Journal of Clinical Neurophysiology

19(2):136–143, Lippincott Williams & Wilkins, Inc., Philadelphia

© 2002 American Clinical Neurophysiology Society

Digital Tools in Polysomnography

*Rajeev Agarwal and †Jean Gotman

*Stellate Systems; and †Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University,
Montreal, Quebec, Canada

Summary: Recent advances in the computing power and storage devices have made
computer-based recording of polysomnograms (PSGs) very attractive. Digital PSGs
offer the possibility of automating many tedious and time-consuming tasks of identi-
fying sleep related events. Automation not only alleviates these laborious tasks, but
also introduces a measure of objectivity in the scoring of various discrete events. In this
paper we briefly review some automatic methods that have been previously developed
by the authors. Automatic sleep staging methods is emphasized with some illustrative
results on inter-scorer variations. We also discuss the leg movement event, respiratory
event, sleep spindle and rapid-eye-movement detection methods. Key Words: Poly-
somnography—Automatic sleep staging—Segmentation—Self– organization.

The replacement of paper tracings by computer-based
recordings in polysomnography (PSG) has saved not
only many trees and a lot of storage space, but it has
provided flexibility in visual review, allowing the display
of traces with varying characteristics such as filters,
gains, and time scale. The processing power of comput-
ers also allows the automation of many tasks that are
tedious and time-consuming, and introduces a degree of
objectivity in decisions that are often quite subjective.
The automation deals particularly with sleep staging and
the detection of discrete events such as respiratory
events, leg movements, eye movements, and spindles.
It must be remembered, however, that it is rare that
these methods can be applied without human validation.
This is for two reasons: The first is that the methods are
not perfect and can sometimes err because of the pres-
ence of artifacts or an unexpected configuration of the
event. The second, and probably the most important,
relates to a fundamental problem of computer-based
analysis: A computer program must have a precise def-
inition of a problem to encode it into an algorithm.
Address correspondence and reprint requests to Dr. Rajeev Agarwal,
Stellate Systems, 345 Victoria Avenue, Suite 300, Montreal, Quebec,
Canada, H3Z 2N2.
However, many of the definitions related to sleep staging
or PSG events are imprecise; for instance, the universally
accepted rules of state (Rechtschaffen and Kales, 1968,
p.5) (hereafter referred to as R&K rules): “Stage 1 is
defined by a relatively low voltage . . . The transition
from an alpha record to stage 1 is characterized by a
decrease in the amount, amplitude and frequency of
alpha activity.” The use of terms such as “low voltage”
or “decrease in amplitude” require subjective interpreta-
tion on the part of the human scorer. They must be
transformed for the computer program into a fixed rule
that may result in sleep staging that will agree with some
scorers and not with others. Each user must therefore
review the results of computer scoring or detection and
make sure they are acceptable.
We review a recently developed method of comput-
er-assisted sleep staging that incorporates the prefer-
ence of each scorer before completing the analysis,
and a series of methods for detecting discrete events
that are of interest in sleep studies. Although auto-
matic detection of spikes and seizures can also be
useful during sleep studies, we do not review them
here because they have been reviewed relatively re-
cently (Gotman, 1999).

136
 DIGITAL TOOLS IN POLYSOMNOGRAPHY
AUTOMATIC SLEEP STAGING
The diagnosis and treatment of patients with sleep-
related problems requires the classification of sleep into
various sleep states. The current practice throughout the
world is to use the classification scheme defined by the
committee headed by Rechtschaffen and Kales (1968).
This standard recommends scoring (more commonly
referred to as staging) 20 or 30-second epochs of PSG
consisting of EEG, electromyographic (EMG), and elec-
tro-oculographic (EOG) data into one of six key sleep
stages: wake, light sleep (consisting of stages 1 and 2),
slow-wave sleep (consisting of stages 3 and 4), and rapid
eye movement (REM) stage according to the defined
rules. The R&K rules were designed according to the
sleep architecture of normal young adult subjects and are
now used for all types of PSGs. The state of sleep is a
continuum from light sleep to deep sleep that is inter-
rupted periodically by REM sleep. Thus, the R&K rules
are in fact a simplification to serve as a standardization
for comparison. As discussed earlier, many of these rules
are qualitative and are not defined precisely. Any crite-
rion that attempts to characterize PSG epochs with dis-
tinct features is bound to lead to considerable variations
in interpretation by different scorers. The level of varia-
tions in scoring is reflected by the interscorer agreement
of 67 to 91% (Gaillard and Tissot, 1973; Kim et al.,
1992; Kubicki et al., 1989; Stanus et al., 1987). Conse-
quently, serious objection has been raised against the
idea of manual scoring (Kubicki and Herrmann, 1996).
Moreover, scoring of all-night PSG is tedious, time-
consuming, and can become very difficult for abnormal
records.
EARLIER APPROACHES TO AUTOMATIC
SLEEP STAGING
To combat some of the problems with manual staging
of PSGs, during the last several decades many techniques
of automating the staging process have been proposed.
During the early years, automatic schemes based on
period analysis (Itil et al., 1969), EEG spectra with
multiple discriminant analysis (Larsen and Walter,
1970), and hybrid techniques that combine analog and
digital techniques (Smith and Karacan, 1971; Smith et
al., 1969) were proposed with varying performance.
Various scoring criteria were used in the development of
automatic methods and their performance was evaluated
using varying techniques. More recently, the ideas of
pattern recognition (Martin et al., 1972), wave detection
and the Bayesian approach (Stanus et al., 1987), the
interval histogram method (Kuwahara et al., 1988), ex-
pert system (Ray et al., 1986), and neural network
137
approaches (Schaltenbrand, 1996) have also been pro-
posed. With these methods the agreement of manual
scoring ranges from 70 to 85% with specific datasets and
testing conditions.
Many of these methods are rule based, for which the
staging rules are translated by the developer based on
experience and the data at hand. The often subjective
nature of the rules, as in the terms “relatively low
amplitude” or “decrease in amplitude,” must be quanti-
fied, which may not meet the preference of all users or all
data types. Many rules require the setting of thresholds,
which will clearly work for the data with which they are
developed; however, as new data are tested these thresh-
olds may not be appropriate. In the case of neural
network-based methods, training data are required. The
performance of automatic staging may not be acceptable
on a dataset from a population other than the one used for
training. Although there have been numerous attempts at
automating the sleep staging process, resulting in part
from some of the previously mentioned reasons, none of
them have found credibility in clinical practice. Many of
the authors of these works readily admit that the perfor-
mance of their method may deteriorate as the technical
quality decreases or the population varies. It is clear that
there is room for an automatic staging method using
evolving or adaptive schemes that can adjust depending
on the type and quality of PSGs. The various thresholds
should be self-adjusting.
COMPUTER-ASSISTED SLEEP STAGING:
SEGMENTATION AND SELF-ORGANIZATION
In a very simple definition of sleep architecture, REM
and non-REM sleep cycle every 60 to 90 minutes
throughout the night. The normal adult sleep architecture
starts through the non-REM state, which consists of the
four substates (R&K stages 1 to 4) describing the depth
of sleep followed by the REM state. Thereafter, the
non-REM and REM states cycle throughout the night.
Within the non-REM state, each of the four R&K stages
persists for a finite time and the transition between stages
is subjective. An important aspect of sleep staging is the
idea that a pattern of the PSG is assumed to exist for a
finite time until a new pattern emerges, signaling the
change of state. These patterns are recurrent throughout
the night and their differentiation is based on primitive
sleep-related patterns such as frequency, amplitude,
sleep spindles, k-complexes, and so forth.
To address some of the problems discussed in the
previous section, in a recent publication we presented the
Computer-Assisted Sleep Staging (CASS) method
(Agarwal and Gotman, 2001a), which takes advantage of
J Clin Neurophysiol, Vol. 19, No. 2, 2002
138 R. AGARWAL AND J. GOTMAN

the notion that patterns are recurrent throughout the TABLE 1. Interscorer agreement for the three sets of
night. The method finds pseudonatural patterns in the hypnograms
PSG, which can be labeled subsequently by the user as Scorer Manual Automatic Rescored
one of the predefined R&K sleep stages or as any other
sleep staging classification scheme of preference. We A vs. B 74.6 91.6 77.1
A vs. C 84.4 94.2 84.3
refer to these patterns as pseudonatural because of the A vs. D 80.1 93.3 77.0
ill-defined (requiring subjective interpretation) transitory A vs. E 78.5 93.3 79.3
epochs (for example, from stage wake to stage 1 or stage B vs. C 75.5 95.0 82.9
B vs. D 71.1 95.8 77.6
1 to stage 2). In reality, the exact change of stage is only B vs. E 71.2 95.8 78.8
a methodological concept because sleep is a continuum. C vs. D 82.5 96.7 85.6
This sleep continuum can be split into any number of C vs. E 80.5 96.7 82.3
D vs. E 78.6 100.0 76.7
patterns defined by the user— hence the pseudonatural
patterns. The method is based on the ideas of segmenta- Average 77.7 95.2 80.2
tion and self-organization to cluster the different PSG SD 4.5 2.3 3.3
patterns. The underlying idea is to group staging epochs, SD, standard deviation.
in which the epochs in a group contain relatively similar
patterns. Subsequently, each group can be labeled with
any name to specify any given stage in the classification context, the properties of the considered epoch clearly
scheme of preference (Agarwal and Gotman, 2001b). allow such a reclassification. For example, some stage 2
The following summarizes the key steps in the method. epochs may be reclassified as REM, wake, or stage 1 if
1. The PSG data channels relevant to staging (EEG the properties of the considered epoch clearly warrant
from central and occipital derivation, submental EMG, such a change and the context favors the change. The
and left and right EOGs) are broken down simulta- thresholds needed for such rules are patient specific,
neously into variable-length epochs in which the signals which the algorithm learns from the preliminary
are relatively stationary (Agarwal and Gotman, 1999). hypnogram.
During the course of the night, this yields several thou- 8. For some of the reasons discussed at the beginning
sand, five-channel, variable-length segments. of this article, it is rare that results of automatic methods
2. Each segment is parameterized by a set of basic can be used without visual review. The final step requires
sleep-related features (amplitude, frequency, presence of the visual review of the automatically generated hypno-
spindles, presence of REM, various spectral measures, gram, during which the reviewer can change the score of
etc.). any with which he disagrees. This process will yield a
3. Based on the parameterization in step 2, the seg- second hypnogram that we have termed the rescored
ments are clustered into a maximum of 8 to 10 groups hypnogram.
using a self-organization scheme based on the k-means Agarwal and Gotman (2001a) showed that on a dataset
clustering method. with varying hypnogram types, the CASS method
4. Segment clustering information is translated onto achieved relatively good performance—more than 80%
conventional, fixed-size staging epochs. Note that we agreement when compared with manual scoring. In this
have created clusters of epochs where each cluster rep- article, we selected subject C of that dataset to get some
resents, in theory, one type of pattern existing in the indication of interscorer differences. Five scorers (four
PSG. registered PSG technologists with substantial clinical
5. The user is shown a few sample epochs from each experience and one with notable research experience in
cluster and is asked to associate a valid R&K stage with scoring PSGs) were asked to score the PSG as described
it. Using this process, we have incorporated user prefer- in Agarwal and Gotman (2001a). For each scorer, this
ence in staging. generated three hypnograms: (1) scored manually
6. The method uses the staged sample epochs to stage (MANUAL), (2) scored automatically using CASS
the remaining epochs in the PSG to generate a prelimi- (AUTO; each scorer has a different AUTO score because
nary hypnogram. the CASS system follows the preference of that scorer,
7. Postprocessing. We used sleep-related primitive and (3) an automatically scored hypnogram that has been
features and apply specific decisional criteria for each corrected or rescored to the scorer’s satisfaction (RES-
stage type to justify the stage assignment of each epoch CORED). The RESCORED set is essentially another set
in the preliminary hypnogram. During this step, it may of MANUAL scoring. Table 1 shows the results of
be necessary to reclassify an epoch if, in the current interscorer agreement for the three sets of hypnograms.

J Clin Neurophysiol, Vol. 19, No. 2, 2002

 DIGITAL TOOLS IN POLYSOMNOGRAPHY
FIG. 1. Example of three different hypnograms generated by one
scorer. (A) Manually scored hypnogram. (B) Automatically scored
using the Computer-Assisted Sleep Staging method. (C) Automatically
generated hypnogram that has been corrected to the scorer’s preference.
The automatically scored hypnogram in B shows more transition
between stages compared with the two manually staged hypnograms
(A, C). This is to be expected because during automatic staging, unlike
manual staging, only minimal contextual information is used. Note,
however, that in all three cases the overall profile (thick gray outline in
each hypnogram) is very similar.
Average interscorer agreement for the MANUAL set is
77.7% (range, 71.1 to 84.4%), for the AUTO set it is
95.2% (range, 91.6 to 100%), and for the RESCORED
set it is 80.2% (range, 76.7 to 85.6%). As expected, the
interscorer agreement for the AUTO set is very high,
because differences come only from the small sample of
epochs shown each scorer. The interscorer agreement for
the RESCORED set is a little better than the MANUAL
set because each scorer starts from hypnograms that are
similar (the AUTO set). Comparison of AUTO and
MANUAL hypnograms across reviewers showed an av-
erage agreement of 65.7 ⫾ 7.2% (standard deviation),
and for the AUTO versus the RESCORED hypnograms
the average agreement was 78.0 ⫾ 5.7%. Considering
that the expected interscorer agreement of the MANUAL
set is 77.7% (column 1 in Table 1), the average 65.7%
agreement of MANUAL versus AUTO scoring is very
acceptable, particularly if the AUTO-generated hypno-
grams are considered as a first pass. In practice, however,
the user is more likely to score the PSG automatically
and then correct it. Thus, the 78% agreement between the
AUTO and the RESCORED sets across reviewers pro-
vides a more meaningful indication of performance of
the CASS method. The 78% agreement is approximately
the same as the average interscorer agreements for both
the MANUAL and the RESCORED sets in Table 1. It is
also interesting to note that the reviewers found that it
139
took, on average, twice as long to score the PSG manu-
ally compared with using the CASS method to generate
the PSG and then correct it (i.e., to obtain the RES-
CORED results).
Figure 1 is an example of the three hypnograms
generated by one scorer. Although there are differences
in an epoch-by-epoch comparison, it is clear that the
overall profile (thick light-gray line) in each of the three
hypnograms is very similar.
Computer-assisted sleep staging has several intrinsic
advantages over manual scoring. In contrast to manual
scoring, the CASS method analyses the signal properties
in the complete recording before staging, thus taking
advantage of patient-specific properties. Unlike most
other automatic staging methods, CASS does not rely on
fixed or hard threshold settings. All thresholds required
during the postprocessing step are learned from the
recording and are specific to the PSG under consider-
ation. For example, not all subjects demonstrate the same
level of muscle activity (e.g., REM behavior disorder);
therefore, REM stage classification using patient-specific
thresholds (as would be done in manual scoring) for
determining atonia will clearly provide for an improved
staging of REM. Hard thresholds in the rule-based meth-
ods may lose REM stage for patients with REM behavior
disorder.
The method attempts to find naturally occurring pat-
terns in the recording based on primitive features, which
are subsequently classified manually by the user (steps 5
and 6 listed earlier). This interactive participation allows
the user to impart his staging preferences according to
any staging criterion. Because of the overwhelming pop-
ularity of the R&K classification, the last step (postpro-
cessing) of the method is designed to meet this need.
This, however, can be modified easily for any other
staging scheme of preference. Because of its generic
nature, the CASS method is amenable to any staging
criterion and it provides a tool to find a more natural
staging scheme.
Most important, the CASS method allows some mea-
sure of objectivity to be introduced in the staging pro-
cess, as reflected by the high interscorer agreement for
the automatic staging (column 2 in Table 1). For exam-
ple, the separation of slow-wave sleep into stages 3 and
4 is more objective and consistent than visual scoring, as
shown by Agarwal and Gotman (2001a).
AUTOMATIC DETECTION OF SLEEP
SPINDLES
Sleep spindles are well-known to sleep investigators
as evidence of onset of light sleep and are typically
J Clin Neurophysiol, Vol. 19, No. 2, 2002
140 R. AGARWAL AND J. GOTMAN
FIG. 2. Examples of spindles detected by both manual and automatic
methods. (A) Clear spindles. (B) Marginal spindles. (C) Spindles
obscured by background slow activity. Note that the two sets of
spindles do not coincide with the start and duration of the spindles.
dominant in stage 2 of the R&K sleep classification.
These transient patterns are known as sigma waves and
they are defined as groups of rhythmic waves that last
from 0.5 to 3 seconds in the 12 to 14-Hz range. These
potentials can show marked variation with regard to
morphology, frequency, spatial distribution, and stage of
sleep. Age and central nervous system disorders can also
influence the appearance of spindles.
Typical spindles are identified relatively easily by
visual inspection of overnight PSGs. However, there are
often spindles that are obscured by superimposed activ-
ity. Regardless of whether they are easy to identify, the
manual detection of spindles is a very tedious and time-
consuming task. Some spindle detection algorithms us-
ing zero-crossing and phase-locked loops (Pivik et al.,
1982) have been presented in the literature. These tech-
niques require the use of specific models and require the
selection of thresholds. We propose a robust algorithm to
detect sleep spindles based on a strategy similar to the
previously discussed CASS method. The method at-
tempts to segment bandpass-filtered EEGs (11.5 to 15
Hz), extract relevant spindle features from each segment,
and cluster the segments based on these features. Clus-
ters most likely to contain spindle segments are extracted
to yield candidate spindles. Similar to the CASS method,
postprocessing based on statistical measures is used to
filter the candidate spindles to remove the segments that
are least likely to contain spindles. As with the CASS
method, the relevant postprocessing thresholds are not
fixed, but are adapted from the PSG under consideration.
Figure 2 shows some examples of automatically detected
spindles. The method achieves a high rate of sensitivity
of approximately 90% and a specificity of approximately
65% with respect to manual scoring. The method allows
for a parameter that can control the specificity/sensitivity
tradeoff.
Automatic Detection of Respiratory Events
To assess respiratory disturbances properly, it is
necessary to monitor airflow (nasal and/or oral) as
J Clin Neurophysiol, Vol. 19, No. 2, 2002
FIG. 3. Examples of respiratory events detected by manual and
automatic methods. (A) Hypopnea. (B) Obstructive apnea (OA). (C)
Central apnea (CA). The exact start and end of the automatically
detected events do not coincide with the manually marked events. In
polysomnography, the number of these events during the course of the
night is the important factor. More important, automatic detection of
respiratory events will be consistent and will not vary with different
scorers.
well as respiratory efforts (chest and/or abdomen).
One channel of airflow and one channel of respiratory
effort are required in standard PSG. Cessation of
airflow and effort are used to define apneic events and
their classifications. Although there are rules that
define apneas and hypopneas, there is always the issue
of translation of qualitative descriptions to computer
methods. For example, hypopneas are defined to be
typically less than 50% cessation in airflow for a
minimum of 10 seconds. Words like “typically” create
a qualitative interpretation that can lead to interscorer
variations. This is particularly so with borderline
events. The automatic method uses a moving back-
ground window in which the inspiratory reference
amplitude is evaluated. Comparing the peak ampli-
tudes in a test window against the inspiratory refer-
ence amplitude allows the detection of respiratory
events. The inspiratory reference amplitude is defined
to be the average peak amplitude in a given window.
Figure 3 shows examples of automatically detected
obstructive apnea, central apnea, and hypopnea. Over-
all, the method achieves an event detection sensitivity
of 96.5% and a specificity of 85.9% when compared
with manual scoring of these events.
AUTOMATIC DETECTION OF PERIODIC LEG
MOVEMENTS
Periodic movement in sleep is defined as short-lasting
periods of brief, repetitive bursts of surface EMG, tonic
 DIGITAL TOOLS IN POLYSOMNOGRAPHY
FIG. 4. Example leg movement events marked automatically and
manually (two scorers) in a single recording of one subject. (A) Clear
leg movement detected by all. (B) Leg movement with clearly lower
amplitude detected by all. (C) Leg movement detected by the automatic
method but not marked manually by the two scorers. (D) Leg move-
ment marked by two scorers but not detected automatically, From B
and C, it is clear that the manual scoring of leg movement events
appears to be inconsistent, unlike automatic detection. More important,
this is achieved without setting any hard detection thresholds.
in nature, that occur during quiet wakefulness and sleep.
Most commonly they involve both legs and are referred
to as periodic leg movements. They can occur during
various pathologic conditions, such as respiratory disor-
ders (apnea), restless leg syndrome, and narcolepsy.
Excessive periodic leg movements, particularly when
associated with repeated arousals, can lead to excessive
daytime sleepiness. Standardized rules are used to score
and quantify the individual leg movements visually,
which are converted to periodic leg movements accord-
ing to set rules. The visual detection of leg movements is
a very tedious and time-consuming task, and consider-
able training is required to achieve high interscorer
agreement. The level of EMG activity required for a leg
movement to occur is ill-defined, and thus substantial
subjectivity is introduced in visual scoring.
To combat some of these issues, we propose an
automatic leg movement detection method in which
the need for the EMG amplitude threshold is removed.
Like the spindle detection method, automatic leg
movement detection is based on the segmentation and
clustering procedure. The method can be separated
into four steps:
1. Segmentation. The EMG data are broken into vari-
able-length segments in which the level of EMG activity
is relatively unchanging.
2. Feature extraction. Features describing the level of
EMG activity in each segment are evaluated.
3. Classification. The two-tiered clustering strategy is
applied to group segments with similar properties.
4. Postprocessing. Clusters containing leg movements
are extracted to derive leg movement detection thresh-
olds, which are used in the final detection of leg
movements.
141
Note during the last step that the necessary detection
thresholds are relative to the PSG under consideration;
hence, there is no need for a priori threshold selection.
Figure 4 shows some examples of manually marked and
automatically detected leg movements. The results ob-
tained on five files (45 hours of data with 1,813 manually
marked leg movement events) show a sensitivity of
84.7% and a specificity of 73.1%. The method allows for
an input parameter that can be used to control the
sensitivity/specificity tradeoff.
AUTOMATIC DETECTION OF RAPID EYE
MOVEMENTS
REM sleep is characterized by EEG activation,
muscle atonia, and episodic bursts of eye movements.
Even in the absence of atonia, REMs recorded with
standard EOG electrodes have become the cardinal
sign for the detection of REM sleep. Moreover, there
is continuing evidence that suggests that REM count
abnormalities exist in several psychiatric syndromes
when compared with normal subjects (Foster et al.,
1976; Zarcone et al., 1987). This information has been
largely ignored primarily because of the tedious and
time-consuming nature of visual identification of
REM events.
Several methods based on eye movement models that
require threshold selection have been proposed in the
literature (see, for example, Degler et al. [1975], Hatzi-
labrou et al. [1994], and Ktonas and Smith [1978]). We
propose a REM detection method that incorporates var-
ious eye movement features without explicitly using an
eye movement model. The root of the method relies on
the idea that REMs have a rapid change in amplitude as
well as phase-reversed synchrony in the left and right
EOG channels. A two-step process is used for REM
detections:
1. Candidate REMs are detected using a detection
criterion based on the previous two features.
2. Candidate REMs are filtered using a series of rules
that can control the sensitivity/specificity tradeoff.
Detection results on the training data indicate the
sensitivity and specificity to be on the order of 84%
when compared with manual scoring of individual REM
events (Agarwal et al., 2002). Figure 5 shows the basic
idea in REM detection.
CONCLUSION
Polysomnographic studies involve the monitoring of
the temporal evolution of different sleep states that are
referred to more commonly as sleep stages, as well as
J Clin Neurophysiol, Vol. 19, No. 2, 2002
142 R. AGARWAL AND J. GOTMAN
FIG. 5. Examples of automatic detection of individual rapid eye
movements (REMs). (A) Criterion to generate a set of candidate REM
(CREM) detections. CREMs are shown as black tick marks below the
detection criterion and are labeled as CREM on the left. The CREMs
are filtered to reflect those that do not satisfy the desired REM
properties. (B) Presented are left and right electro-oculograms (L-EOG
and R-EOG) along with the location of final REM detections (AREM)
and the manually marked REMs (MREM)—shown as the black tick
marks. Clearly there is a high concordance in the AREM and the
MREMs.
many other types of sleep events. Examples of the more
routinely monitored events include apneas and leg move-
ments. The interpretation of the PSG requires staging and
the manual marking of the sleep-related events, which
can be tedious and time-consuming tasks. Furthermore,
the imprecise nature of the detection rules introduces
subjectivity and interscorer variability. In recent years, as
we have progressed from paper to digital PSG, notable
effort has been devoted to the development of computer
methods for the automation of some of these tasks. Of
the many methods available, either as commercial prod-
ucts or from the literature, none have gained much
popularity in clinical practice. Much of this failure is not
the result of the limitation of the computing resources or
the existing signal processing theory, but largely the
translation of “ambiguous” standards to mathematical
models. The qualitative description of the many widely
accepted rules and practices leads to the generation of
imprecise mathematical models across laboratories or
developers. Most such models, with a few exceptions,
require thresholds that need adjustment depending on the
data being examined. This is particularly so with the
automatic sleep staging methods.
We reviewed an automatic sleep staging method in
which the need for hard thresholds has been eliminated
almost completely. The method adapts the staging rules
to the user preferences and the PSG under consideration.
All required thresholds are specific to the PSG under
consideration and are learned from the data at hand.
Additionally, we have reviewed some automatic methods
used in the detection of respiratory events, sleep spin-
J Clin Neurophysiol, Vol. 19, No. 2, 2002
dles, leg movement events, and REM events in which the
preselection of thresholds is practically eliminated. Al-
though the performance of these methods appears to be
quite good, it must be remembered that because of the
high variability in the data types and the varying inter-
pretation of the many ambiguous standards, manual re-
view of any automatically generated results is still es-
sential in the proper assessment of PSGs.
Acknowledgment: The authors thank Suzie Laroche, An-
thony Ferreli, Michael Sauve, Sherrye Hague, and Jim Davis
for their assistance in the PSG scoring.
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