Evaluation of consensus sleep stage scoring of dysregulated sleep in Parkinson's disease.
Evaluation of consensus sleep stage scoring of dysregulated sleep in Parkinson's disease.
复制标题
帕金森病睡眠失调的共识睡眠阶段评分的评估。
DOI：
10.1016/j.sleep.2023.04.031
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发表时间：
2023
期刊：
影响因子：
4.8
通讯作者：
Thompson,JohnA
中科院分区：
文献类型：
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作者：
West,LeslieC;Summers,Michael;Tang,Siqun;Hirt,Lisa;Halpern,CaseyH;Maroni,Dulce;Das,Rig;Gliske,StephenV;Abosch,Aviva;Kushida,CleteA;Thompson,JohnA
目的帕金森病(PD)患者的睡眠失调被认为部分是由于基底节-皮质环路的功能障碍所致。对这种关系的评估需要准确的睡眠阶段判断，这在临床人群中是一个已知的挑战。我们的目标是优化关于睡眠分期过程的共识，并减少高级PD患者队列中评价者之间的变异性。方法15名PD患者来自3个地点，涉及丘脑底核(STN)脑深部刺激(DBS)导联(NCT04620551)的记录。分析了45个晚上的视频多导睡眠图(VPSG)数据。四名经验丰富的评分员在最初的审查中独立对数据进行了评分。共识低于75%的纪元被标记为二次审查。在对不和谐时期的二次评审中，两名原始评分者重新评估纪元，由此得出最终的共识阶段。结果在所有睡眠阶段，初始评分(IS)和二次共识评分(CS)的平均一致性为83.10%，二次共识评分(CS)的一致性达到96.58%。清醒时期(33.6%的不和谐时期)和非快速眼动阶段2(N2)时期(31.8%的不和谐时期)的确定最不一致。评分差异通过直接测量皮质频率和幅度、时代的生理背景和视频回顾来解决。结论我们的多水平初始和二次共识评审评分方法导致的共识评分一致性优于传统标准。这项工作以定制的vPSG软件和审查平台为特色，用于在多站点临床试验中整合共识睡眠阶段评分。
ObjectiveSleep dysregulation in Parkinson's disease (PD) has been hypothesized to occur, in part, from dysfunction in the basal ganglia-cortical circuit. Assessment of this relationship requires accurate sleep stage determination, a known challenge in this clinical population. Our objective was to optimize the consensus on the sleep staging process and reduce interrater variability in a cohort of advanced PD subjects.MethodsFifteen PD subjects were enrolled from three sites in a clinical trial that involved recordings from subthalamic nucleus (STN) deep brain stimulation (DBS) leads (NCT04620551). Video polysomnography (vPSG) data for a total of 45 nights were analyzed. Four experienced scorers independently scored data on initial review. Epochs with less than 75% consensus were flagged for secondary review. In secondary review of discordant epochs, two of the original scorers re-assessed epochs, from which the final consensus stage was derived.ResultsSleep stage classification agreement averaged 83.10% across all sleep stages on initial scoring (IS), and on secondary consensus scoring (CS) review, agreement reached 96.58%. Greatest disagreement was noted in determination of awake epochs (33.6% of discordant epochs) and non-rapid-eye-movement stage 2 (N2) epochs (31.8% of discordant epochs). Scoring discrepancy was resolved with direct measurement of cortical frequency and amplitudes, physiologic context of the epoch, and video review.ConclusionOur method of multi-level initial and then secondary consensus review scoring resulted in consensus scoring agreement superior to conventional standards. This work features a custom-engineered vPSG software and review platform for integration of consensus sleep stage scoring in a multi-site clinical trial.