A review of sleep EEG patterns. Part I: A compilation of amended rules for their visual recognition according to Rechtschaffen and Kales

SummaryQuestion of the studyThe reliable evaluation of polysomnographic recordings (PSG) is an essential precondition for good clinical practice in sleep medicine. Although the scoring rules of Rechtschaffen and Kales [86] are internationally well established, they leave some room for different interpretations, and this may contribute to the limited reliability of visual sleep scoring. The German Sleep Society (DGSM) has set up a task force to devise ways to improve scoring reliability in the framework of their quality management programme. The intention was not to revise the rules of Rechtschaffen and Kales (R&K), but to facilitate their reliable application in sleep scoring and to support the development of standardized algorithms for computerized sleep analysis.MethodsThe task force was formed in September 2004 as a subcommittee of the educational panel of the DGSM: The members of the task force are experienced in sleep scoring and have a background either in physiology, neurology, psychiatry, psychology, or biology. The aim of the task force was to provide interpretation aids and, if needed, specifications or amendments to the R&K rules for the scoring of sleep electroencephalogram (EEG) waveforms and patterns. Decisions were based on the nominal group technique of a nominal panel as the formal consensus-building process. The consensus process was based on scoring and face-to-face discussions of at least 40 examples for each pattern in four 2-day meetings.ResultsRelevant EEG patterns for sleep stage scoring are alpha, theta, and delta waves, sleep spindles, K-complexes, vertex sharp waves, and sawtooth waves. If definitions for a given EEG pattern differed in the literature, the nominal group technique resulted in specifications and amended scoring rules for these EEG patterns. A second part including a series of examples with explanatory comments for each of these EEG patterns is under preparation.ConclusionsAmendatory scoring rules of those EEG patterns that are relevant for sleep scoring may contribute to increasing the reliability of visual sleep scoring and to support the development of standardized algorithms for computerized sleep analysis.ZusammenfassungEinleitungDie reliable Evaluation polysomnographischer Ableitungen ist eine wesentliche Voraussetzung für die Gute Klinische Praxis (GCP) in der Schlafmedizin. Obwohl die Auswertungsregeln von Rechtschaffen und Kales (R&K) [86] international gut etabliert sind, lassen diese einigen Interpretationsspielraum. Dies wird als ein möglicher Grund für die relativ eingeschränkte Reliabilität visueller Auswertungen angesehen. Die Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM) hat daher eine Task Force eingerichtet, die im Rahmen des Qualitätsmanagementprogramms der DGSM Vorschläge zur Verbesserung der Auswertungsreliabilität ausarbeiten soll. Die Intention dieser Task Force ist es nicht, die Regeln von R&K zu revidieren, sondern vielmehr deren reliable Anwendung in der Auswertung von Polysomnographien zu ermöglichen und damit auch die Entwicklung von standardisierten Algorithmen in der computerisierten Schlafanalyse zu unterstützen.ProzedereDie Task Force bildete sich im September 2004 als eine Untergruppe der AG Ausbildung der DGSM. Die Task Force Mitglieder sind erfahren in der Schlafauswertung und sind entweder Physiologen, Neurologen, Psychiater, Psychologen oder Biologen. Das Ziel der Task Force war die Bereitstellung von Interpretationshilfen und—wenn notwendig—von Spezifikationen oder Ergänzungen zu den R&K Regeln zur Erfassung von EEG-Wellenformen und-Mustern. Die Entscheidungen basierten auf einem nominalen Gruppenprozess als formales Konsensusverfahren. Für jedes Element beruhte der Konsens auf der Auswertung mit Gruppendiskussion von mindestens 40 Beispielen pro Wellenform oder EEG-Muster unter Berücksichtigung der Literatur im Rahmen von 4 zweitägigen Treffen.ErgebnisseRelevante EEG-Muster für die Schlafstadienanalyse sind alpha-, theta- und delta-Wellen, Vertexwellen, Schlafspindeln, K-Komplexe und Sägezahnwellen. Sobald die Definitionen für eines dieser Muster in der Literatur divergierten, führte der nominale Gruppenprozess zu Spezifikationen und Ergänzungen der Angaben von R&K. Ein zweiter Publikationsteil in dem die hier erstellten Spezifikationen an einer größeren Anzahl von Beispielen dargestellt werden, ist derzeit in Vorbereitung.DiskussionDie hier vorgestellten spezifizierten und ergänzten Erfassungsregeln für EEG-Muster mit Relevanz für die Schlafstadienanalyse sollen die Reliabilität der visuellen Auswertung verbessern. Gleichzeitig können die Ergebnisse als Grundlage für einen standardisierten Algorithmus der computerisierten Analyse genutzt werden.

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