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Related Experiment Videos

Interobserver variability in recognizing arousal in respiratory sleep disorders

M J Drinnan1, A Murray, C J Griffiths

  • 1Departments of Regional Medical Physics and Respiratory Medicine, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.

American Journal of Respiratory and Critical Care Medicine
|August 12, 1998
PubMed
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Inter-observer agreement for scoring sleep arousals, using the American Sleep Disorders Association definition, was only moderate. This variability impacts the reliability of arousal indices in diagnosing obstructive sleep apnea (OSA).

Area of Science:

  • Sleep Medicine
  • Neurology
  • Respiratory Medicine

Background:

  • Daytime sleepiness is a frequent symptom in patients with obstructive sleep apnea (OSA).
  • Arousal indices are utilized in treatment decisions for OSA, but their consistent scoring by different experts is unproven.
  • The American Sleep Disorders Association (ASDA) provides a definition for scoring arousals based on electroencephalogram (EEG) changes.

Purpose of the Study:

  • To quantify inter-observer agreement in scoring arousals according to the ASDA definition.
  • To identify factors influencing the reliability of arousal scoring among sleep experts.
  • To assess the repeatability of arousal detection in patients with suspected OSA.

Main Methods:

  • Ninety electroencephalogram (EEG) events from 10 patients with suspected OSA were selected, representing light, slow-wave, and rapid-eye-movement (REM) sleep.

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  • These events were independently scored for arousals by experts from 14 sleep laboratories using the ASDA criteria.
  • Statistical analysis, including ANOVA and kappa statistics, was employed to evaluate agreement and identify influencing factors.

    • Main Results:

    • Significant differences were observed in the number of events scored as arousals across observers (ANOVA, p < 0.001).
    • Overall inter-observer agreement was moderate (kappa = 0.47).
    • Agreement varied by sleep stage: best for slow-wave sleep (kappa = 0.60), moderate for REM sleep (kappa = 0.52), and poor for light sleep (kappa = 0.28). Arousal duration did not affect agreement.

    Conclusions:

    • The ASDA definition for scoring arousals demonstrates only moderate repeatability among experienced observers.
    • Variability in arousal scoring is influenced by the sleep stage, with light sleep showing the lowest agreement.
    • Clinical interpretations and comparisons of arousal index data across different sleep centers should account for this inherent scoring variability.