Accuracy of Automatic Polysomnography Scoring Using Frontal Electrodes

J Clin Sleep Med. 2016 May 15;12(5):735-46. doi: 10.5664/jcsm.5808.


Study objectives: The economic cost of performing sleep monitoring at home is a major deterrent to adding sleep data during home studies for investigation of sleep apnea and to investigating non-respiratory sleep complaints. Michele Sleep Scoring System (MSS) is a validated automatic system that utilizes central electroencephalography (EEG) derivations and requires minimal editing. We wished to determine if MSS' accuracy is maintained if frontal derivations are used instead. If confirmed, home sleep monitoring would not require home setup or lengthy manual scoring by technologists.

Methods: One hundred two polysomnograms (PSGs) previously recorded from patients with assorted sleep disorders were scored using MSS once with central and once with frontal derivations. Total sleep time, sleep/stage R sleep onset latencies, awake time, time in different sleep stages, arousal/awakening index and apnea-hypopnea index were compared. In addition, odds ratio product (ORP), a continuous index of sleep depth/quality (Sleep 2015;38:641-54), was generated for every 30-sec epoch in each PSG and epoch-by-epoch comparison of ORP was performed.

Results: Intraclass correlation coefficients (ICCs) ranged from 0.89 to 1.0 for the various sleep variables (0.96 ± 0.03). For epoch-by-epoch comparisons of ORP, ICC was > 0.85 in 96 PSGs. Lower values in the other six PSGs were related to signal artifacts in either derivation. ICC for whole-record average ORP was 0.98.

Conclusions: MSS is as accurate with frontal as with central EEG derivations. The use of frontal electrodes along with MSS should make it possible to obtain high-quality sleep data without requiring home setup or lengthy scoring time by expert technologists.

Keywords: frontal EEG; home sleep studies (HST); odds ratio product (ORP).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Electrodes*
  • Electroencephalography / instrumentation*
  • Electroencephalography / methods*
  • Humans
  • Observer Variation
  • Polysomnography / instrumentation*
  • Polysomnography / methods*
  • Reproducibility of Results
  • Sleep Wake Disorders / diagnosis*