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Infant polysomnography: reliability and validity of infant arousal assessment
David H Crowell1, Thomas D Kulp, Linda E Kapuniai
1Department of Pediatrics, John A Burns School of Medicine, University of Hawaii and Kapi'olani Medical Center for Women and Children, Honolulu, HI 96826, USA. CHIME@kapiolani.org
Insights
This study shows that trained raters can reliably score infant EEG arousals using modified Atlas Task Force standards. However, independent expert validation of these infant arousal scores proved difficult, necessitating further research.
Area of Science:
- Neuroscience
- Pediatrics
- Sleep Medicine
Background:
- Reliable identification of transient electroencephalogram (EEG) arousals in infants is crucial for understanding sleep disorders.
- Existing methods for infant arousal scoring require standardized and validated approaches.
Purpose of the Study:
- To evaluate the reliability of infant arousal scoring based on the Atlas Task Force definition.
- To assess whether independent sleep experts can reliably validate previously scored arousal and no-arousal epochs in infants.
Main Methods:
- Trained raters scored sleep epochs from polysomnograms of infants (35-64 weeks postconceptional age) using modified Atlas Task Force criteria.
- Inter- and intrarater reliability were assessed using kappa statistics.
- Independent sleep experts validated previously scored epochs.
Main Results:
- Substantial to almost perfect inter- and intrarater reliability was achieved by trained raters for infant EEG arousal scoring.
- Initial moderate interrater reliability for spontaneous arousals improved to substantial levels after retraining.
- Independent expert validation showed diverse agreements, with concordance supporting the use of infant EEG criteria.
Conclusions:
- A reliable model for infant EEG arousal assessment using modified Atlas Task Force standards was developed.
- Training on specific criteria enhances inter- and intrarater agreement in infant arousal identification.
- Further validation studies are needed to confirm the reliability of infant EEG arousal assessment criteria.
Abstract:
Infant arousal scoring based on the Atlas Task Force definition of transient EEG arousal was evaluated to determine (1). whether transient arousals can be identified and assessed reliably in infants and (2). whether arousal and no-arousal epochs scored previously by trained raters can be validated reliably by independent sleep experts. Phase I for inter- and intrarater reliability scoring was based on two datasets of sleep epochs selected randomly from nocturnal polysomnograms of healthy full-term, preterm, idiopathic apparent life-threatening event cases, and siblings of Sudden Infant Death Syndrome infants of 35 to 64 weeks postconceptional age. After training, test set 1 reliability was assessed and discrepancies identified. After retraining, test set 2 was scored by the same raters to determine interrater reliability. Later, three raters from the trained group rescored test set 2 to assess inter- and intrarater reliabilities. Interrater and intrarater reliability kappa's, with 95% confidence intervals, ranged from substantial to almost perfect levels of agreement. Interrater reliabilities for spontaneous arousals were initially moderate and then substantial. During the validation phase, 315 previously scored epochs were presented to four sleep experts to rate as containing arousal or no-arousal events. Interrater expert agreements were diverse and considered as noninterpretable. Concordance in sleep experts' agreements, based on identification of the previously sampled arousal and no-arousal epochs, was used as a secondary evaluative technique. Results showed agreement by two or more experts on 86% of the Collaborative Home Infant Monitoring Evaluation Study arousal scored events. Conversely, only 1% of the Collaborative Home Infant Monitoring Evaluation Study-scored no-arousal epochs were rated as an arousal. In summary, this study presents an empirically tested model with procedures and criteria for attaining improved reliability in transient EEG arousal assessments in infants using the modified Atlas Task Force standards. With training based on specific criteria, substantial inter- and intrarater agreement in identifying infant arousals was demonstrated. Corroborative validation results were too disparate for meaningful interpretation. Alternate evaluation based on concordance agreements supports reliance on infant EEG criteria for assessment. Results mandate additional confirmatory validation studies with specific training on infant EEG arousal assessment criteria.