Agreement in the Scoring of Respiratory Events Among International Sleep Centers for Home Sleep Testing.
OBJECTIVE
Home sleep testing (HST) is used worldwide to confirm the presence of obstructive sleep apnea (OSA). We sought to determine the agreement of HST scoring among international sleep centers.


METHODS
Fifteen HSTs, previously recorded using a type 3 monitor, were deidentified and saved in European Data Format. The studies were scored by nine technologists from the sleep centers of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) using the locally available software. Each study was scored separately using one of three different airflow signals: nasal pressure (NP), transformed (square root) nasal pressure signal (transformed NP), and uncalibrated respiratory inductive plethysmography (RIP) flow. Only one of the three airflow signals was visible to the scorer at each scoring session. The scoring procedure was repeated to determine the intrarater reliability.


RESULTS
The intraclass correlation coefficients (ICCs) using the NP were: apnea-hypopnea index (AHI) = 0.96 (95% confidence interval [CI]: 0.93-0.99); apnea index = 0.91 (0.83-0.96); and hypopnea index = 0.75 (0.59-0.89). The ICCs using the transformed NP were: AHI = 0.98 (0.96-0.99); apnea index = 0.95 (0.90-0.98); and hypopnea index = 0.90 (0.82-0.96). The ICCs using the RIP flow were: AH I = 0.98 (0.96-0.99); apnea index = 0.66 (0.48-0.84); and hypopnea index = 0.78 (0.63-0.90). The mean difference of first and second scoring sessions of the same respiratory variables ranged from -1.02 to 0.75/h.


CONCLUSIONS
There is a strong agreement in the scoring of the respiratory events for HST among international sleep centers. Our results suggest that centralized scoring of HSTs may not be necessary in future research collaboration among international sites.


CONCLUSIONS
A commentary on this article appears in this issue on page 7.
Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Ulysses J
UJ
Magalang
Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.|Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Erna S
ES
Arnardottir
Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Ning-Hung
NH
Chen
Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, and University of Sydney, Sydney, Australia.
Peter A
PA
Cistulli
Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.|Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Thorarinn
T
Gíslason
Center for Sleep and Circadian Neurobiology, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Diane
D
Lim
Center of Sleep Medicine, Charité University Hospital, Berlin, Germany.
Thomas
T
Penzel
Center for Sleep and Circadian Neurobiology, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Richard
R
Schwab
Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.
Sergio
S
Tufik
Center for Sleep and Circadian Neurobiology, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Allan I
AI
Pack
D006801:Humans; D038622:Internationality; D017286:Polysomnography / Q000379:methods*; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*
home sleep testing; sleep study scoring