Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18–20, Vienna, Austria.
Neuropsychobiology. 2010;62(4):250-64. doi: 10.1159/000320864. Epub 2010 Sep 9.
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).
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.
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).
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.
2007 年，美国睡眠医学学会（AASM）发布了《睡眠及相关事件评分手册》。关于睡眠分期的视觉分类，这些新规则旨在取代 Rechtschaffen 和 Kales（R&K）规则。
我们改编了自动的 R&K 睡眠评分系统 Somnolyzer 24×7，使其符合 AASM 规则，随后基于 Siesta 数据库中的 72 项多导睡眠图进行了验证研究（56 例健康受试者，16 例患者，女性 38 例，男性 34 例，年龄 21-86 岁）。根据 AASM 规则，由经验丰富的睡眠评分员进行手动评分，并由 Somnolyzer 的 AASM 版本进行半自动评分。手动评分和 Somnolyzer 复查由来自 4 个睡眠中心的至少 8 位专家中的 2 位独立进行。
在质量控制过程中，睡眠专家纠正了自动分配的 4.8%和 3.7%的时相，因此，2 次 Somnolyzer 辅助评分的可靠性为 99%（Cohen's kappa：0.99）。相比之下，2 次手动评分的可靠性为 82%（kappa：0.76）。2 次 Somnolyzer 辅助评分与 2 次视觉评分之间的一致性在 81%（kappa：0.75）至 82%（kappa：0.76）之间。
Somnolyzer 的 AASM 版本显示，半自动和人类专家评分之间的一致性与 R&K 版本发表的结果相当，其有效性与人类专家相当，但可靠性接近 1，从而将评分者间的变异性以及评分时间降至最低。
