COMMENTARY - Standing on the shoulders of giants: the Standardized Sleep Manual after 30 years

Abstract 

More than three decades ago, the Standardized Sleep Manual defined terms and established minimal guidelines for studying sleep in humans. The advent of inexpensive, widely available, powerful computer systems places a powerful ««analytical engine»» (to uses Babbage's term) in most of our hands. When applied to polysomnography, the potential for extending our knowledge is vast. For computerized polysomnography to realize its potential, consensus will need to be reached on terminology, methods and quantitative procedures. This was the key to the success of the Standardized Sleep Manual and it will be the key to the success of current efforts to standardized automated sleep analysis. The Standardized Sleep Manual accomplishments and limitations are reviewed, as are the problems and strengths associated with computerized polysomnography. It is argued that rather than destroying or abandoning the Standardized Sleep Manual , it would be more productive to extend it. Automated analysis should stimulate evolution of our ability to describe and understand sleep. If we stand on the shoulders of giants we will be able to see new horizons.

Keywords: computerized polysomnography, sleep stage scoring, automatic data processing, biomedical engineering.

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• f1 Correspondence to be addressed to: Max Hirshkowitz, Ph.DVAMC-Sleep Center 116A, 2002 Holcombe Blvd., Houston, Texas 77030, USA. Tel: +1 (713) 794-7562; Fax: +1 (713) 794-7558.