Drinnan M J, Murray A, Griffiths C J, Gibson G J
Departments of Regional Medical Physics and Respiratory Medicine, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
Am J Respir Crit Care Med. 1998 Aug;158(2):358-62. doi: 10.1164/ajrccm.158.2.9705035.
Daytime sleepiness is a common consequence of repeated arousal in obstructive sleep apnea (OSA). Arousal indices are sometimes used to make decisions on treatment, but there is no evidence that arousals are detected similarly even by experienced observers. Using the American Sleep Disorders Association (ASDA) definition of arousal in terms of the accompanying electroencephalogram (EEG) changes, we have quantified interobserver agreement for arousal scoring and identified factors affecting it. Ten patients with suspected OSA were studied; three representative EEG events during each of light, slow-wave, and rapid-eye-movement (REM) sleep were extracted from each record (90 events total) and evaluated by experts in 14 sleep laboratories. Observers differed (ANOVA, p < 0.001) in the number of events scored as arousal (totals ranged from 23 to 53 of the 90 events). Overall agreement was moderate (kappa = 0.47), but it was best for events during slow-wave sleep, moderate for REM, and poor for light sleep (kappa = 0.60, 0.52, and 0.28, respectively). Agreement was unrelated to arousal duration. We conclude that the ASDA definition of arousal is only moderately repeatable. Account should be taken of this variability when results from different centers are compared.
日间嗜睡是阻塞性睡眠呼吸暂停（OSA）反复觉醒的常见后果。觉醒指数有时用于指导治疗决策，但尚无证据表明即使是经验丰富的观察者对觉醒的检测结果也相似。根据美国睡眠障碍协会（ASDA）对伴随脑电图（EEG）变化的觉醒定义，我们对觉醒评分的观察者间一致性进行了量化，并确定了影响一致性的因素。对10例疑似OSA患者进行了研究；从每份记录中提取了浅睡眠、慢波睡眠和快速眼动（REM）睡眠期间的三个代表性EEG事件（共90个事件），并由14个睡眠实验室的专家进行评估。观察者对评定为觉醒的事件数量存在差异（方差分析，p < 0.001）（90个事件中，总数范围为23至53个）。总体一致性为中等（kappa = 0.47），但慢波睡眠期间的事件一致性最佳，REM睡眠期间为中等，浅睡眠期间较差（kappa分别为0.60、0.52和0.28）。一致性与觉醒持续时间无关。我们得出结论，ASDA对觉醒的定义仅有适度的可重复性。在比较不同中心的结果时，应考虑到这种变异性。
