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Multicenter Study
. 2013 Apr 1;36(4):591-6.
doi: 10.5665/sleep.2552.

Agreement in the Scoring of Respiratory Events and Sleep Among International Sleep Centers

Free PMC article
Multicenter Study

Agreement in the Scoring of Respiratory Events and Sleep Among International Sleep Centers

Ulysses J Magalang et al. Sleep. .
Free PMC article

Erratum in

  • Sleep. 2014 Sep;37(9):1575


Study objectives: The American Academy of Sleep Medicine (AASM) guidelines for polysomnography (PSG) scoring are increasingly being adopted worldwide, but the agreement among international centers in scoring respiratory events and sleep stages using these guidelines is unknown. We sought to determine the interrater agreement of PSG scoring among international sleep centers.

Design: Prospective study of interrater agreement of PSG scoring.

Setting: Nine center-members of the Sleep Apnea Genetics International Consortium (SAGIC).

Measurements and results: Fifteen previously recorded deidentified PSGs, in European Data Format, were scored by an experienced technologist at each site after they were imported into the locally used analysis software. Each 30-sec epoch was manually scored for sleep stage, arousals, apneas, and hypopneas using the AASM recommended criteria. The computer-derived oxygen desaturation index (ODI) was also recorded. The primary outcome for analysis was the intraclass correlation coefficient (ICC) of the apnea-hypopnea index (AHI). The ICCs of the respiratory variables were: AHI = 0.95 (95% confidence interval: 0.91-0.98), total apneas = 0.77 (0.56-0.87), total hypopneas = 0.80 (0.66-0.91), and ODI = 0.97 (0.93-0.99). The kappa statistics for sleep stages were: wake = 0.78 (0.77-0.79), nonrapid eye movement = 0.77 (0.76-0.78), N1 = 0.31 (0.30-0.32), N2 = 0.60 (0.59-0.61), N3 = 0.67 (0.65-0.69), and rapid eye movement = 0.78 (0.77-0.79). The ICC of the arousal index was 0.68 (0.50-0.85).

Conclusion: There is strong agreement in the scoring of respiratory events among the SAGIC centers. There is also substantial epoch-by-epoch agreement in scoring sleep variables. Our results suggest that centralized scoring of PSGs may not be necessary in future research collaboration among international sites where experienced, well-trained scorers are involved.

Keywords: General; polysomnography; scoring.


Figure 1
Figure 1
The absolute values of the respiratory event scoring of each of the 15 polysomnographs in the different Sleep Apnea Genetics International Consortium centers are shown. As expected from the intraclass correlation coefficient values, there were more variations in the scoring of the total apneas and hypopneas compared with the apnea-hypopnea index (AHI).

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