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Background: In 2007, the AASM Manual for the Scoring of Sleep and Associated Events was published by the American Academy of Sleep Medicine (AASM). Concerning the visual classification of sleep stages, these new rules are intended to replace the rules by Rechtschaffen and Kales (R&K)., Methods: We adapted the automatic R&K sleep scoring system Somnolyzer 24 × 7 to comply with the AASM rules and subsequently performed a validation study based on 72 polysomnographies from the Siesta database (56 healthy subjects, 16 patients, 38 females, 34 males, aged 21-86 years). Scorings according to the AASM rules were performed manually by experienced sleep scorers and semi-automatically by the AASM version of the Somnolyzer. Manual scorings and Somnolyzer reviews were performed independently by at least 2 out of 8 experts from 4 sleep centers., Results: In the quality control process, sleep experts corrected 4.8 and 3.7% of the automatically assigned epochs, resulting in a reliability between 2 Somnolyzer-assisted scorings of 99% (Cohen's kappa: 0.99). In contrast, the reliability between the 2 manual scorings was 82% (kappa: 0.76). The agreement between the 2 Somnolyzer-assisted and the 2 visual scorings was between 81% (kappa: 0.75) and 82% (kappa: 0.76)., Conclusion: The AASM version of the Somnolyzer revealed an agreement between semi-automated and human expert scoring comparable to that published for the R&K version with a validity comparable to that of human experts, but with a reliability close to 1, thereby reducing interrater variability as well as scoring time to a minimum., (Copyright © 2010 S. Karger AG, Basel.)

Interrater variability of sleep stage scorings has an essential impact not only on the reading of polysomnographic sleep studies (PSGs) for clinical trials but also on the evaluation of patients' sleep. With the introduction of a new standard for sleep stage scorings (AASM standard) there is a need for studies on interrater reliability (IRR). The SIESTA database resulting from an EU-funded project provides a large number of studies (n = 72; 56 healthy controls and 16 subjects with different sleep disorders, mean age +/- SD: 57.7 +/- 18.7, 34 females) for which scorings according to both standards (AASM and R&K) were done. Differences in IRR were analysed at two levels: (1) based on quantitative sleep parameter by means of intraclass correlations; and (2) based on an epoch-by-epoch comparison by means of Cohen's kappa and Fleiss' kappa. The overall agreement was for the AASM standard 82.0% (Cohen's kappa = 0.76) and for the R&K standard 80.6% (Cohen's kappa = 0.68). Agreements increased from R&K to AASM for all sleep stages, except N2. The results of this study underline that the modification of the scoring rules improve IRR as a result of the integration of occipital, central and frontal leads on the one hand, but decline IRR on the other hand specifically for N2, due to the new rule that cortical arousals with or without concurrent increase in submental electromyogram are critical events for the end of N2.

Study Objective: To investigate differences between visual sleep scoring according to the classification developed by Rechtschaffen and Kales (R&K, 1968) and scoring based on the new guidelines of the American Academy of Sleep Medicine (AASM, 2007)., Design: All-night polysomnographic recordings were scored visually according to the R&K and AASM rules by experienced sleep scorers. Descriptive data analysis was used to compare the resulting sleep parameters., Participants: Healthy subjects and patients (38 females and 34 males) aged between 21 and 86 years., Interventions: N/A., Measurement and Results: While sleep latency and REM latency, total sleep time, and sleep efficiency were not affected by the classification standard, the time (in minutes and in percent of total sleep time) spent in sleep stage 1 (S1/N1), stage 2 (S2/N2) and slow wave sleep (S3+S4/N3) differed significantly between the R&K and the AASM classification. While light and deep sleep increased (S1 vs. N1 [+10.6 min, (+2.8%)]: P<0.01; S3+S4 vs. N3 [+9.1 min (+2.4%)]: P<0.01), stage 2 sleep decreased significantly according to AASM rules (S2 vs. N2 [-20.5 min, (-4.9%)]: P<0.01). Moreover, wake after sleep onset was significantly prolonged by approximately 4 minutes (P<0.01) according to the AASM standard. Interestingly, the effects on stage REM were age-dependent (intercept at 20 years: -7.5 min; slope: 1.6 min for 10-year age increase). No effects of sex and diagnosis were observed., Conclusion: The study shows significant and age-dependent differences between sleep parameters derived from conventional visual sleep scorings on the basis of R&K rules and those based on the new AASM rules. Thus, new normative data have to be established for the AASM standard.