Home sleep apnea testing: comparison of manual and automated scoring across international sleep centers

Sleep Breath. 2019 Mar;23(1):25-31. doi: 10.1007/s11325-018-1715-6. Epub 2018 Sep 10.


Purpose: To determine the agreement between the manual scoring of home sleep apnea tests (HSATs) by international sleep technologists and automated scoring systems.

Methods: Fifteen HSATs, previously recorded using a type 3 monitor, were saved in European Data Format. The studies were scored by nine experienced technologists from the sleep centers of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) using the locally available software. Each study was scored separately by human scorers using the nasal pressure (NP), flow derived from the NP signal (transformed NP), or respiratory inductive plethysmography (RIP) flow. The same procedure was followed using two automated scoring systems: Remlogic (RLG) and Noxturnal (NOX).

Results: The intra-class correlation coefficients (ICCs) of the apnea-hypopnea index (AHI) scoring using the NP, transformed NP, and RIP flow were 0.96 [95% CI 0.93-0.99], 0.98 [0.96-0.99], and 0.97 [0.95-0.99], respectively. Using the NP signal, the mean differences in AHI between the average of the manual scoring and the automated systems were - 0.9 ± 3.1/h (AHIRLG vs AHIMANUAL) and - 1.3 ± 2.6/h (AHINOX vs AHIMANUAL). Using the transformed NP, the mean differences in AHI were - 1.9 ± 3.3/h (AHIRLG vs AHIMANUAL) and 1.6 ± 3.0/h (AHINOX vs AHIMANUAL). Using the RIP flow, the mean differences in AHI were - 2.7 ± 4.5/h (AHIRLG vs AHIMANUAL) and 2.3 ± 3.4/h (AHINOX vs AHIMANUAL).

Conclusions: There is very strong agreement in the scoring of the AHI for HSATs between the automated systems and experienced international technologists. Automated scoring of HSATs using commercially available software may be useful to standardize scoring in future endeavors involving international sleep centers.

Keywords: Automation; Computer-assisted diagnosis; Sleep apnea.

Publication types

  • Comparative Study

MeSH terms

  • Diagnosis, Computer-Assisted / methods*
  • Female
  • Home Nursing / methods*
  • Humans
  • Male
  • Monitoring, Ambulatory / methods*
  • Polysomnography / instrumentation
  • Polysomnography / methods*
  • Sleep Apnea Syndromes / diagnosis
  • Sleep Apnea, Obstructive / diagnosis*