The AASM Manual for the Scoring of Sleep and Associated Events

1. The AASM Manual for the Scoring of Sleep and Associated Events Respiratory Rules

2. Respiratory Rules Technical Considerations Event Duration Apnea Hypopnea RERA Hypoventilation Cheyne Stokes

3. Technical Considerations for Airflow Use a thermal sensor to detect apnea. Use nasal pressure to detect hypopnea A square root transformation may be used to correct a small bias for over scoring hypopnea. Use alternate sensors if recommended sensor is unreliable For hypopnea, inductive plethysmography is considered an alternate).

4. Technical Considerations for Respiratory Effort Use esophageal pressure or inductive plethysmography to detect respiratory effort. Diaphragmatic/intercostal EMG is considered an alternative sensor for respiratory effort ( no recording specifications are given).

5. Technical Considerations for Blood Oxygen Pulse oximetry should be used to measure blood oxygen. The maximum acceptable moving average window is 3 seconds.

6. Event Duration For apnea or hypopnea: Beginning of event is nadir preceding the first breath of event End of event is beginning of first breath that approximates baseline (not defined). When baseline can�t be determined, terminate: When there is a clear and sustained increase in amplitude. When there is resaturation of at least 2%.

8. Apnea Thermal sensor amplitude attenuated = 90%. Duration = 10 seconds. 90% of event meets amplitude criteria. No saturation criterion.

9. Apnea Obstructive if sustained or increased inspiratory effort throughout. Central if inspiratory effort absent. Mixed if inspiratory effort initially absent but resumes in latter portion of event.

10. Obstructive Apnea

14. Sleep onset Central Apnea

17. Hypopnea Recommended Reduction of nasal pressure amplitude of = 30%. Duration = 10 seconds. Desaturation = 4% below pre-event baseline. 90% of event meets amplitude criteria.

18. Hypopnea

20. Hypopnea Alternative Reduction of nasal pressure amplitude of = 50%. Duration = 10 seconds. Desaturation = 3% below pre-event baseline OR The event is associated with arousal. 90% of event meets amplitude criteria.

21. Cheyne Stokes Breathing Three consecutive cycles of cyclical crescendo-decrescendo change in breathing amplitude. AND Five or more central apneas or hypopneas per sleep hour. OR Crescendo-decrescendo pattern has duration of = 10 minutes.

23. Respiratory Event Related Arousal (RERA) OPTION Ten or greater second sequence of breathes. Evidence of increased respiratory effort, flow limitation or both. Terminal arousal. Does not meet apnea or hypopnea criteria.

24. Respiratory Effort Related Arousal

25. Respiratory Effort Related Arousals

26. RERA

28. Hypoventilation OPTION Ten mm Hg or greater increase of PaCO2 during sleep compared to wake (supine). May be measure with end tidal or transcutaneous capnometry.

30. The AASM Manual for the Scoring of Sleep and Associated Events Cardiac Events

31. ECG LEAD Modified Lead II. Right arm lead placed on R shoulder. Left leg lead placed on torso (sixth intercostal space).

32. Scoring Rules Sinus tachycardia when sustained sinus rate> 90 BPM. Bradycardia when sustained sinus rate < 40 BPM. Asystole when cardiac pauses >3 seconds.

33. More Scoring Rules Wide complex tachycardia* when: 3 consecutive beats or more. rate > 100 BPM. QRS duration = 120 msec. Narrow complex tachycardia when: 3 consecutive beats or more. rate > 100 BPM. QRS duration < 120 msec.

34. One Last Scoring Rule Atrial Fibrillation when: irregularly irregular ventricular rhythm. no P waves rapid oscillations of variable size, shape and timing.