title: Reliability of scoring arousals in normal children and children with obstructive sleep apnea syndrome.
abstract: OBJECTIVE
  Scoring of arousals in children is based on an extension of adult criteria, as defined by the American Sleep Disorders Association (ASDA). By this, a minimum duration of 3 seconds is required. A few recent studies utilized modified criteria for the study of children, with durations as short as 1 second. However, the validity and reliability of scoring these shorter arousals have never been verified. Based on studies in adults, we hypothesized that interscorer agreement for scoring arousals shorter than 3 seconds was poor.
  
  
  METHODS
  Retrospective review of polysomnograms by 2 experienced sleep practitioners who independently scored arousals according to the ASDA 3-second criteria and modified duration criteria of 1 and 2 seconds.
  
  
  METHODS
  Academic hospital.
  
  
  METHODS
  20 polysomnographic studies from children aged 3 to 8 years with mild to severe obstructive sleep apnea syndrome, and 16 polysomnographic studies from normal children.
  
  
  METHODS
  None.
  
  
  RESULTS
  The intraclass correlation coefficient for scoring ASDA arousals was 0.90 (95% confidence interval: 0.81-0.95), indicating excellent interscorer agreement. The intraclass correlation coefficient for scoring modified 1-second and 2-second arousals were 0.35 (95% confidence interval: 0.02-0.61) and 0.42 (95% confidence interval: 0.12-0.65) respectively, indicating poor to fair interscorer agreement. Furthermore, modified 1-second and 2-second arousals accounted for less than 15% of all arousals scored.
  
  
  CONCLUSIONS
  We conclude that there is much poorer interscorer agreement for scoring arousals shorter than 3 seconds, when compared to the standard ASDA criteria. We propose that scoring of arousals in children should follow the standard ASDA criteria.
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong. wongtk@graduate.hku.hk
authors.forename: Tat Kong
authors.initials: TK
authors.lastname: Wong
authors.forename: Patricia
authors.initials: P
authors.lastname: Galster
authors.forename: Tai Shing
authors.initials: TS
authors.lastname: Lau
authors.forename: Janita M
authors.initials: JM
authors.lastname: Lutz
authors.forename: Carole L
authors.initials: CL
authors.lastname: Marcus
mesh_terms: D001143:Arousal / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology*; D012895:Sleep, REM / Q000502:physiology