Vinsamlegast notið þetta auðkenni þegar þið vitnið til verksins eða tengið í það: http://hdl.handle.net/1946/40425
Study Objectives: Upper airway resistance during sleep has been shown to cause daytime fatigue. Esophageal pressure measurement is the gold standard for measuring upper airway resistance. The literature documents breath-by-breath changes in resistance. Inconsistencies abound, however, between scoring rules for identifying which changes are considered pathologic and labeled increased upper airway resistance events. Individual scoring rules are underspecified. The prevalence of the events varies between surveys from being rare to being more common than apneas and hypopneas combined. The choice of hypopnea definition cannot explain the variability. The aim of this study was to quantify how reliably increased upper airway resistance events can be scored.
Methods: Fifteen different scoring rules were employed for scoring increased upper airway resistance events in 26 polysomnograms, irrespective of cortical arousal. Event frequencies and second-by-second agreement were tabulated. Of the scoring rules, thirteen were objective and two were subjective.
Results: Depending on the scoring rule employed, the hourly event rate varied from 0.18/h to 103/h. The ranking of polysomnograms by event frequency differed depending on the scoring rule employed, not least depending on whether events were required to start with lower than baseline pressures. The mean Kendall’s τ was 25%; a low, but positive, correlation between scoring rules.
Conclusions: The inconsistency between scoring rules, and interpretations thereof, was very high. Increased upper airway resistance events cannot be reliably scored without a robust standard scoring rule. It remains to be studied which scoring rules, if any, correlate with arousals, daytime sleepiness, hypotension, or hypertension.
Novel: Inconsistencies between previous studies have raised questions regarding their comparability. Differences in the scoring rules employed for identifying increased upper airway resistance events are common. This study is the first to quantify the implications empirically.
Innovative: Previous studies comparing scoring rules for identifying increased upper airway resistance events only compared subjective scoring rules. This study compares both subjective and objective scoring rules. Consistent use of an objective rule can improve intra-rater and inter-rater reliability.
Important: This study found a plausible explanation for the inconsistent results of epidemiological studies. Inconsistent scoring rules can explain the inconsistencies in the event rates found in epidemiological studies.
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