Polysomnography scoring-related training and quantitative assessment for improving interscorer agreement.

STUDY OBJECTIVES: To efficiently improve the scoring competency of scorers with varying levels of experience across regions in Taiwan, we developed a training program with a cloud-based polysomnography scoring platform to evaluate and improve interscorer agreement. METHODS: A total of 70 scorers from 34 sleep centers in Taiwan (job tenure: 0.5-39.0 years) completed a scoring test. All scorers scored a 742-epoch (30 s/epoch) overnight polysomnography recording of a patient with a moderate apnea-hypopnea index. Subsequently, 8 scoring experts delivered 8 interactive online lectures (each lasting 30 minutes). The training program included identifying scoring weaknesses, highlighting the latest scoring rules, and providing physicians' perspectives. Afterward, the scorers completed the second scoring test on the same participant. Changes in agreement from the first to second scoring test were identified. Sleep staging, sleep parameters, and respiratory events were considered for evaluating scoring agreement. RESULTS: The scorers' agreement in overall sleep stage scoring significantly increased from 74.6 to 82.3% (median score). The proportion of scorers with an agreement of ≥ 80% increased from 20.0% (14/70) to 58.6% (41/70) after the online training program. In addition, the scorers' agreement in overall respiratory-event scoring increased to 88.8% (median score) after training. The scorers with a job tenure of 2.0-4.9 years exhibited the highest level of improvement in overall sleep staging (their median agreement increased from 72.8 to 84.9%; P < .001). CONCLUSIONS: Our interactive online training program efficiently targeted the scorers' scoring weaknesses identified in the first scoring test, leading to substantial improvements in scoring proficiency. CITATION: Liao Y-S, Wu M-C, Li C-X, Lin W-K, Lin C-Y, Liang S-F. Polysomnography scoring-related training and quantitative assessment for improving interscorer agreement. J Clin Sleep Med. 2024;20(2):271-278.

Directions of Deep Brain Stimulation for Epilepsy and Parkinson's Disease.

BACKGROUND: Deep brain stimulation (DBS) is an effective treatment for movement disorders and neurological/psychiatric disorders. DBS has been approved for the control of Parkinson disease (PD) and epilepsy. OBJECTIVES: A systematic review and possible future direction of DBS system studies is performed in the open loop and closed-loop configuration on PD and epilepsy. METHODS: We searched Google Scholar database for DBS system and development. DBS search results were categorized into clinical device and research system from the open-loop and closed-loop perspectives. RESULTS: We performed literature review for DBS on PD and epilepsy in terms of system development by the open loop and closed-loop configuration. This study described development and trends for DBS in terms of electrode, recording, stimulation, and signal processing. The closed-loop DBS system raised a more attention in recent researches. CONCLUSION: We overviewed development and progress of DBS. Our results suggest that the closed-loop DBS is important for PD and epilepsy.

Psychological and behavioral factors in patients with comorbid obstructive sleep apnea and insomnia.

OBJECTIVE: Insomnia symptoms in patients with obstructive sleep apnea (OSA) are commonly assumed to be secondary to respiratory disturbances. Previous studies, however, showed that insomnia might persist after treatment for OSA. Higher levels of emotional disturbances were reported in OSA patients with insomnia than those without insomnia, which suggests that psychological factors may play an important role for their sleep difficulties. This study aimed to further explore sleep-related psychological/behavioral factors that may contribute to insomnia in OSA patients. METHODS: This study included 88 men, of which 33 had OSA (OSA group); 29, primary insomnia; (Insomnia group); and 26, both OSA and insomnia (OSA+Insomnia group). All subjects underwent polysomnography (PSG) overnight and completed a package of questionnaires, including the Insomnia Severity Index (ISI), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Sleep Hygiene Practice Scale (SHPS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Pre-Sleep Arousal Scale (PSAS). RESULTS: The OSA+Insomnia and Insomnia groups had significantly more dysfunctional sleep beliefs, more arousal-inducing sleep-related behaviors, and higher levels of pre-sleep arousal, anxiety, and depression than did the OSA group. The respiratory indices and arousal index were higher for OSA and OSA+Insomnia groups than for the Insomnia group. CONCLUSION: Although OSA patients with insomnia showed a similar degree of respiratory disturbances as patients with OSA only, their psychological and behavioral profiles resembled the features of primary insomnia patients. The results support the concept of comorbid insomnia and suggest the importance of evaluating and treating both physiological and psychological factors in these patients.