Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jan;12(1):71-7.
doi: 10.5664/jcsm.5398.

Agreement in the Scoring of Respiratory Events Among International Sleep Centers for Home Sleep Testing

Affiliations
Free PMC article

Agreement in the Scoring of Respiratory Events Among International Sleep Centers for Home Sleep Testing

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

Abstract

Study objectives: Home sleep testing (HST) is used worldwide to confirm the presence of obstructive sleep apnea (OSA). We sought to determine the agreement of HST scoring among international sleep centers.

Methods: Fifteen HSTs, previously recorded using a type 3 monitor, were deidentified and saved in European Data Format. The studies were scored by nine technologists from the sleep centers of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) using the locally available software. Each study was scored separately using one of three different airflow signals: nasal pressure (NP), transformed (square root) nasal pressure signal (transformed NP), and uncalibrated respiratory inductive plethysmography (RIP) flow. Only one of the three airflow signals was visible to the scorer at each scoring session. The scoring procedure was repeated to determine the intrarater reliability.

Results: The intraclass correlation coefficients (ICCs) using the NP were: apnea-hypopnea index (AHI) = 0.96 (95% confidence interval [CI]: 0.93-0.99); apnea index = 0.91 (0.83-0.96); and hypopnea index = 0.75 (0.59-0.89). The ICCs using the transformed NP were: AHI = 0.98 (0.96-0.99); apnea index = 0.95 (0.90-0.98); and hypopnea index = 0.90 (0.82-0.96). The ICCs using the RIP flow were: AH I = 0.98 (0.96-0.99); apnea index = 0.66 (0.48-0.84); and hypopnea index = 0.78 (0.63-0.90). The mean difference of first and second scoring sessions of the same respiratory variables ranged from -1.02 to 0.75/h.

Conclusion: There is a strong agreement in the scoring of the respiratory events for HST among international sleep centers. Our results suggest that centralized scoring of HSTs may not be necessary in future research collaboration among international sites.

Commentary: A commentary on this article appears in this issue on page 7.

Keywords: home sleep testing; sleep study scoring.

Figures

Figure 1
Figure 1. The absolute values of the apnea-hypopnea index (AHI) by the nine scorers of each of the 15 home sleep tests are shown.
NP, nasal pressure; transformed NP, square root transformation of NP signal; RIP flow, respiratory flow using respiratory inductive plethysmography.
Figure 2
Figure 2. Bland-Altman plot of the agreement between the apnea-hypopnea index (AHI) values using nasal pressure (NP) and the square root transformation of the NP signal (transformed NP).
Figure 3
Figure 3. Bland-Altman plot of the agreement between the apnea-hypopnea index (AHI) values using nasal pressure (NP) and respiratory flow using respiratory inductive plethysmography (RIP flow).
Figure 4
Figure 4. Bland-Altman plot of the agreement between the apnea-hypopnea index (AHI) values using the square root transformation of the NP signal (transformed NP) and respiratory flow using respiratory inductive plethysmography (RIP flow).

Comment in

Similar articles

See all similar articles

Cited by 7 articles

See all "Cited by" articles

Publication types

Feedback