Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Sleep Med. 2023 Aug;108:71-78. doi: 10.1016/j.sleep.2023.05.016. Epub 2023 May 29.
To compare manual scoring: 1) to the American Academy of Sleep Medicine (AASM) auto-scoring rules. 2) to the AASM and World Association of Sleep Medicine (WASM) rules, and evaluate the accuracy of the AASM and WASM for respiratory event-related limb movements (RRLM) in diagnostic and continuous positive airway pressure (CPAP) titration polysomnography (PSG).
We retrospectively, re-scored diagnostic and CPAP titration PSGs of 16 patients with obstructive sleep apnea (OSA), using manual re-scoring by the AASM (mAASM) and WASM (mWASM) criteria for RRLM, periodic limb movements during sleep (PLMS), and limb movements (LM), which were compared to auto-scoring by the AASM (aAASM).
In diagnostic PSG, significant differences were found in LMs (p < 0.05), RRLM (p = 0.009) and the mean duration of PLMS sequences (p = 0.013). In CPAP titration PSG, there was a significant difference in RRLM (p = 0.008) and PLMS with arousal index (p = 0.036). aAASM underestimated LM and RRLM, especially in severe OSA. Changes in RRLM and PLMS with arousal index between diagnostic and titration PSG were significantly different between aAASM and mAASM, but there was no significant difference between scoring by mAASM and mWASM. The ratio of PLMS and RRLM changes between diagnostic and CPAP titration PSG was 0.257 in mAASM and 0.293 in mWASM.
In addition to the overestimation of RRLM by mAASM compared to aAASM, mAASM may also be more sensitive than aAASM in detecting RRLM changes in the titration PSG. Despite intuitive differences in the definition of RRLM between AASM and WASM rules, RRLM results between mAASM and mWASM were not significant and about 30% of RRLMs might be scored as PLMS by both scoring rules.
比较手动评分：1）与美国睡眠医学学会（AASM）自动评分规则。2）与 AASM 和世界睡眠医学协会（WASM）规则，并评估 AASM 和 WASM 对诊断和持续气道正压通气（CPAP）滴定多导睡眠图（PSG）中与呼吸相关的肢体运动（RRLM）的准确性。
我们回顾性地重新评分了 16 例阻塞性睡眠呼吸暂停（OSA）患者的诊断和 CPAP 滴定 PSG，使用手动重新评分 AASM（mAASM）和 WASM（mWASM）标准的 RRLM、睡眠期间周期性肢体运动（PLMS）和肢体运动（LM），并与 AASM（aAASM）的自动评分进行比较。
在诊断 PSG 中，LM（p<0.05）、RRLM（p=0.009）和 PLMS 序列平均持续时间（p=0.013）差异有统计学意义。在 CPAP 滴定 PSG 中，RRLM（p=0.008）和伴有觉醒指数的 PLMS（p=0.036）差异有统计学意义。aAASM 低估了 LM 和 RRLM，尤其是在严重 OSA 中。诊断 PSG 和滴定 PSG 之间的 RRLM 和伴有觉醒指数的 PLMS 变化之间，aAASM 和 mAASM 之间差异有统计学意义，但 mAASM 和 mWASM 之间无统计学差异。mAASM 中 PLMS 和 RRLM 变化的比值为 0.257，mWASM 中为 0.293。
除了 mAASM 相对于 aAASM 高估 RRLM 之外，mAASM 在检测滴定 PSG 中 RRLM 变化时可能比 aAASM 更敏感。尽管 AASM 和 WASM 规则在 RRLM 的定义上存在直观差异，但 mAASM 和 mWASM 之间的 RRLM 结果并无显著差异，大约 30%的 RRLM 可能被两种评分规则均判定为 PLMS。
