Inter-scorer reliability (ISR) must be determined between each scorer and the facility director or a medical staff member board-certified (as defined in Standard B-2) in sleep medicine or a corporate-appointed physician or PhD board-certified in sleep medicine; such individual must be an employee of the corporation and serves as the reference sleep specialist. ISR assessment must be conducted for each individual facility. In cases where a corporate appointed individual serves as the reference standard for ISR, the facility director or medical staff member must attest in writing that he/she has reviewed the results of the ISR assessment and will take corrective action when results fall below the facility’s level of acceptable agreement as defined in its quality assurance program.
For comprehensive PSG, the following parameters must be compared: sleep staging epoch-by-epoch agreement, respiratory events, leg movements and arousals. Sleep technologists must be blinded to the scoring of the facility director/medical staff member and to all other scoring technicians. Comparisons between each scorer and the facility director/medical staff member must be made on 200 consecutive 30-second epochs in each of three polysomnograms per quarter, for a total of 12 polysomnograms per year. Comprehensive PSG studies must report agreement between scorer and the facility director/medical staff member as percent concordance defined as the quotient of the total number of epochs of agreement for a given parameter and the total number of epochs in the analysis sample multiplied by 100. Sleep-related breathing event comparisons for laboratory PSG must include analysis by total number of events and by the following event types: obstructive apnea, central apnea and hypopnea. If the facility reports respiratory effort related arousals, this event must be included in the comparison. Use of the AASM Inter-Scorer Reliability program fulfills the requirements of this standard.