Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.
Sleep. 2011 Jan 1;34(1):73-81. doi: 10.1093/sleep/34.1.73.
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.
Prospective, non-blinded, randomized comparison.
Three Australian tertiary-care hospital clinical sleep laboratories.
30 PSGs from consecutive patients investigated for obstructive sleep apnea (OSA) during December 2007 and January 2008.
N/A.
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.
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.
研究使用美国睡眠医学学会（AASM）推荐的脑电图导联（F4/M1、C4/M1、O2/M1）与单导联（C4/M1）进行多导睡眠图（PSG）对睡眠和皮质唤醒的测量的影响，包括观察者间和观察者内的变异性。
前瞻性、非盲、随机比较。
澳大利亚三家三级保健医院临床睡眠实验室。
2007 年 12 月至 2008 年 1 月期间连续接受阻塞性睡眠呼吸暂停（OSA）检查的 30 例 PSG。
无。
为了研究脑电图导联对 PSG 汇总统计数据的影响，来自不同澳大利亚临床睡眠实验室的 3 名评分员分别两次对 10 套 PSG 进行评分，一次使用 3 个脑电图导联，一次使用 1 个脑电图导联。为了研究对观察者间和观察者内可靠性的影响，所有 3 名评分员 4 次对 10 套 PSG 进行评分，每次使用一种方法。所有 PSG 均进行去识别处理，并根据 2007 年 AASM 睡眠和相关事件评分手册以随机顺序进行评分。按照 AASM 手册建议在 PSG 中使用 3 个参考脑电图导联，而不是 Rechtschaffen 和 Kales（1968）最初建议的单个中央脑电图导联，结果导致 N1 睡眠平均减少 9.6±3.9 分钟（P=0.018），N3 睡眠增加 10.6±2.8 分钟（P=0.001）。在任何其他睡眠或唤醒评分汇总统计数据方面没有观察到显著差异；在评分睡眠或皮质唤醒时，也没有观察到观察者间或观察者内可靠性的差异。
本研究为那些为了遵守 2007 年 AASM 关于 PSG 脑电图导联放置的建议而改变实践的人提供了信息，为那些因通道选项有限而无法遵守建议的便携式设备的人提供了信息，为未来 PSG 评分和记录的标准制定提供了信息。由于使用多个脑电图导联仅导致衍生睡眠阶段分布的微小变化，且评分可靠性没有显著差异，因此本研究质疑 AASM 手册中建议的在临床 PSG 中使用多个脑电图导联的必要性。
