BACKGROUND & AIMS: :This preliminary study investigated the effect of a mandibular advancement device on upper airway collapsibility in seven patients with obstructive sleep apnea. Overnight polysomnography and dynamic magnetic resonance imaging were performed at the retropalatal and retroglossal levels, and the apnea-hypopnea Index(AHI), anteroposterior and lateral distances, and airway volumes were recorded. The tests were repeated following a 3-month period of wearing a customized mandibular advancement device. A significant reduction in AHI (from 31 events per hour to 18.2 events per hour) and improvement in airway dimension at both the retropalatal and retroglossal levels were recorded, suggesting a baseline record for future studies with a larger patient sample.

背景与目标： : 这项初步研究调查了下颌前移装置对7例阻塞性睡眠呼吸暂停患者上呼吸道塌陷的影响。在腭后和舌后水平进行了过夜多导睡眠图和动态磁共振成像，并记录了呼吸暂停低通气指数 (AHI)，前后和侧向距离以及气道容积。佩戴定制的下颌前移装置3个月后，重复测试。记录了AHI的显着降低 (从每小时31个事件降低到每小时18.2个事件) 以及在后腭和舌后水平的气道尺寸的改善，这表明未来研究的基线记录为更大的患者样本。

BACKGROUND & AIMS: OBJECTIVE:Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA). After performing an initial titration study, most physicians do not have the CPAP equipment retitrated unless the patient complains about the CPAP use. Several automated CPAP devices are used clinically that can detect upper airway obstructive events and provide information about residual events while patients are on CPAP. The aim of this study was to compare the apnea-hypopnea index (AHI) determined by automated CPAP devices to that obtained from polysomnography. METHODS:Patients with OSA underwent polysomnography for CPAP titration using the REMstar Auto M-series. The initial two hours of CPAP titration were spent at a subtherapeutic pressure of 4 cmH(2)O so that more breathing events could be observed. The correlations between the simultaneous determination of the AHI with polysomnography (AHI-PSG) and the automated device (AHI-RAM) during the subtherapeutic, therapeutic and overall phases were evaluated. In addition, the apnea index (AI) and the hypopnea index (HI) were each evaluated separately. RESULTS:Sixty patients were enrolled. The mean AHI on diagnostic PSG was 35.2±2.6 events/hour. Strong correlations were observed between the AHI-PSG and the AHI-RAM (subtherapeutic: r=0.958, p<0.001; therapeutic: r=0.824, p<0.001; overall: r=0.927, p<0.001). A slightly stronger correlation was observed between the AI values, whereas a weaker correlation was observed between the HI values in all three phases. CONCLUSION:Strong correlations between the AHI-PSG and the AHI-RAM were observed. The correlations were weakened when the analysis was limited to the HI and the therapeutic phase.

背景与目标：

BACKGROUND & AIMS: :In this retrospective cohort study, we describe acceptability, tolerability and potential efficacy of cognitive behavioural therapy (CBT) in Insomnia Disorder subtypes, derived from polysomnography (PSG): insomnia with normal-sleep duration (I-NSD) and insomnia with short-sleep duration (I-SSD). All research volunteers were offered access to digital CBT, single component sleep restriction therapy and face-to-face group CBT. Follow-up occurred at three months post-treatment using the insomnia severity index (ISI). 96 participants (61 females, mean age of 41 years) were grouped into either normal-sleep (n = 53) or short-sleep (n = 43). CBT was acceptable to 63% of participants (normal-sleep = 31, short-sleep = 29), with 28 completing therapy (tolerability: normal-sleep = 11, short-sleep = 17). For potential efficacy, 39 (normal-sleep = 20, short-sleep = 19) out of 96 participants (41%) completed a follow-up ISI assessment. In this reduced sample, mean (SD) ISI scores decreased across both groups (normal-sleep: 18.0 (4.0) to 10.7 (4.6); short-sleep: 16.5 (5.5) to 11.0 (6.3); both P < 0.01). Those with normal-sleep were more likely to respond (≥6-point ISI reduction) to CBT compared to short-sleep (70%, n = 14/20 vs. 37%, n = 7/19 respectively, P = 0.038). In this cohort, 60 (63%) of participants attempted CBT and of those 28 (47%) completed therapy. Results may be comparable to clinical participants with implications for the successful translation of CBT for insomnia.

背景与目标： : 在这项回顾性队列研究中，我们描述了认知行为疗法 (CBT) 在失眠疾病亚型中的可接受性，耐受性和潜在功效，这些疾病源自多导睡眠图 (PSG): 睡眠时间正常的失眠 (I-NSD) 和睡眠时间短的失眠 (I-SSD)。所有研究志愿者都可以使用数字CBT，单成分睡眠限制疗法和面对面组CBT。使用失眠严重程度指数 (ISI) 在治疗后三个月进行随访。96名参与者 (61名女性，平均年龄41岁) 被分为正常睡眠 (n   =   53) 或短睡眠 (n   =   43)。CBT可接受63% 的参与者 (正常睡眠   =   31，短睡眠   =   29)，28例完成治疗 (耐受性: 正常睡眠   =   11，短睡眠   =   17)。对于潜在疗效，96名参与者 (41% 名) 中有39名 (正常睡眠   =   20，短睡眠   =   19) 完成了ISI随访评估。在这一减少的样本中，两组的平均 (SD) ISI得分均降低 (正常睡眠: 18.0 (4.0) 至10.7 (4.6); 短睡眠: 16.5 (5.5) 至11.0 (6.3); 两者p <  0.01)。与短睡眠 (70%，n   =   14/20 vs. 37%，n   =   7/19，p   =   0.038) 相比，睡眠正常的人更容易对CBT产生反应 (ISI降低 ≥ 6点)。在该队列中，60 (63%) 参与者尝试了CBT，其中28 (47%) 完成了治疗。结果可能与临床参与者相当，对成功翻译CBT治疗失眠有影响。

BACKGROUND & AIMS: :To determine its predictive value, polysomnography was performed on 14 snorers with sleep apnea syndrome (SAS) before and 3 months after uvulopalatopharyngoplasty (UPPP). In the 8 patients considered as cured (less than 10 apneas per hour after UPPP), total apnea index (TAI) decreased from 29.7 +/- 22.6 to 4.9 +/- 3.5. Rapid eye movement sleep (REM) increased from 10.9 +/- 3.6 to 14 +/- 5.7% of the total sleep period (TSP). In the 6 uncured patients, TAI decreased from 59.7 +/- 15.7 to 32 +/- 15.7 and REM increased from 7.7 +/- 5.6 to 15.8 +/- 7.2% of TSP. Snoring and drowsiness decreased in both cured and uncured patients. A presurgical apnea index less than 40 seems to be a reliable predictor of successful UPPP. The association of obstructive apnea with either central apnea or mixed apnea was not a factor of poor prognosis. Better sleeping could explain in part the clinical improvement in both cured and uncured patients, but postoperative polysomnography is needed to detect asymptomatic SAS.

背景与目标： : 为了确定其预测价值，在悬雍垂腭咽成形术 (UPPP) 之前和之后3个月，对14名患有睡眠呼吸暂停综合征 (SAS) 的打鼾者进行了多导睡眠监测。在被认为治愈的8例患者中 (UPPP后每小时少于10个呼吸暂停)，总呼吸暂停指数 (TAI) 从29.7/- 22.6降至4.9/- 3.5。快速眼动睡眠 (REM) 从总睡眠期 (TSP) 的10.9 +/- 3.6增加到14 +/- 5.7%。在6例未治愈的患者中，TSP的TAI从59.7/- 15.7降低到32/- 15.7，REM从7.7/- 5.6增加到15.8/- 7.2%。治愈和未治愈的患者打鼾和嗜睡均减少。术前呼吸暂停指数小于40似乎是成功UPPP的可靠预测指标。阻塞性呼吸暂停与中枢性呼吸暂停或混合性呼吸暂停的相关性不是预后不良的因素。更好的睡眠可以部分解释治愈和未治愈患者的临床改善，但是需要术后多导睡眠图检查来检测无症状的SAS。

BACKGROUND & AIMS: PURPOSE:The purpose of this study is to evaluate the impact of body position during sleep on apnea-hypopnea index (AHI) and night-to-night variability in polysomnography (PSG) parameters. METHODS:Totally, 30 patients with obstructive sleep apnea syndrome (OSAS) were assessed prospectively with successive PSGs performed. The patients were categorized as increased (group A), decreased (group B), and unchanged (group C) AHI between the first and second PSG evaluations performed at least 1-week interval. RESULTS:The mean AHI values were significantly higher in the second night (p = 0.02). A change in AHI was found in almost 85 % of the patients between two successive measurements. According to multivariate and correlation analyses and differences in total AHI in supine position (r = 0.897), it was found that the influence of the supine position was the primary factor contributing to the night-to-night variability. Supine AHI, non-supine AHI, and non-supine time findings did not add any significance on total AHI. CONCLUSIONS:The variability observed in the AHI seems related to amount of sleeping time spent in supine position, suggesting that mean AHI alone is not that reliable in the accurate diagnosis of OSAS severity. A thorough evaluation of AHI in supine and non-supine positions is needed in order to understand better the severity of OSAS.

背景与目标：

BACKGROUND & AIMS: PURPOSE OF REVIEW:Sleep medicine is an increasingly well subscribed component of pediatric medicine. While knowledge has increased significantly in the past five decades, whether the most widely used tool to assess sleep-disordered breathing possesses demonstrable clinical utility remains unknown. The absence of certainty surrounding the impact of polysomnography (PSG) testing on clinical outcomes, superimposed on the cost and inconvenience of PSG testing, prompts a call to reassess the current normative stance toward PSG testing. RECENT FINDINGS:The present study argues for the use of the following: endpoints that have known clinical significance; readily available data provided by parents; and data derived from a randomized, placebo-controlled trial to determine the merits of PSG testing in the context of obstructive sleep apnea. SUMMARY:By rationalizing the use PSG testing, cost, inconvenience, and parental anxiety can be decreased without compromising care.

背景与目标：

BACKGROUND & AIMS: STUDY OBJECTIVES:Polysomnography (PSG) is increasingly used in the assessment of infants. Newborn PSG reference values based on recent standardization are not available. This study provides reference values for PSG variables in healthy newborn infants. METHODS:Cross-sectional study of normal term newborn infants using standardized PSG collection and American Academy of Sleep Medicine interpretation criteria. RESULTS:Thirty infants born between 37 and 42 weeks gestation underwent PSG testing before 30 days of age (mean 19.6 days). The infants had a mean sleep efficiency of 71% with average proportions of transitional, NREM and REM sleep estimated at 16.1%, 43.3% and 40.6% respectively. Mean arousal index was 14.7 events/h with respiratory arousal index of 1.2 events/h. Mean apnea-hypopnea index (AHI) was 14.9 events/h. Central, obstructive, and mixed apnea indices were 5.4, 2.3, and 1.2 events/h respectively. Mean oxygen saturation in sleep was 97.9% with a nadir of 84.4%. Mean end tidal CO2 was 35.4 mmHg with an average of 6.2% of sleep time spent above end-tidal CO2 45 mmHg and 0.6% above 50 mmHg. CONCLUSIONS:The sleep efficiency was significantly lower and the AHI was significantly higher compared to healthy children older than 1 year. The AHI was also higher than reported in healthy infants older than 1 month. These findings suggest current severity classifications of sleep apnea may not apply to newborn infants.

背景与目标：

BACKGROUND & AIMS: STUDY OBJECTIVES:To evaluate the ability of chest wall EMG (CW-EMG) using surface electrodes to classify apneas as obstructive, mixed, or central compared to classification using dual channel uncalibrated respiratory inductance plethysmography (RIP). METHODS:CW-EMG was recorded from electrodes in the eighth intercostal space at the right mid-axillary line. Consecutive adult clinical sleep studies were retrospectively reviewed, and the first 60 studies with at least 10 obstructive and 10 mixed or central apneas and technically adequate tracings were selected. Four obstructive and six central or mixed apneas (as classified by previous clinical scoring) were randomly selected. A blinded experienced scorer classified the apneas on the basis of tracings showing either RIP channels or the CW-EMG channel. The agreement using the two classification methods was determined by kappa analysis and intraclass correlation. RESULTS:The percentage agreement was 89.5%, the kappa statistic was 0.83 (95% confidence interval 0.79 to 0.87), and the intraclass correlation was 0.83, showing good agreement. Of the 249 apneas classified as central by RIP, 26 were classified as obstructive (10.4%) and 7 as mixed (2.8%) by CW-EMG. Of the 229 events classified as central by CW-EMG, 7 (3.1%) were classified as obstructive and 6 (2.6%) as mixed by RIP. CONCLUSIONS:Monitoring CW-EMG may provide a clinically useful method of detection of respiratory effort when used with RIP and can prevent false classification of apneas as central. RIP can rarely detect respiratory effort not easily discernible by CW-EMG and the combination of the two methods is more likely to avoid apnea misclassification.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:Accurate and timely diagnosis for patients with obstructive sleep apnea (OSA) is imperative. Unfortunately, growing interest in this diagnosis has resulted in increased requests and waiting times for polysomnography (PSG), as well as a potential delay in diagnosis and treatment. This study evaluated the accuracy and viability of utilizing SNAP (SNAP Laboratories, LLC, Wheeling, Illinois), a portable home sleep test, as an alternative to traditional PSG in diagnosing OSA. METHODS:This prospective clinical trial included 59 patients evaluated at our institution's sleep laboratory. Concurrent PSG and SNAP testing was performed for 1 night on each patient. Independent, blinded readers at our institution and at an outside-accredited institution read the PSG data, and 2 independent, blinded readers interpreted the SNAP data at SNAP laboratories. The apnea-hypopnea index (AHI) was used to compare the 2 testing modalities. The correlation coefficient, receiver operating characteristic curve analysis, and the Bland-Altman curves, as well as sensitivity, specificity, inter-reader variability, positive predictive value, and negative predictive value, were used to compare SNAP and PSG. RESULTS:There is a definitive, statistically sound correlation between the AHIs determined from both PSG and SNAP. This relationship holds true for all measures of comparison, while displaying a concerning, weaker correlation between the different PSG interpretations. CONCLUSIONS:There is a convincing correlation between the study-determined AHIs of both PSG and SNAP. This finding supports SNAP as a suitable alternative to PSG in identifying OSA, while accentuating the inherent variation present in a PSG-derived AHI. This test expands the diagnostic and therapeutic prowess of the practicing otolaryngologist by offering an alternative OSA testing modality that is associated with not only less expense, decreased waiting time, and increased convenience, but also statistically proven accuracy.

背景与目标：

BACKGROUND & AIMS: BACKGROUND AND PURPOSE:This study investigates the relationship between periodic limb movement (PLM) counts obtained with standard scoring criteria and PLM counts scored without amplitude criterion (AC). PATIENTS AND METHODS:Twenty-four sleep laboratory patients with a PLM index (PLMI) >5 per hour of sleep in a previous polysomnography (PSG) underwent a full night of digital PSG. PLM were twice scored manually: first, according to standard criteria, and second, without AC. RESULTS:The overall PLMI for time in bed was 34.4+/-30.7 with AC and 50.2+/-36.4 without AC. The PLMI in non-rapid eye movement (NREM) sleep was 45.3+/-40.1 versus 63.4+/-47.6 (P<0.001), in REM sleep 11.5+/-15.1 versus 25.7+/-35.4 (P=0.001) and in wakefulness 29.0+/-31.1 versus 46.0+/-36.1 (P<0.001) with and without AC (Wilcoxon tests). CONCLUSIONS:In comparison to PLM counts obtained with standard criteria, PLM counts obtained without consideration of amplitude are remarkably higher. Counting without AC increases the sensitivity to detect small PLM and probably allows for identification of PLM sequences which would not have fulfilled the periodicity criteria otherwise. PLM counts without AC might be more useful to investigate the periodicity of PLM and possible changes with treatment.

背景与目标：

BACKGROUND & AIMS: STUDY OBJECTIVES:This report describes the associations, specificities, sensitivities, and positive likelihood ratios of clinical symptoms to a finding of sleep-disordered breathing (SDB) on polysomnography in children. METHODS:Four hundred eighty unattended home polysomnograms were completed in a community-based cohort of children 6 to 11 years of age (50% boys, 42.3% Hispanic, and 52.9% between the ages of 6 and 8 years). SDB was present if the child had a respiratory disturbance index of > or = 1 event per hour. MEASUREMENTS AND RESULTS:Boys were twice as likely as girls to have SDB (p < .01); however, witnessed apnea, ethnicity, age, obesity, and airway size (based on clinical evaluation) were not significantly different between those with SDB and without SDB. The sensitivity of any individual or combined clinical symptoms was poor, with male sex (60%) and snoring (29.5%) having the greatest proportion of SDB children. However, high specificities for snoring (89.5%), excessive daytime sleepiness (86.3%), and learning problems (95.9%) were noted. Combinations of symptoms such as snoring+male sex (95.1%), snoring+excessive daytime sleepiness (97.0%), and snoring+learning problems (98.9%) had specificities approaching 1. Positive likelihood ratios for snoring (2.8), learning (2.8), and symptoms combined with snoring such as snoring+male sex (3.9), snoring+learning problems (4.0), and snoring+excessive daytime sleepiness (2.9) were observed. CONCLUSIONS:Snoring, excessive daytime sleepiness, and learning problems are each highly specific, but not sensitive, for SDB in 6- to 11-year old children. However, specificities and positive likelihood ratios for the combination of some of these symptoms is sufficiently high to suggest that some children may not require a polysomnogram for the diagnosis of SDB.

背景与目标：

BACKGROUND & AIMS: STUDY OBJECTIVES:To relate reproductive hormones (and the preceding 7-year rates of their change) to objectively and subjectively assessed sleep measures, independent of age, vasomotor symptom frequency, depressive symptoms, and body size. DESIGN:A cross-sectional sleep substudy nested in the Study of Women's Health Across the Nation (SWAN), a longitudinal study of the menopausal transition. SETTING:Community-based. PARTICIPANTS:365 Caucasian, African American, and Chinese women. MEASUREMENTS AND RESULTS:Sleep duration, continuity, and architecture were measured during two nights of in-home polysomnography (PSG) studies. Participants completed the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, sleep diaries for medication, vasomotor symptoms, lifestyle information and questionnaires for depressive symptoms. Blood collected annually in the years prior to sleep study was assayed for follicle stimulating hormone (FSH), estradiol (E2), and total testosterone (T). More rapid rate of FSH change was significantly associated with higher delta sleep percent, longer total sleep time (TST), but less favorable self-reported sleep quality (PSQI). Baseline E2 was modestly and negatively associated with sleep quality. Women in the lowest total testosterone quartile at baseline had more wake time after sleep onset (WASO) than women in the highest quartile. Lower E2/T ratio, an index reflecting the increasing androgenic environment with the menopause transition, was associated with less WASO. CONCLUSIONS:More rapid rate of FSH change was associated with longer sleep duration but poor sleep quality. Women with higher T or who were closer to the completion of the transition process (as indexed by a lower E2/T) had less sleep discontinuity (less WASO).

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Sleep offers a unique window into the brain dysfunctions in schizophrenia. Many past sleep studies have reported abnormalities in both macro-sleep architecture (like increased awakenings) as well as micro-sleep-architecture (like spindle deficits) in patients with schizophrenia (PSZ). The present study attempts to replicate previous reports of macro- and micro-sleep-architectural abnormalities in schizophrenia. In addition, the study also examined sleep-stage changes and spindle-delta dynamics across sleep-cycles to provide further evidence in support of the dysfunctional thalamocortical mechanisms causing sleep instability and poor sleep maintenance associated with schizophrenia pathophysiology. METHODS:Whole-night polysomnography was carried out among 45 PSZ and 39 age- and gender-matched healthy control subjects. Sleep-stage dynamics were assessed across sleep-cycles using a customized software algorithm. Spindle-delta dynamics across sleep-cycles were determined using neuroloop-gain analysis. RESULTS:PSZ showed macro-sleep architecture abnormalities such as prolonged sleeplessness, increased intermittent-awakenings, long sleep-onset latency, reduced non-rapid eye movement (NREM) stage 2 sleep, increased stage transitions, and poor sleep efficiency. They also showed reduced spindle density (sigma neuroloop-gain) but comparable slow wave density (delta neuroloop-gain) throughout the sleep. Sleep-cycle-wise analysis revealed transient features of sleep instability due to significantly increased intermittent awakenings especially in the first and third sleep-cycles, and unstable and recurrent stage transitions in both NREM (first sleep-cycle) and rapid eye movement (REM) sleep-periods (second sleep-cycle). Spindle deficits were persistent across the first three cycles and were positively correlated with sleep disruption during the subsequent REM sleep. CONCLUSIONS:In addition to replicating previously reported sleep deficits in PSZ, the current study showed subtle deficits in NREM-REM alterations across whole-night polysomnography. These results point towards a possible maladaptive interplay between unstable thalamocortical networks, resulting in sleep-cycle-specific instability patterns associated with schizophrenia pathophysiology.

背景与目标：

BACKGROUND & AIMS: Infant polysomnography (IPSG) is an increasingly important procedure for studying infants with sleep and breathing disorders. Since analyses of these IPSG data are subjective, an equally important issue is the reliability or strength of agreement among scorers (especially among experienced clinicians) of sleep parameters (SP) and sleep states (SS). One basic issue of this problem was examined by proposing and testing the hypothesis that infant SP and SS ratings can be reliably scored at substantial levels of agreement, that is, kappa (kappa) > or = 0.61. In light of the importance of IPSG reliability in the collaborative home infant monitoring evaluation (CHIME) study, a reliability training and evaluation process was developed and implemented. The bases for training on SP and SS scoring were CHIME criteria that were modifications and supplements to Anders, Emde, and Parmelee (10). The kappa statistic was adopted as the method for evaluating reliability between and among scorers. Scorers were three experienced investigators and four trainees. Inter- and intrarater reliabilities for SP codes and SSs were calculated for 408 randomly selected 30-second epochs of nocturnal IPSG recorded at five CHIME clinical sites from healthy full term (n = 5), preterm (n = 4), apnea of infancy (n = 2), and siblings of the sudden infant death syndrome (SIDS) (n = 4) enrolled subjects. Infant PSG data set 1 was scored by both experienced investigators and trained scorers and was used to assess initial interrater reliability. Infant PSG data set 2 was scored twice by the trained scorers and was used to reassess inter-rater reliability and to assess intrarater reliability. The kappa s for SS ranged from 0.45 to 0.58 for data set 1 and represented a moderate level of agreement. Therefore, rater disagreements were reviewed, and the scoring criteria were modified to clarify ambiguities. The kappa s and confidence intervals (CIs) computed for data set 2 yielded substantial inter-rater and intrarater agreements for the four trained scorers; for SS, the kappa = 0.68 and for SP the kappa s ranged from 0.62 to 0.76. Acceptance of the hypothesis supports the conclusion that the IPSG is a reliable source of clinical and research data when supported by significant kappa s and CIs. Reliability can be maximized with strictly detailed scoring guidelines and training.

背景与目标： 婴儿多导睡眠图 (IPSG) 是研究患有睡眠和呼吸障碍的婴儿的越来越重要的程序。由于对这些IPSG数据的分析是主观的，因此同样重要的问题是评分者 (尤其是有经验的临床医生) 对睡眠参数 (SP) 和睡眠状态 (SS) 的一致性的可靠性或强度。该问题的一个基本问题是通过提出和检验以下假设来检验的，即婴儿SP和SS等级可以在相当高的一致性水平 (即kappa (kappa)> 或 = 0.61) 下可靠地评分。鉴于IPSG可靠性在协作式家庭婴儿监测评估 (CHIME) 研究中的重要性，开发并实施了可靠性培训和评估过程。关于SP和SS评分的培训基础是CHIME标准，这些标准是对Anders，Emde和Parmelee的修改和补充 (10)。采用kappa统计量作为评估得分之间和得分之间可靠性的方法。得分手是三名经验丰富的调查员和四名受训人员。在健康足月 (n = 5)，早产 (n = 4)，婴儿呼吸暂停 (n = 2) 的五个CHIME临床部位记录的408随机选择的30秒夜间IPSG的SP代码和SSs的内部和内部可靠性，和婴儿猝死综合症 (SIDS) 的兄弟姐妹 (n = 4) 入组受试者。婴儿PSG数据集1由经验丰富的调查人员和训练有素的计分员进行评分，并用于评估初始评分员之间的可靠性。婴儿PSG数据集2被训练有素的计分者评分两次，用于重新评估评分者间的可靠性和评估评分者内的可靠性。对于数据集1，SS的kappa范围从0.45到0.58，表示中等程度的一致性。因此，对评分者的分歧进行了审查，并修改了评分标准以澄清歧义。为数据集2计算的kappa s和置信区间 (CIs) 为四个训练有素的得分手产生了大量的评分者间和内协议; 对于SS，kappa = 0.68，对于SP，kappa的范围为0.62至0.76。对该假设的接受支持了以下结论: 当有重要的kappa s和CIs支持时，IPSG是临床和研究数据的可靠来源。通过严格详细的评分准则和培训，可以最大限度地提高可靠性。

BACKGROUND & AIMS: Two alternative methods for detecting sleep, wrist actigraphy (ACT) and behavioral response monitoring (BRM), were compared to polysomnography (PSG). In the BRM paradigm, a threshold intensity visual or auditory stimulus generated by a palm-top computer was presented about once per minute, and subjects pressed a microswitch if the stimulus was detected. A response within 5 seconds of the stimulus was scored as "wake" and a failure to respond as "sleep." Four males and four females underwent two nights of simultaneous in-home PSG, BRM, and ACT. Each night, subjects underwent a protocol designed to generate five sleep latency trials. Subjects were awakened by alarm clocks at approximately 1-hour intervals and remained awake for 10 minutes before returning to bed for another sleep onset latency (SOL) trial. Minute-by-minute comparisons were made for PSG versus ACT and BRM. All measures were fairly sensitive in detecting sleep, but BRM was more accurate in determining SOL and subsequent wakefulness. Behavioral response monitoring using a tone resulted in more responses and arousals prior to and during light stages of sleep than BRM using a light. It is concluded that BRM has some important advantages as a simple, minimally invasive method for monitoring sleep.

背景与目标： 将两种用于检测睡眠的替代方法，腕关节活动描记术 (ACT) 和行为反应监测 (BRM) 与多导睡眠描记术 (PSG) 进行了比较。在BRM范例中，大约每分钟一次呈现由掌上电脑产生的阈值强度视觉或听觉刺激，如果检测到刺激，则受试者按下微动开关。刺激后5秒内的响应被评分为 “唤醒”，而未能响应为 “睡眠”。四名男性和四名女性同时经历了两晚的家庭PSG，BRM和ACT。每天晚上，受试者都会接受一项旨在产生五次睡眠潜伏期试验的协议。受试者每隔约1小时被闹钟唤醒，并保持清醒10分钟，然后返回床上进行另一次睡眠发作潜伏期 (SOL) 试验。对PSG与ACT和BRM进行了每分钟的比较。所有措施在检测睡眠方面都相当敏感，但BRM在确定SOL和随后的清醒方面更为准确。与使用光照的BRM相比，使用音调进行行为反应监测会在睡眠之前和睡眠期间产生更多的反应和唤醒。结论是，BRM作为一种简单，微创的睡眠监测方法具有一些重要的优势。