The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications is the definitive reference for the evaluation of polysomnography (PSG) and home sleep apnea tests (HSATs). This comprehensive resource provides rules for scoring sleep stages, arousals, respiratory events during sleep, movements during sleep and cardiac events. The AASM Scoring Manual also provides standard montages, electrode placements and digitization parameters. This digital subscription is indispensable for sleep technologists, and it is an essential reference for physicians who interpret sleep studies.

The following summary provides a listing of new sections and an overview of some key changes that have been made in Version 2.6.

• II. Parameters to be Reported for Polysomnography (Section A) – added Rule 10 that synchronized PSG-video is RECOMMENDED.

• II. Parameters to be Reported for Polysomnography (Section E) – added Rule 5 that reporting REM without atonia (RWA) is OPTIONAL, including a note that the leads used to determine the presence of RWA should be included in the PSG report.

• III. Technical and Digital Specifications (Section A) – updated Note 2 to clarify that the Scoring Manual does not specify maximum impedances for ECG or for EMG of the legs, however, it is suggested that the impedance be adjusted so that the baseline amplitude is minimized.

• III. Technical and Digital Specifications (Section B) – updated Rule 3 to recommend that PSG equipment has the capability to provide the minimal recommended sampling rate (or higher) for all signals as opposed to the capability of selecting sampling rates for each channel.

• IV. Sleep Staging Rules, Part 1: Rules for Adults (Section F) – updated Rule 6 to state that the portion of the record containing the eye movements is considered stage N1, and this stage continues until there is evidence for another sleep stage.

• IV. Sleep Staging Rules, Part 1: Rules for Adults (Section I) – updated Rule 6c and Figure 15 to specify what happens after an arousal interrupts stage R.

• IV. Sleep Staging Rules, Part 3: Rules for Infants (Section B) – updated Rule 4 so that synchronized video and audio recording is RECOMMENDED.

• VI. Cardiac Rules (Section A) – clarified the location of electrode placement in Note 3.

• VII. Movement Rules (Section G) – updated the entire ‘Scoring PSG Features of REM Sleep Behavior Disorder (RBD)’ section, which is now titled the ‘Scoring REM Without Atonia (RWA)’ section.

• VIII. Respiratory Rules, Part 1: Rules for Adults (Section A) – added a new note and figure to indicate that surface diaphragmatic/intercostal EMG signal may be used for detection of respiratory effort to complement effort belt signals and that electrode placement can vary from individual to individual.

• VIII. Respiratory Rules, Part 1: Rules for Adults (Section H) – added this new section to address events that occur in positive airway pressure titrations when a backup rate is used.

• VIII. Respiratory Rules, Part 2: Rules for Children (Section B) – added Rules 2e and 4e to include PVDF sum as ACCEPTABLE alternative apnea/hypopnea sensors in children.

• VIII. Respiratory Rules, Part 2: Rules for Children (Section B) – added Rule 6c to include dual thoracoabdominal PVDF belts as ACCEPTABLE for monitoring respiratory effort in children.

• VIII. Respiratory Rules, Part 2: Rules for Children (Section I) – added this new section to address events that occur in positive airway pressure titrations when a backup rate is used.

v.2.6.0

The following are versions of the Scoring Manual, summaries of the revisions made for each major update, and dates when these versions were released.

• Version 2.6 (January 2020)
• Summary of Updates in Version 2.6
• Version 2.5 (April 2018)
• • Summary of Updates in Version 2.5
• Version 2.4 (April 2017)
  • Summary of Updates in Version 2.4
• Version 2.3 (April 2016)
  • Summary of Updates in Version 2.3
• Version 2.2 (July 2015)
  • Summary of Updates in Version 2.2
• Version 2.1 (July 2014)
  • Summary of Updates in Version 2.1
• Version 2.0.3 (January 2014)
• Version 2.0.2 (September 2013)
• Version 2.0.1 (July 2013)
• Version 2.0 (released October 2012)
  • Summary of Updates in Version 2.0

Note:  All AASM-accredited sleep facilities are required to have implemented the new rules in Version 2.6 by July 1, 2020.

Accredited Member Facilities are able to provide digital access to the AASM Scoring Manual for all staff members, fill out this form and we will process the request.