Scoring Blog

Invite, Approve or Deactivate/Delete Scoring Staff! - 7/6/2017

Administrators - The AASM ISR assessment system is designed with the tools necessary to easily manage your scoring staff. The AASM encourages administrators to review the Manage Staff section bi-annually to ensure all active scoring staff is current.

Let’s take a quick review on how to invite, approve and manage your scoring staff from your facility account.

Continue Reading

AAST Bonus Record – The Results! - 6/18/2017

Dear ISR Community,

Results are in for the 50 Epoch Bonus Record from the AAST 39th Annual Meeting! 

Login to your account now to see how you compared to our Gold Standard Panel on this for fun record. 

Didn’t complete the record, no worries! Scorers have the opportunity to complete the bonus record through July 31th, 2017.

Scores received from this bonus record will not affect your overall monthly averages in the ISR program.

If you have questions or need additional assistance, please contact us at

Thank you,
AASM Inter-scorer Reliability Staff

Continue Reading

Important Announcement Regarding October ISR Record - 10/7/2016

Dear ISR Community,

We appreciate the feedback that we’ve received from many of you who questioned some of the scoring decisions in the October ISR record. 

After further review, we agree that the record was monstrously difficult – too much trick, and not enough treat. Although this unintentionally ghoulish record may have been appropriate for the Halloween season, its scoring didn’t provide the clear assessment that is a hallmark of the ISR system.

Therefore, we’ve decided to allow alternate answers for 71 particularly contentious epochs in the October record. This is an unprecedented event in the history of ISR.

Currently, we are in the process of re-grading the assessments for those of you who already have scored the October record. You should receive a new score within a few hours.

If you have questions or need additional assistance, please contact us at Thank you for being a valuable member of the ISR community.

Continue Reading

AASM ISR will implement new scoring rules starting July 1 - 5/23/2016

Beginning with the July 2016 record, the AASM Inter-scorer Reliability assessment system will incorporate the new scoring rules published in the AASM Manual for the Scoring of Sleep and Associated Events, Version 2.3.

Released online on April 1, the AASM Scoring Manual Version 2.3 includes:

  • A new Technical Specifications section in the Movement Rules chapter, which includes new rules and figures for electrode placement for monitoring or detecting movements, along with rules about video PSG requirements for diagnosing sleep related rhythmic movement disorder and REM sleep behavior disorder
  • New rules, figures, and clarifications for scoring periodic limb movements in sleep (PLMS)
  • A revision to the rule for scoring bruxism so that masseter EMG activity is included as a way to detect bruxism
  • A new rule and figure for scoring sleep stages when 3 or more segments of an epoch meet criteria for different stages
  • A new note clarifying how to score an arousal immediately preceding a transition to wake

All AASM-accredited sleep facilities are required to implement the new rules in Version 2.3 by Oct. 1, 2016. The July 1 implementation date for AASM ISR will help your facility assess scorers’ familiarity with the new rules prior to this important accreditation deadline.

As the premier sleep scoring assessment system, AASM Inter-scorer Reliability helps you ensure accurate, consistent and reliable sleep study reporting. If you have questions about AASM ISR, please email or call (630) 737-9765.

Continue Reading

Important Update on February 2016 Record - 2/16/2016

As many of you are aware, the February 2016 record contained an issue which required the record to be removed from the website.  Unfortunately, the record was unable to be salvaged.  I am happy to report that a replacement record (February 2016 74 F Diagnostic V2) has been found and is now available for all.

If you scored the previous February record (February 2016 39 M CPAP V1), you will be credited with completing the February record.  Additionally, if you were on a credit plan, your facility will be refunded for every credit used on that record. 

In the case where the previous February record was not completed, it was forcibly closed and scored.  If your exam was automatically scored and you are not satisfied with the result, please contact Kristi at and request the exam be deleted from your account.  Please note: If you do this, you will not receive credit for completing the February record and will be required to complete the new February record.

I truly apologize for the inconvenience this may have caused you.  We are working to make sure this never happens again.

Continue Reading

Gold Standard Panel - 6/5/2015

We are always making changes to the Inter-scorer Reliability program to improve your experience as a user. The Gold Standard Panel has been expanded to bring in more scoring expertise from varying backgrounds, including an additional sleep technologist. Mark A. McCarthy, MD, FAASM, FCCP, and Scott Williams, MD, are now co-chairs of the Gold Standard Panel, and will be responsible for creating video content and quizzes as well as answering questions from users of the Inter-scorer Reliability program. Dr. McCarthy is the medical director for an AASM-accredited sleep center in New Orleans as well as for a CAAHEP accredited polysomnography program. Dr. McCarthy also brings years of experience as an educator, where he regularly trains and teaches sleep technologists. Dr. Scott Williams is chief and medical director of the sleep disorders center at Womack Army Medical Center at Fort Bragg and also an assistant professor of medicine at the Uniformed Service University of the Health Sciences.

The panel now is comprised of 5 expert members:

  • Scott Williams, MD (co-chair)
  • Mark McCarthy, MD (co-chair)
  • Michael Zachek, MD
  • Faye Burnette, RRT, RPSGT
  • Claude Albertario, RST, RPSGT

The panel now participates in monthly conference calls to reconcile their individual scoring of the future records and discuss in detail their rationale, which will improve the overall reliability and accuracy. Stay tuned for more updates and improvements to the Inter-scorer Reliability program!

Continue Reading

Changes to ISR - 3/27/2015

As many of you are aware, Rich Rosenberg, PhD has resigned from his position as an AASM professional education development consultant and the March ISR Record Review video will be his last. Dr. Rosenberg has been leading Inter-scorer Reliability since the very beginning and has helped the program grow into what it is today. He has provided first rate education and insight that will surely be missed. We wish Rich the best of luck in his future endeavors.

The show must go on...

I'm excited to announce that Scott Williams, MD will be joining the Gold Standard panel and will be producing video content for the record reviews. Dr. Williams is the chief and medical director of the sleep disorders center at Womack Army Medical Center in Fort Bragg, NC. He is an assistant professor of medicine at the Uniformed Service University of the Health Sciences and serves on the AASM education committee where he has worked to revise and update the A-STEP curriculum and exam. Dr. William’s background and expertise will be a great asset to the ISR program.

We are committed to keeping ISR as the premiere destination for scoring education. We have exciting things to announce in the near future. Stay tuned…

Continue Reading

Improvements to the ISR Interface for 2014 - 2/28/2014

We’re continuing to improve the AASM Inter-scorer Reliability experience to better serve our subscribers needs. Based on your feedback, we’re rolling out new improvements with AASM Inter-scorer Reliability Version 4.0, launching with the March and February 2014 record assessments.

New Hypnogram

We’ve long received requests for a hypnogram from our users. It’s finally here and it’s a key part of the Version 4.0 of AASM Inter-scorer Reliability. Users have the option to view the hypnogram at the bottom of their screen as they score their record. The hypnogram will plot out the sleep stages in real-time as each epoch is scored. The hypnogram is also an easy way to navigate through your record. Click any part of the hypnogram to instantly jump to the corresponding epoch. Users who don’t want to view the hypnogram can hide it with the click of a button.

Interface Improvements

Version 4.0 of AASM Inter-scorer Reliability retains all of the same functionality as previous versions with a more intuitive user interface. We’ve made custom montages easier to access and easier to customize. We’ve also turned the Review function into a full progress tracker, available alongside the hypnogram. This tracker lets users see which epochs they’ve scored, which epochs they’ve marked for later review and which epochs remain. The progress tracker is also an easy way to navigate across the record. For a closer look at potential events in an epoch, users can now zoom in with a click and drag of the mouse. This feature is available in modern browsers only. For information on these changes and other new features, please take a moment to look at the help file when you begin your next record exam.

Interactive Record Review

Beginning with the February Record Review, the record review video will be moved to the new Interactive Record Review interface. The Interactive Record Review allows users to follow along on their own scored record while the gold standard scorer discusses the sections with a high level of disagreement. An optional guided review feature automatically navigates through the record and changes the montage to highlight the events that the gold standard scorer references. More information about the Interactive Record Review will be available in a FAQ when the February review becomes available.

As always, we’ve taken the opportunity to make some improvements on our end. AASM Inter-scorer Reliability should be faster than ever. We recommend using the Google Chrome browser for an optimal experience. Not every new feature is compatible with older browsers.

If you have any issues or suggestions for future improvements to AASM Inter-scorer Reliability, please contact us.

Continue Reading

ISR to revert to 4 percent hypopnea desaturation criteria beginning with September exam - 8/29/2013
The AASM will suspend the required use of 3 percent hypopnea desaturation criteria for the AASM Inter-scorer Reliability program. ISR users will score hypopneas using a criterion of 4 percent beginning September. All other rules highlighted in the AASM Scoring Manual Version 2.0 will remain in effect. 

This change will be effective for all AASM ISR exams beginning with the September scoring exam. The June, July and August exams will utilize the 3 percent criterion; all exams going forward will revert to the 4 percent criteria. 

In August, the AASM Board of Directors suspended the requirement for sleep centers to score hypopneas according to the 3 percent oxygen desaturation criterion in the AASM Scoring Manual Version 2.0, as dictated by the AASM Standards for Accreditation. For more information, view the full announcement on the AASM website. Continue Reading

Transition to New Respiratory Scoring Rules - 5/7/2013
Beginning June 1, 2013, AASM Inter-scorer Reliability will require the use of the scoring rules found in the AASM Scoring Manual Version 2.0. Users are encouraged to familiarize themselves with the scoring rules changes highlighted in the video below:

Transition to New Respiratory Scoring Rules: AASM Inter-scorer Reliability from AASMorg on Vimeo.

Continue Reading

ISR to switch to AASM Scoring Manual v2.0 (2012) in June - 4/8/2013

In October 2012 the AASM published its first major update to the AASM Manual for the Scoring of Sleep and Associated Events: Rules Terminology and Technical Specifications. In preparation for the effective compliance date of October 1, 2013, AASM Inter-scorer Reliability will begin requiring use of the scoring rules found in the AASM Scoring Manual Version 2.0. These scoring rules will be required for all Inter-scorer Reliability scoring exams beginning June 1, 2013.

All changes to the AASM Scoring Manual were determined by the AASM Scoring Manual Committee, which consists of a group of physicians, researchers and technologists. Their suggestions were based on a combination consensus and findings-based process.

One of the most significant change to the AASM Scoring Manual is the new rules for scoring respiratory events. Per the manual, you are instructed to “score a respiratory event as a hypopnea if ALL of the following criteria are met:

a)      The peak signal excursions drop by ≥30 percent of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study) or an alternative hypopnea sensor (diagnostic study).
b)      The duration of the ≥30 percent drop in signal excursion is ≥ 10 seconds.
c)      There is a ≥3 percent oxygen desaturation from pre-event baseline or the event is associated with an arousal.”

To gain access to the AASM Scoring Manual, go to Subscribers may purchase a print copy, or use  the AASM Scoring Manual iPhone/iPad app free of charge.

Continue Reading

Improving record exam performance on your machine - 9/18/2012
One benefit of the new version of AASM Inter-scorer Reliability is improved exam performance for most users. Major changes to the programming are intended to speed up the load times, while offering a suite of new features to improve process of scoring epoch exams.

A small number of users have contacted us with specific performance issues. We have observed a few recurring issues. Follow this troubleshooting guide to improve record exam performance on your computer. Continue Reading

Scoring numerous EEG arousals - 9/4/2012
After scoring the June record you may be saying to yourself, “I scored tons of arousals and it took forever, but what was the point?” The scoring of arousal has two points. The first point is that you have successfully followed the rules, and rules are important. The second point, as Bonnet and his co-authors describe in the review article for the scoring manual (1), is that EEG arousals have a high correlation with daytime sleepiness. This relationship holds in normal volunteers, patients with sleep related breathing disorders and in studies of experimental sleep fragmentation. The sleepiness produced by sleep fragmentation includes reduced latency on the MSLT, performance deficits and changes in subjective level of sleepiness. A variety of other measures have been correlated with EEG arousals as well. Continue Reading

Welcome to the third generation of AASM Inter-scorer Reliability Testing - 9/3/2012
You may have noticed the AASM Inter-scorer Reliability website looks much different than last time you logged in. The website's visual overhaul is just the beginning of the changes the American Academy of Sleep Medicine has introduced in the third generation of the AASM Inter-scorer Reliability Testing system. For starters, this article you're reading is part of the new Scoring Blog. This is a platform for AASM Gold Standard Scorers and other experienced sleep professionals to share their expertise in scoring sleep studies. Continue Reading