Comparison between an automatic and a visual scoring method of the chin muscle tone during rapid eye movement sleep.
OBJECTIVE
To compare two different methods, one visual and the other automatic, for the quantification of rapid eye movement (REM) sleep without atonia (RSWA) in the diagnosis of REM sleep behavior disorder (RBD).


METHODS
Seventy-four RBD patients (mean age, 62.14±9.67 years) and 75 normal controls (mean age, 61.04±12.13 years) underwent one night video-polysomnographic recording. The chin electromyogram (EMG) during REM sleep was analyzed by means of a previously published visual method quantifying the percentage of 30s epochs scored as tonic (abnormal, > or =30%) and that of 2s mini-epochs containing phasic EMG events (abnormal, > or =15%). For the computer quantitative analysis we used the automatic scoring algorithm known as the atonia index (abnormal, <0.8). The percentage correct classification, sensitivity, specificity, and Cohen kappa were calculated.


RESULTS
The atonia index correctly classified 82.6% of subjects, similar to the percentage of correct classifications with individual components of the visual analysis (83.2% each for tonic and phasic), and the combined visual parameters (85.9%). The sensitivity and specificity of automatic analysis (84% and 81%) was similar to the combined visual analysis (89% and 83%). The correlation coefficient between the automatic atonia index and the percentage of visual tonic EMG was high (r = -0.886, P<0.00001), with moderately high correlation with the percentage of phasic EMG (r = -0.690, P<0.00001). The agreement between atonia index and the visual parameters (individual or combined) was approximately 85% with Cohen's kappa, ranging from 0.638 to 0.693.


CONCLUSIONS
Sensitivity, specificity, and correct classifications were high with both methods. Moreover, there was general agreement between methods, with Cohen's kappa values in the 'good' range. Given the considerable practical advantages of automatic quantification of REM atonia, automatic quantification may be a useful alternative to visual scoring methods in otherwise uncomplicated polysomnograms.
Sleep Research Centre, Department of Neurology I.C., Oasi Institute (IRCCS), Troina, Italy. Electronic address: rferri@oasi.en.it.
Raffaele
R
Ferri
Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Québec, Canada; Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.
Jean-François
JF
Gagnon
Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Québec, Canada; Department of Neurology, Montreal General Hospital, McGill University, Montreal, Québec, Canada.
Ronald B
RB
Postuma
Sleep Research Centre, Department of Neurology I.C., Oasi Institute (IRCCS), Troina, Italy.
Francesco
F
Rundo
Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Québec, Canada; Department of Psychiatry, Université de Montréal, Québec, Canada.
Jacques Y
JY
Montplaisir
D016022:Case-Control Studies; D002680:Chin / Q000502:physiology*; D004576:Electromyography; D005152:Facial Muscles / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009129:Muscle Tonus / Q000502:physiology*; D017286:Polysomnography; D020187:REM Sleep Behavior Disorder / Q000175:diagnosis* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D012895:Sleep, REM / Q000502:physiology*; D064232:Visual Analog Scale
Atonia index; Automatic analysis; Phasic chin EMG; REM sleep behavior disorder; REM sleep without atonia; Tonic chin EMG