Process and outcome for international reliability in sleep scoring
Process and outcome for international reliability in sleep scoring
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DOI：
10.1007/s11325-014-0990-0
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发表时间：
2015-03
影响因子：
2.5
通讯作者：
Xiaozhe Zhang;Xiao-song Dong;J. Kantelhardt;Jing Li;Long Zhao;Carmen Garcia;M. Glos;T. Penzel
中科院分区：
文献类型：
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作者：
Xiaozhe Zhang;Xiao-song Dong;J. Kantelhardt;Jing Li;Long Zhao;Carmen Garcia;M. Glos;T. Penzel
ObjectivesThe的目的是评估评分者之间的可靠性在两个睡眠实验室在柏林德国和北京China.MethodsThe科目包括多导睡眠图（PSG）从15个主题在德国睡眠实验室，7轻度至中度睡眠呼吸暂停低通气综合征（SAHS）患者和8名健康对照，和PSG从15发作性睡病患者在中国睡眠实验室。五名经验丰富的技术人员（包括两名中国人和三名德国人）根据2007年AASM手册对PSG进行了评分，但EEG信号仅包括两个EEG导联（C3/A2和C4/A1）。在评分员之间的协议的差异进行了分析的基础上，通过科恩的κ时代的比较，和定量睡眠参数的类内correlation coefficients.ResultsInter-laboratory时代之间的协议比较，从两国的评分员之间产生了一个中等的协议，平均κ值为0.57为控制，0.58为SAHS，和0.54为发作性睡病。与对照组相比，SAHS患者的觉醒和N3期评分以及发作性睡病患者的N1和N3评分的评分间一致性较高（p <0.05）。在SAHS（κ 0.69 vs.0.79，p = 0.034）和发作性睡病（κ 0.66 vs.0.79，p = 0.022）中，唯一评分一致性较低的睡眠阶段是REM阶段。实验室间的比较表明，最常见的偏离评分组合是N1和N2，N2和N3，以及N1和尾流。觉醒和REM评分偏离率为6.5%，N1和REM评分偏离率为13.4%，表明发作性睡病的实验室间评分约为SAHS和对照组的2倍。这进一步证实了协议分析的定量参数使用类内相关系数ICC（2，1）表明REM睡眠评分的一致性低于对照组（p <0.05）。结论低REM阶段评分的一致性存在发作性睡病和SAHS，这表明有必要研究睡眠阶段评分的一致性为特定的睡眠障碍。在国际多中心研究中，睡眠评分需要强化培训，以提高评分一致性。
ObjectivesThe aim was to evaluate the inter-rater reliability in scoring sleep stages in two sleep labs in Berlin Germany and Beijing China.MethodsThe subjects consist of polysomnography (PSGs) from 15 subjects in a German sleep laboratory, with 7 mild to moderate sleep apnea hypopnea syndrome (SAHS) patients and 8 healthy controls, and PSGs from 15 narcolepsy patients in a Chinese sleep laboratory. Five experienced technologists including two Chinese and three Germans without common training scored the PSGs following the 2007 AASM manual except the EEG signals included only two EEG leads (C3/A2 and C4/A1). Differences in inter-scorer agreement were analyzed based on epoch-by-epoch comparison by means of Cohen’sκ, and quantitative sleep parameters by means of intra-class correlation coefficients.ResultsInter-laboratory epoch-by-epoch agreement comparison between scorers from the two countries yielded a moderate agreement with a meanκvalue of 0.57 for controls, 0.58 for SAHS, and 0.54 for narcolepsy. When compared with controls, the inter-scoring agreement is higher for wake and N3 stage scoring in SAHS and N1 and N3 scoring in narcolepsy (p< 0.05). The only sleep stage with lower scoring agreement in both SAHS (κ0.69 vs. 0.79,p= 0.034) and narcolepsy (0.66 vs 0.79,p= 0.022) was stage REM. Inter-laboratory comparisons showed that the most common combinations of deviating scorings were N1 and N2, N2 and N3, and N1 and wake. A 6.5 % deviating scoring rate of wake and REM and a 13.4 % deviating scoring rate of N1 and REM indicated that inter-laboratory scoring in narcolepsy was about twice as in SAHS and controls confused. This was further confirmed by agreement analysis of quantitative parameters using intra-class correlation coefficients ICC(2,1) indicating REM sleep scoring agreement was lower in narcolepsy than in controls (p< 0.05).ConclusionLow REM stage scoring agreement exists for narcoleptics and SAHS, indicating the necessity to study sleep stage scoring agreement for a specific sleep disorder. Intensive training is needed for the scoring of sleep in international multiple center studies to improve the scoring agreement.