The AASM Scoring Manual four years later

J Clin Sleep Med. 2012 Jun 15;8(3):323-32. doi: 10.5664/jcsm.1928.


Purpose 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 identified 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 AASM Scoring Manual was published with far less criticism than those who developed it feared. The AASM Manual provides a foundation upon which we all can build rules and methods which identify the complexity of sleep and its disorders.

Keywords: AASM standard; Sleep scoring parameters; polysomnography/classification/standards; practice guidelines as topic sleep apnea; practice guidelines as topic sleep scoring.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Child
  • Humans
  • Observer Variation
  • Polysomnography
  • Practice Guidelines as Topic*
  • Sleep Apnea Syndromes / classification
  • Sleep Apnea Syndromes / diagnosis
  • Sleep Apnea Syndromes / physiopathology
  • Sleep Stages / physiology
  • Sleep Wake Disorders / classification
  • Sleep Wake Disorders / diagnosis*
  • Sleep Wake Disorders / physiopathology
  • Sleep* / physiology
  • Societies, Medical
  • United States