Reliability of scoring respiratory disturbance indices and sleep staging
Reliability of scoring respiratory disturbance indices and sleep staging
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DOI：
10.1093/sleep/21.7.749
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发表时间：
1998-11-01
期刊：
影响因子：
5.6
通讯作者：
Nieto, FJ
中科院分区：
文献类型：
--
作者：
Whitney, CW;Gottlieb, DJ;Nieto, FJ
研究目的：无人值勤、基于家庭的多导睡眠图（PSG）越来越多地用于研究和临床环境，作为传统实验室研究的替代方案，尽管这些研究的评分可靠性尚未得到描述。本研究的目的是描述睡眠心脏健康研究（SHHS）中PSG评分的可靠性，SHHS是一项多中心研究，通过使用便携式睡眠监测仪在家中使用PSG测量睡眠呼吸障碍与心血管结局之间的关系。设计：SHHS评分者的可靠性是基于每个评分者随机选择的20项研究来评估的，评估了评分者之间和评分者内部的可靠性。结果：各时期睡眠分期的间、内比较均具有极好的信度（kappa统计量>.80），其中阶段1评分差异最大，阶段3/4最可靠。唤醒指数（每小时睡眠唤醒次数）是中等可靠的，类内相关性（ICC）为0.54。评分者在各种呼吸障碍指数（RDIs）上的可靠性很高，这些指标包括呼吸事件定义中的相关氧饱和度（2%至5%），以及呼吸事件定义中是否额外使用相关脑电图唤醒（ICC>0.90）。当RDI的定义不考虑氧饱和度或唤醒来定义呼吸事件时，RDI是中等可靠的（ICC=0.74）。在定义呼吸事件时，额外使用相关的脑电图唤醒，而不是氧饱和度，对提高RDI测量的可靠性几乎没有作用（ICC=0.77）。结论：在无人值守的家庭PSG研究中，SHHS在睡眠阶段和RDI评分方面取得了很高的评分者内和评分者间可靠性。
Study Objectives: Unattended, home-based polysomnography (PSG) is increasingly used in both research and clinical settings as an alternative to traditional laboratory-based studies, although the reliability of the scoring of these studies has not been described. The purpose of this study is to describe the reliability of the PSG scoring in the Sleep Heart Health Study (SHHS), a multicenter study of the relation between sleep-disordered breathing measured by unattended, in-home PSG using a portable sleep monitor, and cardiovascular outcomes.Design: The reliability of SHHS scorers was evaluated based on 20 randomly selected studies per scorer, assessing both interscorer and intrascorer reliability.Results: Both inter- and intrascorer comparisons on epoch-by-epoch sleep staging showed excellent reliability (kappa statistics >0.80), with stage 1 having the greatest discrepancies in scoring and stage 3/4 being the most reliably discriminated. The arousal index (number of arousals per hour of sleep) was moderately reliable, with an intraclass correlation (ICC) of 0.54. The scorers were highly reliable on various respiratory disturbance indices (RDIs), which incorporate an associated oxygen desaturation in the definition of respiratory events (2% to 5%) with or without the additional use of associated EEG arousal in the definition of respiratory events (ICC>0.90). When RDI was defined without considering oxygen desaturation or arousals to define respiratory events, the RDI was moderately reliable (ICC=0.74). The additional use of associated EEG arousals, but not oxygen desaturation, in defining respiratory events did little to increase the reliability of the RDI measure (ICC=0.77).Conclusions: The SHHS achieved a high degree of intrascorer and interscorer reliability for the scoring of sleep stage and RDI in unattended in-home PSG studies.