The AASM Scoring Manual four years later.
PURPOSE OF REVIEW
Review published studies and critiques which evaluate the impact and effects of the American Academy of Sleep Medicine (AASM) Sleep Scoring Manual in the four years since its publication.


FINDINGS
USING THE AASM MANUAL RULES TO SCORE SLEEP AND EVENTS IN A POLYSOMNOGRAM (PSG) RESULTS IN: (1) very large differences in apnea-hypopnea indexes (AHI) when using the recommended and alternative rule for scoring hypopneas in adults; (2) increases in NREM 1 and sleep stage shifts with compensatory decreases in NREM 2 in children and adults when following rule 5.C.b. for ending NREM 2 sleep; (3) increases in NREM 3 in adults scoring slow wave activity in the frontal EEG derivations; (4) improved interscorer reliability; and (5) successfully identified fragmented sleep in children with obstructive sleep apnea (OSA) from primary snorers or normal controls because they had more NREM 1 and stage shifts using rule 5.C.b. Criticism of the Manual most often cited: (1) two rules for scoring hypopneas; (2) alternative EEG montage cancellation effects; (3) scoring stages 3 and 4 as NREM 3; and (4) too few rules for scoring arousals and REM sleep without atonia.


SUMMARY
Four years have passed since the AASM Scoring Manual was published with far less criticism than those who developed it feared. The AASM Manual provides a foundation upon which we all can build rules and methods which identify the complexity of sleep and its disorders.
['Grigg-Damberger|Madeleine M|MM|']
D000293:Adolescent D000328:Adult D000367:Age Factors D002648:Child D006801:Humans D015588:Observer Variation D017286:Polysomnography D017410:Practice Guidelines as Topic D012890:Sleep D012891:Sleep Apnea Syndromes D012894:Sleep Stages D012893:Sleep Wake Disorders D012955:Societies, Medical D014481:United States
AASM standard Sleep scoring parameters polysomnography/classification/standards practice guidelines as topic sleep apnea practice guidelines as topic sleep scoring