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The AASM Scoring Manual four years later.

Madeleine M Grigg-Damberger¹

¹University of New Mexico School of Medicine, MSC 10 5620, One University of NM, Albuquerque, New Mexico 87131-0001, USA. MGriggD@salud.unm.edu

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine

|June 16, 2012

Summary

The American Academy of Sleep Medicine (AASM) Sleep Scoring Manual impacts sleep studies, affecting apnea-hypopnea index calculations and sleep stage identification. While improving reliability, some rules require refinement for comprehensive sleep disorder assessment.

Keywords:

AASM standard Sleep scoring parameters polysomnography/classification/standards practice guidelines as topic sleep apnea practice guidelines as topic sleep scoring

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Area of Science:

Sleep Medicine
Polysomnography Analysis
Sleep Disorder Diagnosis

Background:

The American Academy of Sleep Medicine (AASM) Sleep Scoring Manual is a critical tool for standardizing sleep analysis.
Its publication aimed to improve consistency and accuracy in diagnosing sleep disorders.
Four years post-publication, its impact and effects warrant a comprehensive review.

Purpose of the Study:

To review published studies and critiques evaluating the impact and effects of the AASM Sleep Scoring Manual.
To assess the manual's influence on polysomnogram (PSG) scoring and clinical interpretations.

Main Methods:

Systematic review of published literature and critical analyses of the AASM Sleep Scoring Manual.
Analysis of studies reporting on the application of AASM scoring rules in polysomnography.

Main Results:

Significant variations in apnea-hypopnea index (AHI) due to hypopnea scoring rules.
Changes in NREM sleep staging (N1, N2, N3) and increased sleep stage shifts observed.
Improved inter-scorer reliability and better identification of fragmented sleep in pediatric obstructive sleep apnea (OSA).
Criticisms include dual hypopnea rules, EEG montage effects, NREM 3 scoring, and limited rules for arousals and REM sleep without atonia.

Conclusions:

The AASM Manual has faced less criticism than anticipated, establishing a foundational framework for sleep research.
It provides a basis for developing refined rules to address the complexities of sleep and its disorders.
Ongoing refinement of scoring rules is essential for advancing sleep medicine.