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Visual and automatic classification of the cyclic alternating pattern in electroencephalography during sleep.

R Largo1,2, M C Lopes1,3, K Spruyt4

  • 1LaSEEB - Evolutionary Systems and Biomedical Engineering Laboratory, Institute for Systems and Robotics (ISR-Lisboa), Instituto Superior Técnico (IST), University of Lisbon, Lisbon, Portugal.

Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas
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Summary

Cyclic alternating pattern (CAP) scoring is feasible using a single electroencephalogram (EEG) channel, achieving reliable inter-scorer agreement comparable to automatic systems. This simplifies CAP analysis in sleep studies.

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Area of Science:

  • Neurophysiology
  • Sleep Medicine
  • Biomedical Engineering

Background:

  • Cyclic alternating pattern (CAP) is a recognized neurophysiological marker in sleep.
  • Current visual scoring of CAP relies on international criteria and multiple EEG channels.
  • Evaluating the efficiency and reliability of single-channel CAP scoring is essential for broader application.

Purpose of the Study:

  • To determine the feasibility of visual CAP scoring using only one electroencephalogram (EEG) channel.
  • To assess inter-scorer agreement for single-channel CAP scoring across diverse sleep recordings.
  • To compare the agreement of visual scoring with automatic scoring systems.

Main Methods:

  • Utilized 16 hours of single-channel sleep EEG recordings from four European sleep laboratories.
  • Seven independent scorers performed visual CAP scoring based on international criteria.
  • Two automatic blind scoring systems were employed for comparison.
  • Event-based inter-scorer agreement analysis, including pairwise inter-scorer agreement (PWISA), was conducted.

Main Results:

  • Pairwise inter-scorer agreement (PWISA) ranged from 55.5% to 84.3%, with an average PWISA above 60% for all scorers.
  • The global average inter-scorer agreement was 69.9%.
  • Automatic scoring systems demonstrated results comparable to visual scoring.

Conclusions:

  • Cyclic alternating pattern (CAP) can be reliably scored using a single EEG channel.
  • Single-channel CAP scoring exhibits sufficient inter-scorer agreement, supporting its clinical utility.
  • The findings suggest that CAP scoring can be integrated into automated sleep analysis systems with performance similar to manual scoring.