Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/87705
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Type: Journal article
Title: The 2007 AASM recommendations for EEG electrode placement in polysomnography: impact on sleep and cortical arousal scoring
Author: Ruehland, W.
O'Donoghue, F.
Pierce, R.
Thornton, A.
Singh, P.
Copland, J.
Stevens, B.
Rochford, P.
Citation: Sleep, 2011; 34(1):73-81
Publisher: OXFORD UNIV PRESS INC
Issue Date: 2011
ISSN: 0161-8105
1550-9109
Statement of
Responsibility: 
Warren R. Ruehland, Fergal J. O’Donoghue, Robert J. Pierce, Andrew T. Thornton, Parmjit Singh, Janet M. Copland, Bronwyn Stevens, Peter D. Rochford
Abstract: STUDY OBJECTIVE: To examine the impact of using American Academy of Sleep Medicine (AASM) recommended EEG derivations (F4/M1, C4/M1, O2/M1) vs. a single derivation (C4/M1) in polysomnography (PSG) on the measurement of sleep and cortical arousals, including inter- and intra-observer variability. DESIGN: Prospective, non-blinded, randomized comparison. SETTING: Three Australian tertiary-care hospital clinical sleep laboratories. PATIENTS OR PARTICIPANTS: 30 PSGs from consecutive patients investigated for obstructive sleep apnea (OSA) during December 2007 and January 2008. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: To examine the impact of EEG derivations on PSG summary statistics, 3 scorers from different Australian clinical sleep laboratories each scored separate sets of 10 PSGs twice, once using 3 EEG derivations and once using 1 EEG derivation. To examine the impact on inter- and intra-scorer reliability, all 3 scorers scored a subset of 10 PSGs 4 times, twice using each method. All PSGs were de-identified and scored in random order according to the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Using 3 referential EEG derivations during PSG, as recommended in the AASM manual, instead of a single central EEG derivation, as originally suggested by Rechtschaffen and Kales (1968), resulted in a mean ± SE decrease in N1 sleep of 9.6 ± 3.9 min (P = 0.018) and an increase in N3 sleep of 10.6 ± 2.8 min (P = 0.001). No significant differences were observed for any other sleep or arousal scoring summary statistics; nor were any differences observed in inter-scorer or intra-scorer reliability for scoring sleep or cortical arousals. CONCLUSION: This study provides information for those changing practice to comply with the 2007 AASM recommendations for EEG placement in PSG, for those using portable devices that are unable to comply with the recommendations due to limited channel options, and for the development of future standards for PSG scoring and recording. As the use of multiple EEG derivations only led to small changes in the distribution of derived sleep stages and no significant differences in scoring reliability, this study calls into question the need to use multiple EEG derivations in clinical PSG as suggested in the AASM manual.
Keywords: Electroencephalography; polysomnography; sleep scoring; cortical arousal scoring; sleep architecture; obstructive sleep apnea; sleep disordered breathing; inter-scorer reliability; intra-scorer reliability; kappa
Rights: © 2011 Associated Professional Sleep Societies, LLC.
RMID: 0030013896
DOI: 10.1093/sleep/34.1.73
Grant ID: http://purl.org/au-research/grants/nhmrc/430300
http://purl.org/au-research/grants/nhmrc/430302
Published version: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001799/
Appears in Collections:Medicine publications

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