The visual scoring of sleep in adults
Abstract
The 1968 Rechtschaffen and Kales (R & K) sleep scoring manual was published 15 years after REM sleep was discovered. Advances in the ensuing 28 years warranted a re-look at visual scoring of sleep stages. This paper describes the work of the AASM Visual Scoring Task Force, including methodology, a literature review and the rationale behind the new rules. Reliability studies of R & K scoring were reviewed; reliability was low for stage one and moderate for slow wave sleep. Evidence indicated that K complexes and slow waves are expressed maximal frontally, spindles centrally and alpha rhythm over the occipital region. Three derivations of EEG, two of electro-oculography, and one of chin EMG were recommended. Scoring by 30-second epochs was retained. New terminology for sleep stages was proposed. Attenuation of alpha rhythm was determined to be the most valid electrophysiological marker of sleep onset. Alternative measures were proposed for non-alpha generating subjects. K complexes associated with arousals were determined to be insufficient alone to define the new stage N2. No evidence was found to justify dividing slow wave sleep into two stages. No reasons were found to alter the current slow wave amplitude criteria at any age. The phenomena of REM sleep were defined. The rules for defining onset and termination of REM sleep periods were simplified. Movement time was eliminated and major body movements defined. Studies are needed to test the reliability of the new rules. Future advances in technology may require modification of these rules with time.
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Sleep recordings were scored manually by a licensed sleep technician according to the classification criteria of the American Academy of Sleep Medicine.
“Analyses were scored manually by a licensed sleep technician according to the classification criteria of the American Academy of Sleep Medicine (Silber et al., 2017).”
From Sex-specific association of the lunar cycle with sleep (2022) · cites this paper as Silber et al., 2017
Sleep was measured by polysomnography and scored by an experienced scorer according to standard criteria.
“Sleep was subsequently scored by an experienced scorer (J.E.B.) according to standard criteria (Silber et al., 2007).”
From Sleep restriction alters plasma endocannabinoids concentrations before but not after exercise in humans (2016) · cites this paper as Silber et al., 2007
Sleep was recorded by polysomnography and scored by an experienced scorer blinded to study conditions using standardized criteria.
“An experienced scorer blinded to the study conditions adhered to standardized criteria for subsequent sleep analysis [36].”
From Gut microbiota and glucometabolic alterations in response to recurrent partial sleep deprivation in normal-weight young individuals (2016) · cites this paper as [36]
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Adult obstructive sleep apnoea
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“An experienced scorer blinded to the study conditions adhered to standardized criteria for subsequent sleep analysis [36].”
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Linking Light Exposure and Subsequent Sleep: A Field Polysomnography Study in Humans
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- Authors
- Silber, M. H., Ancoli-Israel, S., Bonnet, M. H., Chokroverty, S., Grigg-Damberger, M. M., Hirshkowitz, M., Kapen, S., Keenan, S. A., Kryger, M. H., Penzel, T., Pressman, M. R., & Iber, C.
- Affiliations
- Mayo Clinic (US)
- Wright State University (US)
- John F. Kennedy Medical Center (US)
- University of New Mexico (US)
- Baylor College of Medicine (US)
- Wayne State University (US)
- University of Manitoba (CA)
- Philipps University of Marburg (DE)
- Paoli Hospital (US)
- University of Minnesota (US)
- ORCID
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2007-03-15
- Volume
- 3
- Issue
- 2
- Pages
- 121-131
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- OpenAlex
- W7692620
- Cited by
- 1,064
- References
- 111
- Citations by year
- 2026: 25 · 2025: 43 · 2024: 41 · 2023: 48 · 2022: 67 · 2021: 64 · 2020: 83 · 2019: 68 · 2018: 73 · 2017: 83 · 2016: 72 · 2015: 67 · 2014: 94 · 2013: 65 · 2012: 46
- FWCI
- 33.26
- Type
- journal article
- Language
- en
- Update notices
- erratum (2007-08-15)
- Open access
- closed
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › EEG and Brain-Computer Interfaces
- Keywords
- sleep stage classification, visual grading, REM sleep, slow-wave sleep, K-complexes, sleep onset, electrooculography, scoring reliability
- MeSH terms
- Adult, Electroencephalography, Electrooculography, Humans, Research, Research Design, Sleep, Sleep Wake Disorders, Sleep Stages, Sleep, REM, Polysomnography
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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