Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Sleep. 2021 Sep 13;44(9). doi: 10.1093/sleep/zsab094.
To evaluate interrater reliability for artifact correction in the context of semiautomated quantification of rapid eye movement (REM) sleep without atonia (RWA) in the mentalis and flexor digitorum superficialis (FDS) muscles.
We included video-polysomnographies of 14 subjects with apnea-hypopnea index in REM sleep (AHIREM) < 15/h and 11 subjects with AHIREM ≥ 15/h. Eight subjects had isolated REM sleep behavior disorder. A validated algorithm (www.osg.be) automatically scored phasic and "any" EMG activity in the mentalis muscle, and phasic EMG activity in the FDS muscles. Four independent expert scorers performed artifact correction according to the SINBAR (Sleep Innsbruck Barcelona) recommendations. Interrater reliability for artifact correction was computed with B-statistics. The variability across scorers of four RWA indices (phasic mentalis, "any" mentalis, phasic FDS and SINBAR-i.e. "any" mentalis and/or phasic FDS-EMG activity indices) was computed. With Friedman tests, we compared B-statistics obtained for mentalis and FDS muscles, and the variability of the RWA indices. Influence of AHIREM and REM sleep behavior disorder (RBD) diagnosis on the RWA indices variability was evaluated with linear regressions.
Interrater reliability for artifact correction was higher in the FDS than in the mentalis muscle (p < 0.001). Phasic FDS activity was minimally affected by artifacts. Accordingly, the phasic FDS EMG activity index had the lowest variability across scorers (p < 0.001). Variability across scorers of the RWA indices including the mentalis muscle increased with AHIREM and was independent from RBD diagnosis.
Due to the consistently found low number of artifacts, phasic FDS activity is a reliable measure of RWA.
评估在 mentalis 和 flexor digitorum superficialis（FDS）肌肉的非快速眼动（REM）睡眠无张力（RWA）的半自动定量中，人工制品校正的评分者间可靠性。
我们纳入了 REM 睡眠中呼吸暂停低通气指数（AHIREM）<15/h 的 14 名受试者和 AHIREM≥15/h 的 11 名受试者的视频多导睡眠图。8 名受试者有孤立的 REM 睡眠行为障碍。一个经过验证的算法（www.osg.be）自动评分 mentalis 肌肉的相位和“任何”肌电图活动，以及 FDS 肌肉的相位肌电图活动。四名独立的专家评分者根据 SINBAR（Sleep Innsbruck Barcelona）建议进行人工制品校正。采用 B 统计量计算人工制品校正的评分者间可靠性。计算四个 RWA 指数（相位 mentalis、“任何”mentalis、相位 FDS 和 SINBAR-即“任何”mentalis 和/或相位 FDS-肌电图活动指数）在评分者之间的变异性。通过 Friedman 检验，我们比较了 mentalis 和 FDS 肌肉的 B 统计量，以及 RWA 指数的变异性。通过线性回归评估 AHIREM 和 REM 睡眠行为障碍（RBD）诊断对 RWA 指数变异性的影响。
人工制品校正的评分者间可靠性在 FDS 中高于 mentalis 肌肉（p<0.001）。相位 FDS 活动受人工制品的影响最小。因此，相位 FDS 肌电图活动指数在评分者之间的变异性最低（p<0.001）。包括 mentalis 肌肉在内的 RWA 指数的评分者间变异性随着 AHIREM 的增加而增加，与 RBD 诊断无关。
由于始终发现人工制品数量较少，相位 FDS 活动是 RWA 的可靠测量指标。
