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…
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.
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.
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.
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
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 http://www.aasmnet.org/scoringmanual/default.aspx. Subscribers may purchase a print copy, or use the AASM Scoring Manual iPhone/iPad app free of charge.
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.
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.
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.