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The AASM scoring manual: a critical appraisal
1University of New Mexico School of Medicine, Albuquerque, New Mexico 87131-0001, USA. MGriggD@salud.unm.edu
Current Opinion in Pulmonary Medicine
|September 10, 2009
Summary
The American Academy of Sleep Medicine (AASM) Sleep Scoring Manual shows improved reliability in scoring sleep stages. However, it significantly alters apnea-hypopnea indexes (AHIs) and may miss sleep disordered breathing in some patients.
Area of Science:
- Sleep Medicine
- Neurology
- Pulmonology
Background:
- The American Academy of Sleep Medicine (AASM) published its updated Sleep Scoring Manual to standardize sleep analysis.
- Previous scoring methods had limitations in reliability and consistency.
Purpose of the Study:
- To review recent studies and critiques on the impact of the AASM Sleep Scoring Manual.
- To evaluate changes in sleep stage scoring and diagnostic accuracy.
Main Methods:
- Retrospective analysis of studies evaluating the AASM Sleep Scoring Manual.
- Comparison of sleep stage percentages and apnea-hypopnea indexes (AHIs) using new versus old criteria.
Main Results:
- Increased Non-Rapid Eye Movement Sleep (NREM) stages N1 and N3, with decreased N2 sleep.
- Improved interscorer reliability for adult sleep stage scoring.
- Significant discrepancies in AHIs based on different hypopnea scoring definitions.
- The recommended hypopnea definition identified no significant sleep disordered breathing in 40% of symptomatic OSA patients.
Conclusions:
- The AASM Manual has faced less criticism than anticipated and has improved interscorer reliability.
- The alternative hypopnea rule warrants endorsement as a recommended option.
- The Manual provides a foundation for quantifying sleep complexity, with multicenter validation encouraged.
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