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- Title
Inter-rater agreement in sleep stage classification between centers with different backgrounds.
- Authors
Basner, Mathias; Griefahn, Barbara; Penzel, Thomas
- Abstract
To investigate inter-rater agree- ment between scorers from three centers with clinical (Marburg University, UMA) or research (German Aerospace Center, DLR and Dortmund University, UDO) backgrounds. Additionally, sleep scoring rules of the new AASM manual for the scoring of sleep and associated events were reviewed regarding possible implications for inter-rater agreement. Each of three centers contributed 20 nights. All 60 nights (37 subjects, 9 female, mean age ± sd = 41.8 ± 16.1 years) were scored by each center according to the rules of Rechtschaffen and Kales. Twenty subjects underwent obstructive sleep apnea (OSA) diagnosis, the remaining subjects participated in studies on the effects of traffic noise on sleep and were free of intrinsic sleep disorders. According to kappa statistics, inter-rater agreement between the three centers was excellent in 38 %, fair to good in 62 % and never poor. Mean kappa values decreased in the order rapid eye movement sleep, wake, stage 2, slow wave sleep, stage 4, stage 1 and stage 3. Time spent in the different sleep stages was positively correlated with kappa values. Pairwise comparisons revealed that agreement on stage 1 was significantly worse for UDO, but concerning all other stages none of the centers deviated significantly from the other two. Analyses of Venn diagrams showed tendencies of UDO for scoring wake alone and of UMA for scoring stage 4 alone. Differences between clinical and research centers were overall minor. Pairwise kappa comparisons of several centers/scorers as well as Venn diagrams may detect systematic deviances of single centers/ scorers that consequently should receive additional training. The revised AASM rules for sleep scoring will most likely increase inter-rater agreement, but future studies will have to prove this.
- Subjects
POLYSOMNOGRAPHY; SLEEP disorder diagnosis; SLEEP apnea syndromes; TRAFFIC noise; RAPID eye movement sleep; SLEEP stages
- Publication
Somnologie, 2008, Vol 12, Issue 1, p75
- ISSN
1432-9123
- Publication type
Article
- DOI
10.1007/s11818-008-0327-y