Instructions

Registering an Administrator Account

1. Enter your center’s accreditation number and the primary e-mail address affiliated with your center’s accreditation at http://www.aasmnet.org/ISR/ProgramRegistration.aspx. If you do not know your center’s accreditation number or primary e-mail address, you may contact the AASM accreditation department at (630) 737-9700 or accreditation@aasmnet.org.
2. Verify your center’s contact information.
3. Register your account by designating one individual as your account administrator and creating a username and password.
4. Complete your registration by confirming your administrator e-mail address through the automated message sent to your account.

Managing Your Center’s Account

1. Establish a standard passing score for your facility’s staff. This score will be used to determine if any of your staff requires additional training.
2. Purchase the desired number of exam credits needed for your facility.
3. Send your center’s access code to all individuals who should contribute their results to your center.
4. Confirm permission to allow individuals to access your center’s purchased credits. This can be completed by clicking on the automated e-mail that your center administrator receives once a user has registered an individual account using your access code or through the Staff Management page in your account.
5. Utilize the Reports and Staff Management pages in your account to monitor your staff’s results and manage user access.

Registering an Individual User Account

1. Copy your center’s access code from the e-mail invitation that you receive and enter this code at http://www.aasmnet.org/ISR/UserRegistration.aspx.
2. Register your account by completing the contact information and creating a username and password.
3. Once your center administrator has confirmed your access to use exam credits under the center’s account, you may begin taking all available exams.

Taking Exams

In order to take an exam and contribute your results to your facility’s account, the center must have purchased credits available. If you are attempting to take an exam and your center does not have any available credits, please notify your center’s account administrator before attempting to take the exam.

1. Login to your account.
2. Select the exam that you want to take from the list of available exams
3. Use the rules from the AASM Manual for the Scoring of Sleep and Associated Events to score 200 consecutive 30-second epochs from a single recording. For each epoch, you will score the STAGE, RESPIRATORY EVENTS, number of LIMB MOVEMENTS and number of AROUSALS:
   1. STAGE: Chose one stage for each epoch: W, N1, N2, N3 or R. Use all of the information in the recording to score sleep stage. For example, score N2 for an epoch even if the epoch does not contain a single spindle or K complex if the previous epoch was scored as N2.
   2. RESPIRATORY EVENTS: Score any event that appears in an epoch, even if the event appears across multiple epochs, and only a portion of the event occurs in the current epoch. For example, if an obstructive apnea starts in epoch 97 and ends in epoch 98, score obstructive apnea for both epochs 97 and 98. If there is an obstructive apnea and a central apnea in epoch 125, score both the obstructive apnea and the central apnea. Score up to 2 respiratory events for each epoch. Only 1 event of each type may be scored. If there are 2 obstructive apneas in epoch 36, score an obstructive apnea only once for the epoch. Use Rule 4.A. for scoring hypopneas. The criteria are a drop of 30% of the nasal pressure transducer signal and an oxygen desaturation of at least 4%. The pre-event baseline should be defined as the closest stable oximetry reading prior to the event or in the case where events are sufficiently frequent such that recovery of oxygenation does not occur, the highest value prior to the event. The FAQ page states that "Although it is recognized that apneas and hypopneas can occur during drowsiness preceding stage N1 sleep, these should not be scored because of the difficulty of defining the denominator to calculate an apnea hypopnea index." Therefore, enter "None" as the respiratory score for all epochs scored as W.
   3. LIMB MOVEMENT SCORING: Score all periodic limb movements that are part of a series, in the epoch in which they start. Your selection will be limited to a single choice of between 0 and 3 limb movements. If there are more than three limb movements, select 3. Do not score isolated limb movements. The AASM Scoring Manual states that a limb movement must last from 0.5 to 10 seconds; there must be at least five seconds and no more than 90 seconds between limb movements to be included in a series. There must be at least four limb movements in a series. If limb movements occur in both legs they are scored as a single movement unless they are separated by at least 5 seconds. Do not score limb movements that occur 0.5 seconds before or after a respiratory event. Do not score limb movements that occur during a respiratory event. Score 0 if there are no limb movements in an epoch.
   4. d. AROUSAL SCORING: Score all arousals that start in an epoch. Your selection will be limited to a single choice of between 0 and 3 arousals. If there are more than three arousals, select 3. The AASM Scoring Manual states that arousals must last at least three seconds. Arousals must be preceded by at least 10 seconds of continuous sleep. Arousals during stage R sleep must also have an increase of chin EMG lasting at least 1 second. Arousals may occur during stage W and may occur with respiratory events. Score “none” if there are no arousals in an epoch.
4. Use the Space Bar to toggle the duration of the record that appears in your window. The default 30-second view allows you to closely examine a single epoch and is useful for scoring sleep stages and arousals. The alternative 120-second view provides a look at four continuous epochs. This view is ideal for scoring respiratory and limb movement events. In the 120-second view you will only score the epoch that appears in the red box. Extra epochs will appear at the beginning and end of the records; you cannot score these epochs.
5. If you are uncertain about the score for an epoch, you may mark the epoch for review.
6. At any time during the test, you can click the “Review" button at the top of your window to get a list of all of the epochs you have completed, all those marked for review and those remaining. You may return to any of the epochs by clicking on the number in the Review Exam screen.
7. When you have completed scoring all of the epoch, click the “Grade Record" button at the top of your screen. To submit your results, you must type “yes” to confirm that you are finished with the exam.

Have additional questions? Review the Inter-scorer Reliability Testing Frequently Asked Questions or contact the AASM National Office at isr@aasmnet.org or (630) 737-9765.