title: Interrater reliability for sleep scoring according to the Rechtschaffen & Kales and the new AASM standard.
abstract: Interrater variability of sleep stage scorings has an essential impact not only on the reading of polysomnographic sleep studies (PSGs) for clinical trials but also on the evaluation of patients' sleep. With the introduction of a new standard for sleep stage scorings (AASM standard) there is a need for studies on interrater reliability (IRR). The SIESTA database resulting from an EU-funded project provides a large number of studies (n = 72; 56 healthy controls and 16 subjects with different sleep disorders, mean age +/- SD: 57.7 +/- 18.7, 34 females) for which scorings according to both standards (AASM and R&K) were done. Differences in IRR were analysed at two levels: (1) based on quantitative sleep parameter by means of intraclass correlations; and (2) based on an epoch-by-epoch comparison by means of Cohen's kappa and Fleiss' kappa. The overall agreement was for the AASM standard 82.0% (Cohen's kappa = 0.76) and for the R&K standard 80.6% (Cohen's kappa = 0.68). Agreements increased from R&K to AASM for all sleep stages, except N2. The results of this study underline that the modification of the scoring rules improve IRR as a result of the integration of occipital, central and frontal leads on the one hand, but decline IRR on the other hand specifically for N2, due to the new rule that cortical arousals with or without concurrent increase in submental electromyogram are critical events for the end of N2.
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany. heidi.danker-hopfe@charite.de
authors.forename: Heidi
authors.initials: H
authors.lastname: Danker-Hopfe
authors.forename: Peter
authors.initials: P
authors.lastname: Anderer
authors.forename: Josef
authors.initials: J
authors.lastname: Zeitlhofer
authors.forename: Marion
authors.initials: M
authors.lastname: Boeck
authors.forename: Hans
authors.initials: H
authors.lastname: Dorn
authors.forename: Georg
authors.initials: G
authors.lastname: Gruber
authors.forename: Esther
authors.initials: E
authors.lastname: Heller
authors.forename: Erna
authors.initials: E
authors.lastname: Loretz
authors.forename: Doris
authors.initials: D
authors.lastname: Moser
authors.forename: Silvia
authors.initials: S
authors.lastname: Parapatics
authors.forename: Bernd
authors.initials: B
authors.lastname: Saletu
authors.forename: Andrea
authors.initials: A
authors.lastname: Schmidt
authors.forename: Georg
authors.initials: G
authors.lastname: Dorffner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000175:diagnosis / Q000503:physiopathology; D001143:Arousal / Q000502:physiology; D002540:Cerebral Cortex / Q000503:physiopathology; D019992:Databases as Topic; D004569:Electroencephalography / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008370:Manuals as Topic; D008875:Middle Aged; D020189:Nocturnal Myoclonus Syndrome / Q000175:diagnosis / Q000503:physiopathology; D015588:Observer Variation; D010300:Parkinson Disease / Q000175:diagnosis / Q000503:physiopathology; D017286:Polysomnography / Q000592:standards*; D012015:Reference Standards; D012189:Retrospective Studies; D012815:Signal Processing, Computer-Assisted; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000503:physiopathology; D012894:Sleep Stages / Q000502:physiology; D012893:Sleep Wake Disorders / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology; D013223:Statistics as Topic; D055815:Young Adult