title: The 2007 AASM recommendations for EEG electrode placement in polysomnography: impact on sleep and cortical arousal scoring.
abstract: OBJECTIVE
  To examine the impact of using American Academy of Sleep Medicine (AASM) recommended EEG derivations (F4/M1, C4/M1, O2/M1) vs. a single derivation (C4/M1) in polysomnography (PSG) on the measurement of sleep and cortical arousals, including inter- and intra-observer variability.
  
  
  METHODS
  Prospective, non-blinded, randomized comparison.
  
  
  METHODS
  Three Australian tertiary-care hospital clinical sleep laboratories.
  
  
  METHODS
  30 PSGs from consecutive patients investigated for obstructive sleep apnea (OSA) during December 2007 and January 2008.
  
  
  METHODS
  N/A.
  
  
  RESULTS
  To examine the impact of EEG derivations on PSG summary statistics, 3 scorers from different Australian clinical sleep laboratories each scored separate sets of 10 PSGs twice, once using 3 EEG derivations and once using 1 EEG derivation. To examine the impact on inter- and intra-scorer reliability, all 3 scorers scored a subset of 10 PSGs 4 times, twice using each method. All PSGs were de-identified and scored in random order according to the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Using 3 referential EEG derivations during PSG, as recommended in the AASM manual, instead of a single central EEG derivation, as originally suggested by Rechtschaffen and Kales (1968), resulted in a mean ± SE decrease in N1 sleep of 9.6 ± 3.9 min (P = 0.018) and an increase in N3 sleep of 10.6 ± 2.8 min (P = 0.001). No significant differences were observed for any other sleep or arousal scoring summary statistics; nor were any differences observed in inter-scorer or intra-scorer reliability for scoring sleep or cortical arousals.
  
  
  CONCLUSIONS
  This study provides information for those changing practice to comply with the 2007 AASM recommendations for EEG placement in PSG, for those using portable devices that are unable to comply with the recommendations due to limited channel options, and for the development of future standards for PSG scoring and recording. As the use of multiple EEG derivations only led to small changes in the distribution of derived sleep stages and no significant differences in scoring reliability, this study calls into question the need to use multiple EEG derivations in clinical PSG as suggested in the AASM manual.
authors.affiliation: Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia. Warren.Ruehland@austin.org.au
authors.forename: Warren R
authors.initials: WR
authors.lastname: Ruehland
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: O'Donoghue
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Pierce
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Thornton
authors.forename: Parmjit
authors.initials: P
authors.lastname: Singh
authors.forename: Janet M
authors.initials: JM
authors.lastname: Copland
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Stevens
authors.forename: Peter D
authors.initials: PD
authors.lastname: Rochford
mesh_terms: D000328:Adult; D001143:Arousal / Q000502:physiology*; D002540:Cerebral Cortex / Q000502:physiology*; D004566:Electrodes / Q000592:standards; D004569:Electroencephalography / Q000295:instrumentation / Q000592:standards*; D005260:Female; D017408:Guidelines as Topic / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D017286:Polysomnography / Q000295:instrumentation / Q000592:standards*; D011446:Prospective Studies; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology; D012894:Sleep Stages / Q000502:physiology