and EEG arousal statistics. Keywords: EEG, recommended montage, acceptable montage, sleep staging, EEG arousal scoring, polysomnography, sleep apnea, inter-scorer agreement, intra-scorer agreement, kappa Citation: Duce B, Rego C, Milosavljevic J, Hukins C. The AASM recommended and acceptable EEG montages are comparable for the staging of sleep and scoring of EEG arousals. J Clin Sleep Med 2014;10(7):803-809.http://dx.doi.org/10.5664/jcsm.3880 S C I E N T I F I C I N V E S T I G A T I O N SA standard of clinical polysomnography (PSG) is the characterization of sleep and sleep fragmentation via the staging of sleep and scoring of EEG arousals.1 For a number of decades the staging of sleep was conducted according to the Rechtschaffen and Kales (R&K) criteria.2 This standard recommended a single central derivation, despite its apparent shortcomings. 3 In 2007 the American Academy of Sleep Medicine (AASM) published The AASM Manual for the Scoring of Sleep and Associated Events. 4 This was seen as a long-overdue update of the criteria, incorporating the evidence accumulated since the publication of R&K and recognizing the need to improve inter-scorer agreement. 5 Among the changes in the AASM manual was the increase to three derivations in the EEG montage as well as the provision of two different EEG montages. The introduction of two extra derivations into the EEG montage was based on evidence that regional differences in EEG morphology exist and may be important in describing sleep. [6][7][8][9] The two EEG montages allowed differ in the type of derivations that make up each montage. The recommended montage (M rec ) consists of all referential derivations, with negative input electrodes over the frontal, central, and occipital regions. The acceptable mo...

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“…Sleep was documented using standard electroencephalographic (EEG), electro-oculographic (EOG), and electromyographic (EMG) criteria. The EEGs were recorded using electrodes applied to C3-A2 and C4-A1 (according to the criteria of Rechtschaffen and Kales) (Ruehland et al, 2011). EMG activity was recorded from the genioglossus, anterior tibial muscles, and diaphragmatic muscles.…”

Section: Polysomnographymentioning

confidence: 99%

Dynamic alterations of the tongue in obstructive sleep apnea-hypopnea syndrome during sleep: analysis using ultrafast MRI

Wang¹,

McDonald²,

Liu³

et al. 2014

Genet. Mol. Res.

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ABSTRACT.Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) were evaluated using ultrafast magnetic resonance imaging (UMRI) while asleep and awake to analyze tongue changes. The upper airway of 21 OSAHS patients and 20 normal controls were examined during sleep using UMRI. A series of midline sagittal images of the upper airway were obtained to measure dynamic changes in tongue size and the distance from the tongue to the x-axis (an extended line from the anterior nasal spine to posterior nasal spine) and the y-axis (a perpendicular line from the center of the pituitary to the x-axis). The maximum and minimum sagittal Dynamic changes of the tongue in OSAHS during sleep diameters of the tongue were shorter in the OSAHS group than in the control group (P < 0.01) while awake, whereas the difference between the maximum and minimum vertical diameters of the tongue and the upper and central part of tongue between the posterior border and the retropharyngeal wall were greater (P < 0.05). During sleep, the maximum values and differences between the maximum and minimum tongue sizes in the OSAHS group were larger than in the control group (P < 0.05), whereas the minimum values were lower than in the control group (P < 0.01). Tongue size significantly differs between OSAHS patients and normal controls during sleep. The tongue tends to move downward during OSAHS, which may be attributed to increased upper airway resistance.

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The 2007 AASM Recommendations for EEG Electrode Placement in Polysomnography: Impact on Sleep and Cortical Arousal Scoring

Cited by 85 publications

References 27 publications

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

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

The AASM Recommended and Acceptable EEG Montages are Comparable for the Staging of Sleep and Scoring of EEG Arousals

Dynamic alterations of the tongue in obstructive sleep apnea-hypopnea syndrome during sleep: analysis using ultrafast MRI

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