The accuracy, night-To-night variability, and stability of frontopolar sleep electroencephalography biomarkers

Daniel J. Levendowski, Luigi Ferini-Strambi, Charlene Gamaldo, Mindy Cetel, Robert Rosenberg, Philip R. Westbrook

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Study Objectives: To assess the validity of sleep architecture and sleep continuity biomarkers obtained from a portable, multichannel forehead electroencephalography (EEG) recorder. Methods: Forty-seven subjects simultaneously underwent polysomnography (PSG) while wearing a multichannel frontopolar EEG recording device (Sleep Profiler). The PSG recordings independently staged by 5 registered polysomnographic technologists were compared for agreement with the autoscored sleep EEG before and after expert review. To assess the night-To-night variability and first night bias, 2 nights of self-Applied, in-home EEG recordings obtained from a clinical cohort of 63 patients were used (41% with a diagnosis of insomnia/depression, 35% with insomnia/obstructive sleep apnea, and 17.5% with all three). The between-night stability of abnormal sleep biomarkers was determined by comparing each night's data to normative reference values. Results: The mean overall interscorer agreements between the 5 technologists were 75.9%, and the mean kappa score was 0.70. After visual review, the mean kappa score between the autostaging and five raters was 0.67, and staging agreed with a majority of scorers in at least 80% of the epochs for all stages except stage N1. Sleep spindles, autonomic activation, and stage N3 exhibited the least between-night variability (P > .0001) and strongest between-night stability. Antihypertensive medications were found to have a significant effect on sleep quality biomarkers (P > .02). Conclusions: A strong agreement was observed between the automated sleep staging and human-scored PSG. One night's recording appeared sufficient to characterize abnormal slow wave sleep, sleep spindle activity, and heart rate variability in patients, but a 2-night average improved the assessment of all other sleep biomarkers. Commentary: Two commentaries on this article appear in this issue on pages 771 and 773.

Original languageEnglish (US)
Pages (from-to)791-803
Number of pages13
JournalJournal of Clinical Sleep Medicine
Issue number6
StatePublished - 2017


  • Biomarkers
  • In-home
  • Scoring
  • Sleep EEG
  • Sleep architecture
  • Sleep continuity
  • Validity
  • Variability

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology


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