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Aasm Scoring Manual 2012 Pdf.zip


In 2012 the AASM introduced an update of the 2007 Manual (hereafter known as the 2012 Manual).7 The changes to the 2012 Manual are mostly in the respiratory event scoring rules, with changes to event definitions and sensor recommendations. Of particular interest was the 2012 Manual reverting to a single hypopnea definition (AASM2012). The new hypopnea definition appears to be an amalgamation of the AASM2007Rec and AAS




aasm scoring manual 2012 pdf.zip



In this study we also examined the contribution of rule changes to differences in the hypopnea index (Table 5). When we examined the implementation of AASM2012 from AASM2007Rec, we found that the inclusion of EEG arousals contributed almost equally to hypopnea index differences as the decrease in SpO2 desaturation requirement. This has wider implications for quality assurance processes should a laboratory decide to the AASM2012 hypopnea criteria. Since the scoring of EEG arousals typically shows poorer inter-scorer reliability,19 irrespective of the AASM montage utilized,20 the reliability of scoring hypopneas may decrease with AASM2012. Nonetheless, we believe that the inclusion of EEG arousals in the hypopnea criteria is a positive step forward. Patients are often referred by primary care physicians because of neurocognitive deficits (excessive daytime somnolence, poor concentration, and changes in mood) often related to OSA. These symptoms and subsequent resolution with therapy can occur in the absence of SpO2 desaturations as demonstrated by the study of Guilleminault et al.21 Thus the inclusion of EEG arousals, while controversial in some quarters, would appear to provide a direct link between OSA and its associated neurocognitive deficits.


The underlying rules and definitions for sleep stage scoring remain largely unchanged in the AASM Manual from 2007; however, major revisions to the wording of these sections were undertaken in 2012 for added clarity, with further minor revisions of the text in subsequent versions. Thus the ASA/ANZSSA Panel accepts the majority of the AASM recommendations. The only departures are as follows:


  • processing.... Drugs & Diseases > Neurology Sleep Stage Scoring Updated: Aug 19, 2019 Author: Andres A Gonzalez, MD, MMM, FACNS; Chief Editor: Selim R Benbadis, MD more...

Share Email Print Feedback Close Facebook Twitter LinkedIn WhatsApp webmd.ads2.defineAd(id: 'ads-pos-421-sfp',pos: 421); Sections Sleep Stage Scoring Sections Sleep Stage Scoring Introduction/ Historical Perspective Polysomnographic Leads and Recommended Technical Requirements for Sleep Scoring Sleep Stages Special Considerations Normative Sleep Stage Data Questions & Answers Show All Media Gallery Tables References Introduction/ Historical Perspective This article is based on the updated 2016 American Academy of Sleep Medicine Manual for the Scoring of Sleep and Associated Events. [1] This manual represents the evolution and development of the 2007 AASM manual which was itself a restructuring, consolidation, and standardization of the original Rechtshaffen and Kales sleep scoring manual of 1968, commonly known as the "R and K" rules. [2]


In 1968, Rechtschaffen and Kales convened a panel of experts to agree on a standardized manual for the scoring of sleep stages, which were then divided into wakefulness, stage 1-4 (non-REM), and REM. At least one EEG lead was recommended (C3 or C4 referenced to the opposite ear or mastoid) as well as two electrooculogram (EOG) leads and a submental electromyography (EMG) lead. The R and K rules recommended dividing the polysomnographic record of sleep into thirty second epochs, commencing at the start of the study. Historically, the 30-second interval was used because at a paper speed of 10 mm/s, ideal for viewing alpha and spindles, one page equates to thirty seconds. Each epoch was assigned a stage and if two or more stages coexist during a single epoch the stage comprising the majority of the thirty seconds was scored.


In 2004, the American Academy of Sleep Medicine (AASM) commissioned a steering committee to assemble a new sleep scoring manual that would address sleep staging as well as the scoring of arousals, respiratory, cardiac, and movement events. Eight separate task forces were assembled to address the various issues. The establishment of rules was guided by the following principles: the rules should be compatible with published evidence, they should be based on biologic principles, they should be applicable to both normal and abnormal sleep, and they should be easy to use by clinicians, technologists, and scientists.


In the years following the transition from R and K to the adoption of the AASM scoring system of 2007 there have been some notable changes to polysomnographic data analysis with potential clinical effects. Outlined in a review from 2012, these include, but may not be limited to, large variances in adult apnea-hypopnea indexes when scored using the recommended versus alternative rules, decreases in N2 sleep with increases in N1 sleep and sleep transitions due to a rule governing transition from N2 to N1 sleep, increased N3 sleep in adults with the addition of frontal EEG lead tracings and improved slow wave detection, and improved interscorer reliability [6] . This article focuses on sleep stage scoring criteria from the 2015 AASM Manual [1] .


In April 2016, minor clarifications were made to the sleep scoring manual. The two changes that pertain to sleep staging are: 1) how to score epochs when multiple stages are present and 2) how to better capture arousals. 350c69d7ab


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