External proficiency testing improves inter-scorer reliability of polysomnography scoring.

Area of Science:

• Sleep Medicine
• Medical Diagnostics

Background:

• Polysomnography (PSG) is crucial for diagnosing sleep disorders.
• Inter-scorer reliability (ISR) in PSG scoring can vary significantly across sleep centers.
• Standardized scoring is essential for accurate diagnosis and research.

Purpose of the Study:

• To assess if external proficiency testing (EPT) can improve PSG inter-scorer reliability (ISR) across sleep centers.
• To determine if EPT combined with method alignment training offers further improvements in ISR.
• To evaluate the impact of EPT on respiratory, arousal, and sleep scoring reliability.

Main Methods:

• Randomized 30 experienced sleep scorers from 15 centers into three groups: control, EPT (passive), and EPT with active training.
• Monitored ISR for respiratory, arousal, and sleep scoring over six months using PSG fragments.
• Compared ISR changes between groups from baseline to six months.

Main Results:

• No ISR improvement was observed in the control group.
• Both EPT groups demonstrated statistically significant ISR improvements for respiratory, arousal, and sleep scoring (p < 0.05).
• Poorer performing scorers showed the greatest improvement, indicating EPT's effectiveness in standardizing scoring.

Conclusions:

• External proficiency testing provides a modest but significant improvement in PSG ISR among experienced scorers.
• Implementing EPT can enhance the clinical management of sleep disorders.
• Improved ISR through EPT can increase the statistical power of sleep research studies.