Purpose

This study evaluated whether or not polysomnography (PSG) inter-scorer reliability (ISR) across sleep centres could be improved by external proficiency testing (EPT), or by EPT combined with method alignment training.

Methods

Experienced scorers form 15 sleep centres were randomised to the following: (1) a control group, (2) a group that received a self-directed intervention of EPT reports (EPT_Passive) or (3) a group that received an active intervention of method alignment training and EPT reports (EPT_Active). Respiratory, arousal and sleep scoring ISR from sixteen PSG fragments were compared between groups across time.

Results

Among 30 scorers, there were no ISR changes in controls between baseline (BL) and 6 months (6 m). Both EPT groups showed ISR improvement from BL to 6 m for respiratory, arousal and sleep scoring (p < 0.05). Respiratory scoring back-transformed mean (95CI) proportion of specific agreement (PSA) for the EPT_Passive group improved from 0.78 (0.72–0.84) to 0.80 (0.74–0.86) and for the EPT_Active group from 0.80 (0.74–0.85) to 0.82 (0.76–0.88). Arousal scoring PSA for the EPT_Passive group improved from 0.72 (0.66–0.77) to 0.74 (0.69–0.79) and for the EPT_Active group from 0.71 (0.65–0.76) to 0.77 (0.72–0.82). Sleep scoring kappa for the EPT_Passive group improved from 0.64 (0.58–0.69) to 0.73 (0.68–0.77) and for the EPT_Active group from = 0.75 (0.71–0.80) to 0.80 (0.76–0.85). Overall, poorer performers achieved greater improvement.

Conclusion

External proficiency testing produced modest, statistically significant PSG inter-scorer reliability improvements among experienced scorers across sleep centres, with potential to improve clinical management of individual patients and increase research study statistical power.

中文翻译：

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外部能力测试提高了多导睡眠图评分的评分员间可靠性

目的

本研究评估了是否可以通过外部能力测试 (EPT) 或 EPT 与方法对齐训练相结合来提高跨睡眠中心的多导睡眠图 (PSG) 评分员间可靠性 (ISR)。

方法

来自 15 个睡眠中心的经验丰富的评分员被随机分配到以下组：(1) 对照组，(2) 接受 EPT 报告自主干预的组（EPT 被动）或 (3) 接受主动干预_的组方法对齐培训和 EPT 报告 (EPT _Active )。跨时间跨组比较来自 16 个 PSG 片段的呼吸、觉醒和睡眠评分 ISR。

结果

在 30 名评分者中，基线 (BL) 和 6 个月 (6 m) 之间的对照组没有 ISR 变化。两个 EPT 组在呼吸、觉醒和睡眠评分方面均显示从 BL 到 6 m 的 ISR 改善 ( p  < 0.05)。_EPT被动组的呼吸评分反向转换平均值 (95CI) 特异性一致性 (PSA) 比例从 0.78 (0.72–0.84) 提高到 0.80 (0.74–0.86)，EPT_主动组从 0.80 (0.74–0.85) 提高到0.82 (0.76–0.88)。EPT_被动组的觉醒评分 PSA 从 0.72 (0.66-0.77) 提高到 0.74 (0.69-0.79)，EPT_主动组从 0.71 (0.65-0.76) 提高到 0.77 (0.72-0.82)。EPT_{被动的睡眠评分 kappa}组从 0.64 (0.58–0.69) 提高到 0.73 (0.68–0.77)，EPT _Active组从 = 0.75 (0.71–0.80) 提高到 0.80 (0.76–0.85)。总的来说，表现较差的人取得了更大的进步。

结论

外部能力测试在睡眠中心经验丰富的评分员中产生了适度的、统计上显着的 PSG 评分员间可靠性改进，有可能改善个体患者的临床管理并提高研究统计能力。