Institute for Continuing Education

Scoring Sleep Studies

Course Objectives

Upon successful completion of this module, you will be able to:

• Apply the current AASM Manual for the Scoring of Sleep and Associated Events (Version 3, with updates through 2025) to accurately score sleep stages including wake (W), NREM stages N1, N2, and N3, and REM sleep (R), understanding the physiological basis for EEG, EOG, and EMG criteria, the 30-second epoch rule and exceptions, age-specific scoring considerations, and controversial or ambiguous scoring scenarios requiring clinical judgment and expertise.
• Differentiate between normal physiological patterns and artifacts in polysomnography, recognizing common artifact types (electrode artifacts, movement artifacts, electrocardiographic artifacts, environmental electrical interference, biological artifacts), understanding artifact sources and mechanisms, employing troubleshooting strategies to minimize artifacts during acquisition, and applying appropriate techniques for artifact identification during scoring to prevent misclassification of physiological events.
• Score and quantify respiratory events according to current AASM criteria including obstructive apneas, central apneas, mixed apneas, hypopneas (using recommended and acceptable scoring rules), respiratory effort-related arousals (RERAs), and hypoventilation, understanding the physiological basis and clinical significance of each event type, applying appropriate sensor requirements (nasal pressure, thermal airflow, thoracoabdominal effort, oxygen saturation), and calculating respiratory indices (AHI, RDI, oxygen desaturation index) with clinical interpretation.
• Identify and score cardiac events, limb movements, and other physiological phenomena including cardiac arrhythmias and rate abnormalities visible on ECG, periodic limb movements in sleep (PLMS) and periodic limb movement index (PLMI) calculation, sleep-related bruxism using masseter/temporalis EMG when monitored, parasomnias and abnormal behaviors captured on video-audio monitoring, and other relevant physiological events affecting sleep quality or indicating pathology.
• Recognize and score arousals and awakenings according to AASM criteria, understanding arousal definitions (EEG frequency shift criteria, minimum duration requirements, stage-specific rules including REM sleep arousal criteria requiring concurrent chin EMG increase), differentiating spontaneous arousals from event-related arousals (respiratory, limb movement, spontaneous), calculating arousal index and interpreting clinical significance, and understanding the relationship between sleep fragmentation and clinical outcomes.
• Synthesize scored polysomnography data into clinically meaningful summary statistics and reports, calculating standard sleep architecture parameters (total sleep time, sleep efficiency, sleep latency, REM latency, wake after sleep onset, sleep stage percentages), computing respiratory and movement indices with appropriate context, recognizing patterns suggesting specific sleep disorders (obstructive sleep apnea, central sleep apnea, periodic limb movement disorder, narcolepsy, parasomnias, insufficient sleep), and communicating findings clearly in technical reports supporting physician interpretation.
• Evaluate the strengths, limitations, and appropriate applications of automated scoring algorithms and artificial intelligence in polysomnography, understanding how automated systems function (pattern recognition, machine learning approaches, training datasets), recognizing scenarios where automated scoring performs well versus requiring manual review and correction, maintaining human oversight and quality assurance in scoring processes, and anticipating future developments in scoring technology while preserving the essential role of trained sleep technologists.

Course Information

The implementation of new rules for scoring and summarizing sleep recordings has finally arrived and marks one of the most important milestones in the history of sleep medicine. The American Academy of Sleep Medicine published the first comprehensive and standardized scoring rules for sleep recordings in 2007. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Technical Specifications is the result of years of deliberations and research among colleagues and industry concerning standardization of practices and technology in the field of sleep medicine. The final development of the new scoring manual includes changes in sleep stage terminology, technical specifications for recording and data management, and the standardized scoring of sleep. Since the publication of the AASM scoring manual, sleep disorders centers, physicians and sleep technologists have been preparing to comply with the new rules that became effective for all accredited sleep disorders centers on July 1, 2008. Understanding the changes and the use of new technology for sleep recordings presents a challenge for many technologists as well as sleep physicians.