DOES EXTERNAL PROFICIENCY TESTING AND METHOD INTERVENTION IMPROVE INTER-SCORER AND INTER-LABORATORY POLYSOMNOGRAM SCORING RELIABILITY?

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Polysomnography (PSG) is a clinical test that is used to diagnose breathing disorders that occur during sleep. The most common of this type of disorder is Obstructive Sleep Apnoea (OSA). People with OSA experience periods of partial or complete obstruction of the throat during sleep. It is a serious disorder when severe, with good treatments available. Accurate diagnostic tests are therefore very important. The main outcome measures from the PSG test are the number of obstructions per hour of sleep, the number of arousals from sleep and the amount and quality of sleep. Scoring these features from PSG recordings relies heavily on visual pattern recognition by trained observers applying pre-defined rules. The recognition of features and application of the rules is therefore subject to interpretation by individual scorers and this has the potential to affect measurement reliability. Inter-scorer variations in PSG outcome measures may affect the accuracy of clinical evaluation of individual patients and also decrease statistical power in research studies, particularly multicentre research studies. Several studies have examined the reliability of scoring PSGs. All have demonstrated significant variability in scoring of PSGs and there is therefore a strong incentive to investigate sources of inter-scorer variability and to develop methods aimed at achieving improvements. Our group has recently developed methods that allow measurement of PSG scoring reliability to be assessed and potentially improved through external proficiency testing (EPT). They rely on distributing test PSGs to participating laboratories and determining the consistency of scoring using a purpose-written computer application. However, there are no studies that evaluate whether applying the principles of EPT to PSG scoring is effective in improving scoring consistency. If EPT proves to be ineffective, then it is likely that an active process that aims to align scorer technique will be necessary. The purposes of this study are therefore to: 1. Evaluate whether a program of EPT improves scorer consistency 2. Evaluate whether an active process for identifying and correcting causes of discordance (alignment process) in addition to EPT further improves scorer consistency The demonstration of effective methods for improving scorer consistency will have important benefits for both patient care and research.

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