Agreement in the scoring of respiratory events among international sleep centers for home sleep testing

Ulysses J. Magalang*, Erna S. Arnardottir, Ning Hung Chen, Peter A. Cistulli, Thorarinn Gíslason, Diane Lim, Thomas Penzel, Richard Schwab, Sergio Tufik, Allan I. Pack

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

28 Scopus citations


Study Objectives: Home sleep testing (HST) is used worldwide to confirm the presence of obstructive sleep apnea (OSA). We sought to determine the agreement of HST scoring among international sleep centers. Methods: Fifteen HSTs, previously recorded using a type 3 monitor, were deidentified and saved in European Data Format. The studies were scored by nine technologists from the sleep centers of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) using the locally available software. Each study was scored separately using one of three different airflow signals: nasal pressure (NP), transformed (square root) nasal pressure signal (transformed NP), and uncalibrated respiratory inductive plethysmography (RIP) flow. Only one of the three airflow signals was visible to the scorer at each scoring session. The scoring procedure was repeated to determine the intrarater reliability. Results: The intraclass correlation coefficients (ICCs) using the NP were: apnea-hypopnea index (AHI) = 0.96 (95% confidence interval [CI]: 0.93-0.99); apnea index = 0.91 (0.83-0.96); and hypopnea index = 0.75 (0.59-0.89). The ICCs using the transformed NP were: AHI = 0.98 (0.96-0.99); apnea index = 0.95 (0.90-0.98); and hypopnea index = 0.90 (0.82-0.96). The ICCs using the RIP flow were: AH I = 0.98 (0.96-0.99); apnea index = 0.66 (0.48-0.84); and hypopnea index = 0.78 (0.63-0.90). The mean difference of first and second scoring sessions of the same respiratory variables ranged from-1.02 to 0.75/h. Conclusion: There is a strong agreement in the scoring of the respiratory events for HST among international sleep centers. Our results suggest that centralized scoring of HSTs may not be necessary in future research collaboration among international sites. Commentary: A commentary on this article appears in this issue on page 7.

Original languageEnglish
Pages (from-to)71-77
Number of pages7
JournalJournal of Clinical Sleep Medicine
Issue number1
StatePublished - 2016
Externally publishedYes


  • Home sleep testing
  • Sleep study scoring


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