Derived fuzzy knowledge model for estimating the depth of anesthesia

A system based on machine learning for improving sleep

Closed-loop auditory stimulation is one of the well-known and emerging sensory stimulation techniques, which achieves the purpose of sleep regulation by driving the EEG slow oscillation (SO, <1 Hz) through auditory stimulation. The main challenge is to accurately identify the stimulation timing and provide feedback in real-time, which has high requirements on the response time and recognition accuracy of the closed-loop auditory stimulation system. To reduce the impact of systematic errors on the regulation results, most traditional closed-loop auditory stimulation systems try to identify a single feature to determine the timing of stimulus delivery and reduce the system feedback delay by simplifying the calculation. Unlike existing closed-loop regulation systems that identify specific brain features, this paper proposes a closed-loop auditory stimulation sleep regulation system deploying machine learning. The process is: through online sleep real-time automatic staging, tracking the sleep stage to provide feedback quickly, and continuously offering external auditory stimulation at a specific SO phase. This paper uses this system to conduct sleep auditory stimulation regulation experiments on ten subjects. The experimental results show that the sleep closed-loop regulation system proposed in this paper can achieve consistency (effective for almost all subjects in the experiment) and immediate (taking effect immediately after stimulation) modulation effects on SOs. More importantly, the proposed method is superior to existing advanced methods. Therefore, the system designed in this paper has great potential to be more reliable and flexible in sleep regulation.

Altered brain dynamics index levels of arousal in complete locked-in syndrome

Complete locked-in syndrome (CLIS) resulting from late-stage amyotrophic lateral sclerosis (ALS) is characterised by loss of motor function and eye movements. The absence of behavioural indicators of consciousness makes the search for neuronal correlates as possible biomarkers clinically and ethically urgent. EEG-based measures of brain dynamics such as power-law exponent (PLE) and Lempel-Ziv complexity (LZC) have been shown to have explanatory power for consciousness and may provide such neuronal indices for patients with CLIS. Here, we validated PLE and LZC (calculated in a dynamic way) as benchmarks of a wide range of arousal states across different reference states of consciousness (e.g., awake, sleep stages, ketamine, sevoflurane). We show a tendency toward high PLE and low LZC, with high intra-subject fluctuations and inter-subject variability in a cohort of CLIS patients with values graded along different arousal states as in our reference data sets. In conclusion, changes in brain dynamics indicate altered arousal in CLIS. Specifically, PLE and LZC are potentially relevant biomarkers to identify or diagnose the arousal level in CLIS and to determine the optimal time point for treatment, including communication attempts.

Parliamentary roll-call voting as a complex dynamical system: The case of Chile

A method is proposed to study the temporal variability of legislative roll-call votes in a parliament from the perspective of complex dynamical systems. We studied the Chilean Chamber of Deputies' by analyzing the agreement ratio and the voting outcome of each vote over the last 19 years with a Recurrence Quantification Analysis and an entropy analysis (Sample Entropy). Two significant changes in the temporal variability were found: one in 2014, where the voting outcome became more recurrent and with less entropy, and another in 2018, where the agreement ratio became less recurrent and with higher entropy. These changes may be directly related to major changes in the Chilean electoral system and the composition of the Chamber of Deputies, given that these changes occurred just after the first parliamentary elections with non-compulsory voting (2013 elections) and the first elections with a proportional system in conjunction with an increase in the number of deputies (2017 elections) were held.

Brain Entropy is Associated with Divergent Thinking

Creativity is the ability to generate original and useful products, and it is considered central to the progression of human civilization. As a noninherited emerging process, creativity may stem from temporally dynamic brain activity, which, however, has not been well studied. The purpose of this study was to measure brain dynamics using entropy and to examine the associations between brain entropy (BEN) and divergent thinking in a large healthy sample. The results showed that divergent thinking was consistently positively correlated with regional BEN in the left dorsal anterior cingulate cortex/pre-supplementary motor area and left dorsolateral prefrontal cortex, suggesting that creativity is closely related to the functional dynamics of the control networks involved in cognitive flexibility and inhibitory control. Importantly, our main results were cross-validated in two independent cohorts from two different cultures. Additionally, three dimensions of divergent thinking (fluency, flexibility, and originality) were positively correlated with regional BEN in the left inferior frontal gyrus and left middle temporal gyrus, suggesting that more highly creative individuals possess more flexible semantic associative networks. Taken together, our findings provide the first evidence of the associations of regional BEN with individual variations in divergent thinking and show that BEN is sensitive to detecting variations in important cognitive abilities in healthy subjects.

Monitoring the level of hypnosis using a hierarchical SVM system

Monitoring level of hypnosis is a major ongoing challenge for anesthetists to reduce anesthetic drug consumption, avoiding intraoperative awareness and prolonged recovery. This paper proposes a novel automated method for accurate assessing of the level of hypnosis with sevoflurane in 17 patients using the electroencephalogram signal. In this method, a set of distinctive features and a hierarchical classification structure based on support vector machine (SVM) methods, is proposed to discriminate the four levels of anesthesia (awake, light, general and deep states). The first stage of the hierarchical SVM structure identifies the awake state by extracting Shannon Permutation Entropy, Detrended Fluctuation Analysis and frequency features. Then deep state is identified by extracting the sample entropy feature; and finally light and general states are identified by extracting the three mentioned features of the first step. The accuracy of the proposed method of analyzing the brain activity during anesthesia is 94.11%; which was better than previous studies and also a commercial monitoring system (Response Entropy Index).

Validating team communication data using a transmission-duration threshold and voice activity detection algorithm

The processes underlying team effectiveness can be understood by analyzing the temporal dynamics of team communication sequences. The results of such analyses have shown that the complexity of team communication is associated with team performance on task-related variables, and hence communication complexity statistics have been proposed for use as measures for real-time feedback on team performance. In two analyses of historical team communication sequences, we found that filtering via use of a transmission-duration threshold and voice activity detection algorithm resulted in significant changes in complexity relative to not filtering the data or using a transmission-duration filter alone. The use of these filtering techniques showed significant effects on the complexity of communication sequences in both a laboratory-based experiment, with participants with little experience with voice communication protocols, and in a mission simulation with trained military operators. There was also a significant non-linear relationship between the complexity of communication sequences and task performance. However, an analysis of the impact of the changes in communication dynamics gained through filtering did not demonstrate that the changed temporal dynamics of filtered data better explained team performance. It is concluded that pre-filtering of invalid communication data should be included during the data cleaning stage of statistical analysis as a matter of good scientific practice. Furthermore, such use of filtering will ensure that inferences made about the relationship between the complexity of communication between team members and their performance are not confounded by the presence of invalid communication events.

Fuzzy Entropy Analysis of the Electroencephalogram in Patients with Alzheimer's Disease: Is the Method Superior to Sample Entropy?

Alzheimer’s disease (AD) is the most prevalent form of dementia in the world, which is characterised by the loss of neurones and the build-up of plaques in the brain, causing progressive symptoms of memory loss and confusion. Although definite diagnosis is only possible by necropsy, differential diagnosis with other types of dementia is still needed. An electroencephalogram (EEG) is a cheap, portable, non-invasive method to record brain signals. Previous studies with non-linear signal processing methods have shown changes in the EEG due to AD, which is characterised reduced complexity and increased regularity. EEGs from 11 AD patients and 11 age-matched control subjects were analysed with Fuzzy Entropy (FuzzyEn), a non-linear method that was introduced as an improvement over the frequently used Approximate Entropy (ApEn) and Sample Entropy (SampEn) algorithms. AD patients had significantly lower FuzzyEn values than control subjects (p < 0.01) at electrodes T6, P3, P4, O1, and O2. Furthermore, when diagnostic accuracy was calculated using Receiver Operating Characteristic (ROC) curves, FuzzyEn outperformed both ApEn and SampEn, reaching a maximum accuracy of 86.36%. These results suggest that FuzzyEn could increase the insight into brain dysfunction in AD, providing potentially useful diagnostic information. However, results depend heavily on the input parameters that are used to compute FuzzyEn.

Study of memory deficit in Alzheimer's disease by means of complexity analysis of fNIRS signal

Working memory deficit is a signature of Alzheimer's disease (AD). The free and cued selective reminding test (FCSRT) is a clinical test that quantifies memory deficit for AD diagnosis. However, the diagnostic accuracy of FCSRT may be increased by accompanying it with neuroimaging. Since the test requires doctor-patient interaction, brain monitoring is challenging. Functional near-infrared spectroscopy (fNIRS) could be suited for such a purpose because of the fNIRS flexibility. We investigated whether the complexity, based on sample entropy and multiscale entropy metrics, of the fNIRS signal during FCSRT was correlated with memory deficit in early AD. fNIRS signals were recorded over the prefrontal cortex of healthy and early AD participants. Group differences were tested through Wilcoxon-Mann-Whitney test ([Formula: see text]). At group level, we found significant differences for Brodmann areas 9 and 46. The results, although preliminary, demonstrate the feasibility of performing ecological studies on early AD with fNIRS. This approach may provide a potential neuroimaging-based method for diagnosis of early AD, viable at the doctor's office level, improving test-based diagnosis. The increased entropy of the fNIRS signal in early AD suggests the opportunity for further research on the neurophysiological status in AD and its relevance for clinical symptoms.

In situ detection of water quality contamination events based on signal complexity analysis using online ultraviolet-visible spectral sensor

The contaminant detection in water distribution systems is essential to protect public health from potentially harmful compounds resulting from accidental spills or intentional releases. As a noninvasive optical technique, ultraviolet-visible (UV-Vis) spectroscopy is investigated for detecting contamination events. However, current methods for event detection exhibit the shortcomings of noise susceptibility. In this paper, a new method that has less sensitivity to noise was proposed to detect water quality contamination events by analyzing the complexity of the UV-Vis spectrum series. The proposed method applied approximate entropy (ApEn) to measure spectrum signals' complexity, which made a distinction between normal and abnormal signals. The impact of noise was attenuated with the help of ApEn's insensitivity to signal disturbance. This method was tested on a real water distribution system data set with various concentration simulation events. Results from the experiment and analysis show that the proposed method has a good performance on noise tolerance and provides a better detection result compared with the autoregressive model and sequential probability ratio test.

Classification of Alzheimer's disease from quadratic sample entropy of electroencephalogram

Currently accepted input parameter limitations in entropy-based, non-linear signal processing methods, for example, sample entropy (SampEn), may limit the information gathered from tested biological signals. The ability of quadratic sample entropy (QSE) to identify changes in electroencephalogram (EEG) signals of 11 patients with a diagnosis of Alzheimer's disease (AD) and 11 age-matched, healthy controls is investigated. QSE measures signal regularity, where reduced QSE values indicate greater regularity. The presented method allows a greater range of QSE input parameters to produce reliable results than SampEn. QSE was lower in AD patients compared with controls with significant differences (p < 0.01) for different parameter combinations at electrodes P3, P4, O1 and O2. Subject- and epoch-based classifications were tested with leave-one-out linear discriminant analysis. The maximum diagnostic accuracy and area under the receiver operating characteristic curve were 77.27 and more than 80%, respectively, at many parameter and electrode combinations. Furthermore, QSE results across all r values were consistent, suggesting QSE is robust for a wider range of input parameters than SampEn. The best results were obtained with input parameters outside the acceptable range for SampEn, and can identify EEG changes between AD patients and controls. However, caution should be applied because of the small sample size.

Volume conduction effects on bivariate Lempel-Ziv Complexity of Alzheimer's disease electroencephalograms

The spurious increase in coherence of electroencephalogram (EEG) signals between distant electrode points has long been understood to be due to volume conduction of the EEG signal. Reducing the volume conduction components of EEG recordings in pre-processing attenuates this. However, the effect of volume conduction on non-linear signal processing of EEG signals is yet to be fully described. This pilot study aimed to investigate the impact of volume conduction on results calculated with a distance based, bivariate form of Lempel-Ziv Complexity (dLZC) by analyzing EEG signals from Alzheimer's disease (AD) patients and healthy age-matched controls with and without pre-processing with Current Source Density (CSD) transformation. Spurious statistically significant differences between AD patients and control's EEG signals seen without CSD pre-processing were not seen with CSD volume conduction mitigation. There was, however, overlap in the region of electrodes which were seen to hold this statistically significant information. These results show that, while previously published findings are still valid, volume conduction mitigation is required to ensure non-linear signal processing methods identify changes in signals only due to the purely local signal alone.

Sample entropy reveals high discriminative power between young and elderly adults in short fMRI data sets

Some studies have placed Sample entropy on the same data length constraint of 10^m–20^m (m: pattern length) as approximate entropy, even though Sample entropy is largely independent of data length and displays relative consistency over a broader range of possible parameters (r, tolerance value; m, pattern length; N, data length) under circumstances where approximate entropy does not. This is particularly erroneous for some fMRI experiments where the working data length is less than 100 volumes (when m = 2). We therefore investigated whether Sample entropy is able to effectively discriminate fMRI data with data length, N less than 10^m (where m = 2) and r = 0.30, from a small group of 10 younger and 10 elderly adults, and the whole cohort of 43 younger and 43 elderly adults, that are significantly (p < 0.001) different in age. Ageing has been defined as a loss of entropy; where signal complexity decreases with age. For the small group analysis, the results of the whole brain analyses show that Sample entropy portrayed a good discriminatory ability for data lengths, 85 ≤ N ≤ 128, with an accuracy of 85% at N = 85 and 80% at N = 128, at q < 0.05. The regional analyses show that Sample entropy discriminated more brain regions at N = 128 than N = 85 and some regions common to both data lengths. As data length, N increased from 85 to 128, the noise level decreased. This was reflected in the accuracy of the whole brain analyses and the number of brain regions discriminated in the regional analyses. The whole brain analyses suggest that Sample entropy is relatively independent of data length, while the regional analyses show that fMRI data with length of 85 volumes is consistent with our hypothesis of a loss of entropy with ageing. In the whole cohort analysis, Sample entropy discriminated regionally between the younger and elderly adults only at N = 128. The whole cohort analysis at N = 85 was indicative of the ageing process but this indication was not significant (p > 0.05).

A Predictive Model of Anesthesia Depth Based on SVM in the Primary Visual Cortex

In this paper, a novel model for predicting anesthesia depth is put forward based on local field potentials (LFPs) in the primary visual cortex (V1 area) of rats. The model is constructed using a Support Vector Machine (SVM) to realize anesthesia depth online prediction and classification. The raw LFP signal was first decomposed into some special scaling components. Among these components, those containing higher frequency information were well suited for more precise analysis of the performance of the anesthetic depth by wavelet transform. Secondly, the characteristics of anesthetized states were extracted by complexity analysis. In addition, two frequency domain parameters were selected. The above extracted features were used as the input vector of the predicting model. Finally, we collected the anesthesia samples from the LFP recordings under the visual stimulus experiments of Long Evans rats. Our results indicate that the predictive model is accurate and computationally fast, and that it is also well suited for online predicting.

Interpretation of coarse-graining of Lempel-Ziv complexity measure in ECG signal analysis

Lempel-Ziv (LZ) complexity measure has been applied to classify ventricular tachycardia (VT) and ventricular fibrillation (VF). The coarse-graining process plays a crucial role in the LZ complexity measure analysis, which directly affects the separating performance of VT and VF in ECG signal analysis. The question of different coarse-graining approaches interpretability in ECG signal analysis and their influence on the performance of ECG classification have not yet been previously addressed in the literature. In this paper, we present four coarse-graining process approaches, K-Means, Mean, Median and Mid-point. Our test shows that K-Means algorithm is superior to the other three approaches in VT and VF separation rate, Particularly, optimum performance is achieved at a 8-second window length.

Entropy and Complexity Analyses in Alzheimer's Disease: An MEG Study

Alzheimer’s disease (AD) is one of the most frequent disorders among elderly population and it is considered the main cause of dementia in western countries. This irreversible brain disorder is characterized by neural loss and the appearance of neurofibrillary tangles and senile plaques. The aim of the present study was the analysis of the magnetoencephalogram (MEG) background activity from AD patients and elderly control subjects. MEG recordings from 36 AD patients and 26 controls were analyzed by means of six entropy and complexity measures: Shannon spectral entropy (SSE), approximate entropy (ApEn), sample entropy (SampEn), Higuchi’s fractal dimension (HFD), Maragos and Sun’s fractal dimension (MSFD), and Lempel-Ziv complexity (LZC). SSE is an irregularity estimator in terms of the flatness of the spectrum, whereas ApEn and SampEn are embbeding entropies that quantify the signal regularity. The complexity measures HFD and MSFD were applied to MEG signals to estimate their fractal dimension. Finally, LZC measures the number of different substrings and the rate of their recurrence along the original time series. Our results show that MEG recordings are less complex and more regular in AD patients than in control subjects. Significant differences between both groups were found in several brain regions using all these methods, with the exception of MSFD (p-value < 0.05, Welch’s t-test with Bonferroni’s correction). Using receiver operating characteristic curves with a leave-one-out cross-validation procedure, the highest accuracy was achieved with SSE: 77.42%. We conclude that entropy and complexity analyses from MEG background activity could be useful to help in AD diagnosis.

A putatively novel form of spontaneous coordination in neural activity

We simultaneously recorded local field potentials from three sites along the olfactory-entorhinal axis in rats lightly anesthetized with isoflurane, as part of another experiment. While analyzing the initial data from that experiment with spectrograms, we discovered a potentially novel form of correlated neural activity, with near-simultaneous occurrence across the three widely separated brain sites. After validating their existence further, we named these events Synchronous Frequency Bursts (SFBs). Here we report our initial investigations into their properties and their potential functional significance. In Experiment 1, we found that SFBs have highly regular properties, consisting of brief (approximately 250 ms), high amplitude bursts of LFP energy spanning frequency ranges from the delta band (1-4 Hz) to at least the low gamma band (30-50 Hz). SFBs occurred almost simultaneously across recording sites, usually with onsets <25 ms apart, and there was no clear pattern of temporal leading or lagging among the sites. While the SFBs had fairly typical, exponentially decaying power spectral density plots, their coherence structure was unusual, with high peaks in several narrow frequency ranges and little coherence in other bands. In Experiment 2, we found that SFBs occurred far more often under light anesthesia than deeper anesthetic states, and were especially prevalent as the animals regained consciousness. Finally, in Experiment 3 we showed that SFBs occur simultaneously at a significant rate across brain sites from putatively different functional subsystems--olfactory versus motor pathways. We suggest that SFBs do not carry information per se, but rather, play a role in coordinating activity in different frequency bands, potentially brain-wide, as animals progress from sleep or anesthesia toward full consciousness.

The evaluation of EEG response to photic stimulation in normal and diseased subjects

In this paper, our aim is to determine two photic stimulation frequencies, which would represent normal and diseased subjects, separately. Following features were extracted for this aim; linear prediction coefficients (LPC), subband wavelet entropy (SWE), subband wavelet variance (SWV), and relative power (RP). After extracting related features, analysis of variance (ANOVA) statistical test was used for the statistical evaluation of these features. According to the obtained results, wavelet transform-based entropy gave the best results to determine the representing stimulation frequencies. As a result, 29 Hz stimulation frequency was determined as the most representative frequency for normal subjects, whereas 8 Hz stimulation frequency was determined as the most representative frequency for diseased subjects.

Approximate entropy and auto mutual information analysis of the electroencephalogram in Alzheimer's disease patients

We analysed the electroencephalogram (EEG) from Alzheimer's disease (AD) patients with two nonlinear methods: approximate entropy (ApEn) and auto mutual information (AMI). ApEn quantifies regularity in data, while AMI detects linear and nonlinear dependencies in time series. EEGs from 11 AD patients and 11 age-matched controls were analysed. ApEn was significantly lower in AD patients at electrodes O1, O2, P3 and P4 (p < 0.01). The EEG AMI decreased more slowly with time delays in patients than in controls, with significant differences at electrodes T5, T6, O1, O2, P3 and P4 (p < 0.01). The strong correlation between results from both methods shows that the AMI rate of decrease can be used to estimate the regularity in time series. Our work suggests that nonlinear EEG analysis may contribute to increase the insight into brain dysfunction in AD, especially when different time scales are inspected, as is the case with AMI.

Electroencephalogram background activity characterization with approximate entropy and auto mutual information in Alzheimer's disease patients

The aim of this study was to analyze the electroencephalogram (EEG) background activity in Alzheimer's disease (AD) with two non-linear methods: Approximate Entropy (ApEn) and Auto Mutual Information (AMI). ApEn quantifies the regularity in data, while AMI detects linear and non-linear dependencies in time series. EEGs were recorded from the 19 scalp loci of the international 10-20 system in 11 AD patients and 11 age-matched controls. ApEn was significantly lower in AD patients at electrodes O1, O2, P3 and P4 (p<0.01). The AMI of the AD patients decreased significantly more slowly with time delays than the AMI of normal controls at electrodes T5, T6, O1, O2, P3 and P4 (p<0.01). Furthermore, we observed a strong correlation between the results obtained with both non-linear methods, suggesting that the AMI rate of decrease can be used to estimate the regularity in time series. The decreased irregularity found in AD patients suggests that EEG analysis with ApEn and AMI could help to increase our insight into brain dysfunction in AD.

Measure of the electroencephalographic effects of sevoflurane using recurrence dynamics

This paper proposes a novel method to interpret the effect of anesthetic agents (sevoflurane) on the neural activity, by using recurrence quantification analysis of EEG data. First, we reduce the artefacts in the scalp EEG using a novel filter that combines wavelet transforms and empirical mode decomposition. Then, the determinism in the recurrence plot is calculated. It is found that the determinism increases gradually with increasing the concentration of sevoflurane. Finally, a pharmacokinetic and pharmacodynamic (PKPD) model is built to describe the relationship between the concentration of sevoflurane and the processed EEG measure ('determinism' of the recurrence plot). A test sample of nine patients shows the recurrence in EEG data may track the effect of the sevoflurane on the brain.

Predicting survival in critical patients by use of body temperature regularity measurement based on approximate entropy

Body temperature is a classical diagnostic tool for a number of diseases. However, it is usually employed as a plain binary classification function (febrile or not febrile), and therefore its diagnostic power has not been fully developed. In this paper, we describe how body temperature regularity can be used for diagnosis. Our proposed methodology is based on obtaining accurate long-term temperature recordings at high sampling frequencies and analyzing the temperature signal using a regularity metric (approximate entropy). In this study, we assessed our methodology using temperature registers acquired from patients with multiple organ failure admitted to an intensive care unit. Our results indicate there is a correlation between the patient's condition and the regularity of the body temperature. This finding enabled us to design a classifier for two outcomes (survival or death) and test it on a dataset including 36 subjects. The classifier achieved an accuracy of 72%.

Approximate Entropy-Based Epileptic EEG Detection Using Artificial Neural Networks

The electroencephalogram (EEG) signal plays an important role in the diagnosis of epilepsy. The EEG recordings of the ambulatory recording systems generate very lengthy data and the detection of the epileptic activity requires a time-consuming analysis of the entire length of the EEG data by an expert. The traditional methods of analysis being tedious, many automated diagnostic systems for epilepsy have emerged in recent years. This paper proposes a neural-network-based automated epileptic EEG detection system that uses approximate entropy (ApEn) as the input feature. ApEn is a statistical parameter that measures the predictability of the current amplitude values of a physiological signal based on its previous amplitude values. It is known that the value of the ApEn drops sharply during an epileptic seizure and this fact is used in the proposed system. Two different types of neural networks, namely, Elman and probabilistic neural networks, are considered in this paper. ApEn is used for the first time in the proposed system for the detection of epilepsy using neural networks. It is shown that the overall accuracy values as high as 100% can be achieved by using the proposed system.

Heart rate regularity analysis obtained from pulse oximetric recordings in the diagnosis of obstructive sleep apnea

Approximate entropy (ApEn) is a technique that can be used to quantify the irregularity or variability of time series. We prospectively evaluated the validity of ApEn of heart rate data obtained from pulse oximetric recordings as a diagnostic test for obstructive sleep apnea (OSA) in patients clinically suspected of suffering this disease. A sample of 187 referred outpatients (147 men and 40 women), with a mean age of 57.9+/-12.8 years and a body mass index of 29.5+/-5.5 kg/m(2), clinically suspected of having OSA were studied using nocturnal pulse oximetric recording performed simultaneously with complete polysomnography. A diagnosis of OSA was confirmed in 111 (59.3%). Patients with OSA presented significantly higher ApEn levels than those without OSA (1.334+/-0.189 vs 1.167+/-0.182). Chronic obstructive pulmonary disease (COPD) was diagnosed for 42 patients. Among these patients, 22 (52.4%) were diagnosed with OSA. COPD patients with OSA showed significantly higher ApEn levels than COPD patients without OSA (1.337+/-0.193 vs 1.184+/-0.173; p=0.01). ApEn correlated significantly with apnea-hypopnea index (r=0.38; p=0.000). There was no significant correlation between ApEn and either age or body mass index. No significant changes were observed in ApEn throughout the night in OSA patients. Using receiver operating characteristic curve analysis, we obtained a diagnostic sensitivity of 71.2%, specificity of 78.9%, positive predictive value of 81.3%, and negative predictive value of 66% at a threshold of 1.272. We conclude that ApEn analysis of heart rate data obtained from pulse oximetric recordings could be a useful tool in the study of OSA.

Decreased Lempel-Ziv complexity in Alzheimer's disease patients' magnetoencephalograms

The aim of the present research is to study the magnetoencephalogram (MEG) background activity in patients with Alzheimer's disease (AD) using the Lempel-Ziv (LZ) complexity. We recorded the MEG with a 148-channel whole-head magnetometer (MAGNES 2500 WH, 4D Neuroimaging) in 10 patients with probable AD and 10 age-matched control subjects, during five minutes. Artefact-free epochs were selected for the non-linear analysis. In all MEG channels, the AD patients had lower complexity than control subjects. In 77 of them the differences were statistically significant (p < 0.01). These preliminary results suggest that cognitive dysfunction in AD is associated with a decreased complexity in certain regions of the brain.

Linear and nonlinear analysis of electroencephalogram of the coma

The coma is common in intensive care units. The bedside physical examination provides a means to measuring the neurological status, but it cannot be a continuous evaluation, whereas electroencephalogram (EEG) can reflect the immediate electrical activities of the brain. In this paper, we investigate the spectral parameters, complexity and irregular measures, and spectral entropy in the coma. Compared to the normal subject, the EEG of the coma has a dominance of slow wave, low complexity, less irregularity, and low spectral entropy. This result demonstrates the possibility to use EEG analysis for the monitoring of neurological function.

Analysis of biomedical signals by the lempel-Ziv complexity: the effect of finite data size

The Lempel-Ziv (LZ) complexity and its variants are popular metrics for characterizing biological signals. Proper interpretation of such analyses, however, has not been thoroughly addressed. In this letter, we study the the effect of finite data size. We derive analytic expressions for the LZ complexity for regular and random sequences, and employ them to develop a normalization scheme. To gain further understanding, we compare the LZ complexity with the correlation entropy from chaos theory in the context of epileptic seizure detection from EEG data, and discuss advantages of the normalized LZ complexity over the correlation entropy.

Utility of Approximate Entropy From Overnight Pulse Oximetry Data in the Diagnosis of the Obstructive Sleep Apnea Syndrome

Approximate entropy (ApEn) is a family of statistics introduced as a quantification of regularity in time series without any a priori knowledge about the system generating them. The aim of this preliminary study was to assess whether a time series analysis of arterial oxygen saturation (SaO2) signals from overnight pulse oximetry by means of ApEn could yield essential information on the diagnosis of obstructive sleep apnea (OSA) syndrome. We analyzed SaO2 signals from 187 subjects: 111 with a positive diagnosis of OSA and 76 with a negative diagnosis of OSA. We divided our data in a training set (44 patients with OSA Positive and 30 patients with OSA Negative) and a test set (67 patients with OSA Positive and 46 patients with OSA Negative). The training set was used for algorithm development and optimum threshold selection. Results showed that recurrence of apnea events in patients with OSA determined a significant increase in ApEn values. This method was assessed prospectively using the test dataset, where we obtained 82.09% sensitivity and 86.96% specificity. We conclude that ApEn analysis of SaO2 from pulse oximetric recording could be useful in the study of OSA.

Interpretation of the Lempel-Ziv complexity measure in the context of biomedical signal analysis

Lempel-Ziv complexity (LZ) and derived LZ algorithms have been extensively used to solve information theoretic problems such as coding and lossless data compression. In recent years, LZ has been widely used in biomedical applications to estimate the complexity of discrete-time signals. Despite its popularity as a complexity measure for biosignal analysis, the question of LZ interpretability and its relationship to other signal parameters and to other metrics has not been previously addressed. We have carried out an investigation aimed at gaining a better understanding of the LZ complexity itself, especially regarding its interpretability as a biomedical signal analysis technique. Our results indicate that LZ is particularly useful as a scalar metric to estimate the bandwidth of random processes and the harmonic variability in quasi-periodic signals.

Forecasting the Unresponsiveness to Verbal Command on the Basis of EEG Frequency Progression During Anesthetic Induction With Propofol

The objective of this study is to model the association between the electroencephalogram (EEG) spectral features and the novel r scale representing the sedative effects of the propofol anesthetic drug. On the basis of the r scale, the unresponsiveness to the verbal command (LVC) is forecasted. EEG recordings are taken from a 16-patient study population undergoing propofol anesthetic induction. EEG was filtered into consecutive 4-Hz passbands up to 28 Hz. Of these time-series, the amplitude envelopes were extracted and used as input features to the first and the second-order polynomial multiple linear regression models. The values r epsilon [0.4, 1] were predicted with the R2 value of 0.775 with a cross validation. The LVC times were forecasted with the median error of 5%-7% or equivalently 10-13 s. In contrast, using the median of the measured LVC times of the training population as a forecast, the corresponding error was 12% or 26 s. The results suggest an acceptable correlation between the r scale and the EEG spectrum in the studied range. Moreover, the r values of an individual can be predicted using a population model. The suggested framework enables forecasting the LVC, which may open new possibilities for steering the drug administration.

Analysis of electroencephalograms in Alzheimer's disease patients with multiscale entropy

The aim of this study was to analyse the electroencephalogram (EEG) background activity of Alzheimer's disease (AD) patients using multiscale entropy (MSE). MSE is a recently developed method that quantifies the regularity of a signal on different time scales. These time scales are inspected by means of several coarse-grained sequences formed from the analysed signals. We recorded the EEGs from 19 scalp electrodes in 11 AD patients and 11 age-matched controls and estimated the MSE profile for each epoch of the EEG recordings. The shape of the MSE profiles reveals the EEG complexity, and it suggests that the EEG contains information in deeper scales than the smallest one. Moreover, the results showed that the EEG background activity is less complex in AD patients than control subjects. We found significant differences between both subject groups at electrodes F3, F7, Fp1, Fp2, T5, T6, P3, P4, O1 and O2 (p-value < 0.01, Student's t-test). These findings indicate that the EEG complexity analysis performed on deeper time scales by MSE may be a useful tool in order to increase our knowledge of AD.

Oxygen saturation regularity analysis in the diagnosis of obstructive sleep apnea

OBJECTIVE

The present study assessed the validity of approximate entropy (ApEn) analysis of arterial oxygen saturation (SaO(2)) data obtained from pulse oximetric recordings as a diagnostic test for obstructive sleep apnea (OSA) in patients clinically suspected of suffering this disease.

METHODOLOGY

A sample of 187 referred outpatients, clinically suspected of having OSA, was studied using nocturnal pulse oximetric recording performed simultaneously with complete polysomnography. ApEn analysis was applied to SaO(2) data.

RESULTS

Patients with OSA presented significantly higher approximate entropy levels than those without OSA (1.08+/-0.30 versus 0.47+/-0.26). Apnea-hypopnea index was correlated significantly with ApEn (r=0.607; p<0.001). Using receiver operating characteristic curve analysis, we obtained a diagnostic sensitivity of 88.3% and specificity of 82.9%, positive predictive value of 88.3% and a negative predictive value of 82.9%, at a threshold of 0.679. As a diagnostic test, this method presents high sensitivity and specificity compared to traditional methods in the diagnosis of OSA.

CONCLUSION

We conclude that ApEn analysis of SaO(2) data obtained from pulse oximetric recordings could be useful as a diagnostic technique for OSA subjects.

Analysis of EEG background activity in Alzheimer's disease patients with Lempel–Ziv complexity and central tendency measure

In this study we have investigated the electroencephalogram (EEG) background activity in patients with Alzheimer's disease (AD) using non-linear analysis methods. We calculated the Lempel-Ziv (LZ) complexity - applying two different sequence conversion methods - and the central tendency measure (CTM) of the EEG in 11 AD patients and 11 age-matched control subjects. CTM quantifies the degree of variability, while LZ complexity reflects the arising rate of new patterns along with the EEG time series. We did not find significant differences between AD patients and control subjects' EEGs with CTM. On the other hand, AD patients had significantly lower LZ complexity values (p<0.01) at electrodes P3 and O1 with a two-symbol sequence conversion, and P3, P4, O1 and T5 using three symbols. Our results show a decreased complexity of EEG patterns in AD patients. In addition, we obtained 90.9% sensitivity and 72.7% specificity at O1, and 72.7% sensitivity and 90.9% specificity at P3 and P4. These findings suggest that LZ complexity may contribute to increase the insight into brain dysfunction in AD in ways which are not possible with more classical and conventional statistical methods.

An effective correlation dimension and burst suppression ratio of the EEG in rat. Correlation with sevoflurane induced anaesthetic depth

BACKGROUND AND OBJECTIVE

Anaesthesiologists need parameters that measure the depth of anaesthesia. In the context of this need, the present study investigated in rats how two variables from the electroencephalogram, the burst suppression ratio and effective correlation dimension correlated with a measure of anaesthetic depth as measured in the strength of a noxious withdrawal reflex.

METHODS

Eight rats were exposed to different inspiratory concentrations of sevoflurane, each rat in two separate experiments. In the first experiment, spontaneously breathing animals could move freely and no painful stimuli were applied. In the second experiment, in mechanically ventilated restrained anaesthetized rats, the withdrawal reflex was measured every 80 s. In both experiments the electroencephalogram was continuously recorded. The concentration in the effector compartment was estimated using a first order two compartment model. Correlation dimension was computed following the Grassberger/Procaccia/Takens approach with optimized parameter settings to achieve maximum sensitivity to anaesthetic drug effects and enable real-time computation. The Hill, equation was fitted to the data, describing the effect as a function of sevoflurane concentration.

RESULTS

Good correlations of Depth of Anaesthesia with correlation dimension as well as burst suppression ratio were established in both types of experiments. Arousal by noxious stimuli decreased burst suppression ratio and increased correlation dimension. The effective sevoflurane concentration associated with 50% of the maximum effect (C50) was higher in experiment II (stimulation) than in experiment I (no stimulation): i.e. for correlation dimension 2.18% vs. 0.60% and for burst suppression ratio 3.07% vs. 1.73%. The slope factors were: gammaCD = 4.15 vs. gammaCD = 1.73 and gammaBSR = 5.2 vs. gammaBSR = 5.4. Correlation dimension and burst suppression ratio both correlated with the strength of the withdrawal reflex with correlation coefficients of 0.46 and 0.66 respectively (P < 0.001).

CONCLUSIONS

Both correlation dimension and burst suppression ratio are related to anaesthetic depth and are affected by noxious stimuli. The relationship between anaesthetic depth and burst suppression ratio is confirmed and the potential of correlation dimension is demonstrated.

Nonlinear characteristics of blood oxygen saturation from nocturnal oximetry for obstructive sleep apnoea detection

Nocturnal oximetry is an attractive option for the diagnosis of obstructive sleep apnoea (OSA) syndrome because of its simplicity and low cost compared to polysomnography (PSG). The present study assesses nonlinear analysis of blood oxygen saturation (SaO(2)) from nocturnal oximetry as a diagnostic test to discriminate between OSA positive and OSA negative patients. A sample of 187 referred outpatients, clinically suspected of having OSA, was studied using nocturnal oximetry performed simultaneously with complete PSG. A positive OSA diagnosis was found for 111 cases, while the remaining 76 cases were classified as OSA negative. The following oximetric indices were obtained: cumulative time spent below a saturation of 90% (CT90), oxygen desaturation indices of 4% (ODI4), 3% (ODI3) and 2% (ODI2) and the delta index (Delta index). SaO(2) records were subsequently processed applying two nonlinear methods: central tendency measure (CTM) and Lempel-Ziv (LZ) complexity. Significant differences (p < 0.01) were found between OSA positive and OSA negative patients. Using CTM we obtained a sensitivity of 90.1% and a specificity of 82.9%, while with LZ the sensitivity was 86.5% and the specificity was 77.6%. CTM and LZ accuracies were higher than those provided by ODI4, ODI3, ODI2 and CT90. The results suggest that nonlinear analysis of SaO(2) signals from nocturnal oximetry could yield useful information in OSA diagnosis.

Complexity analysis of the magnetoencephalogram background activity in Alzheimer's disease patients

The aim of the present study was to analyse the magnetoencephalogram (MEG) background activity in patients with Alzheimer's disease (AD) using the Lempel-Ziv (LZ) complexity. This non-linear method measures the complexity of finite sequences and is related to the number of distinct substrings and the rate of their occurrence along the sequence. The MEGs were recorded with a 148-channel whole-head magnetometer (MAGNES 2500 WH, 4D Neuroimaging) in 21 patients with AD and in 21 age-matched control subjects. Artefact-free epochs were selected for complexity analysis. Results showed that MEG signals from AD patients had lower complexity than control subjects' MEGs and the differences were statistically significant (p<0.01). In order to reduce the dimension of the LZ complexity results, a principal components analysis (PCA) was applied, and only the first principal component was retained. The first component score from PCA was graphically analysed using a box plot and a receiver-operating characteristic (ROC) curve. A specificity of 85.71%, a sensitivity of 80.95% and an area under the ROC curve of 0.9002 were obtained. These preliminary results suggest that cognitive dysfunction in AD is associated with a decreased LZ complexity in the MEG signals.

Variability, Regularity, and Complexity of Time Series Generated by Schizophrenic Patients and Control Subjects

We analyzed time series generated by 20 schizophrenic patients and 20 sex- and age-matched control subjects using three nonlinear methods of time series analysis as test statistics: central tendency measure (CTM) from the scatter plots of first differences of data, approximate entropy (ApEn), and Lempel-Ziv (LZ) complexity. We divided our data into a training set (10 patients and 10 control subjects) and a test set (10 patients and 10 control subjects). The training set was used for algorithm development and optimum threshold selection. Each method was assessed prospectively using the test dataset. We obtained 80% sensitivity and 90% specificity with LZ complexity, 90% sensitivity, and 60% specificity with ApEn, and 70% sensitivity and 70% specificity with CTM. Our results indicate that there exist differences in the ability to generate random time series between schizophrenic subjects and controls, as estimated by the CTM, ApEn, and LZ. This finding agrees with most previous results showing that schizophrenic patients are characterized by less complex neurobehavioral and neuropsychologic measurements.

Entropy analysis of the EEG background activity in Alzheimer's disease patients

Alzheimer's disease (AD) is the most common neurodegenerative disorder. Although a definite diagnosis is only possible by necropsy, a differential diagnosis with other types of dementia and with major depression should be attempted. The aim of this study was to analyse the electroencephalogram (EEG) background activity of AD patients to test the hypothesis that the regularity of the AD patients' EEG is higher than that of age-matched controls. We recorded the EEG from 19 scalp electrodes in 11 AD patients and 11 age-matched controls. Two different methods were used to estimate the regularity of the EEG background activity: spectral entropy (SpecEn) and sample entropy (SampEn). We did not find significant differences between AD patients and control subjects' EEGs with SpecEn. On the other hand, AD patients had significantly lower SampEn values than control subjects (p < 0.01) at electrodes P3, P4, O1 and O2. Our results show an increase of EEG regularity in AD patients. These findings suggest that nonlinear analysis of the EEG with SampEn could yield essential information and may contribute to increasing the insight into brain dysfunction in AD in ways which are not possible with more classical and conventional statistical methods.

Complex analysis of intracranial hypertension using approximate entropy*

OBJECTIVE

To determine whether decomplexification of intracranial pressure dynamics occurs during periods of severe intracranial hypertension (intracranial pressure >25 mm Hg for >5 mins in the absence of external noxious stimuli) in pediatric patients with intracranial hypertension.

DESIGN

Retrospective analysis of clinical case series over a 30-month period from April 2000 through January 2003.

SETTING

Multidisciplinary 16-bed pediatric intensive care unit.

PATIENTS

Eleven episodes of intracranial hypertension from seven patients requiring ventriculostomy catheter for intracranial pressure monitoring and/or cerebral spinal fluid drainage.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We measured changes in the intracranial pressure complexity, estimated by the approximate entropy (ApEn), as patients progressed from a state of normal intracranial pressure (<25 mm Hg) to intracranial hypertension. We found the ApEn mean to be lower during the intracranial hypertension period than during the stable and recovering periods in all the 11 episodes (0.5158 +/- 0.0089, 0.3887 +/- 0.077, and 0.5096 +/- 0.0158, respectively, p < .01). Both the mean reduction in ApEn from the state of normal intracranial pressure (stable region) to intracranial hypertension (-0.1271) and the increase in ApEn from the ICH region to the recovering region (0.1209) were determined to be statistically significant (p < .01).

CONCLUSIONS

Our results indicate that decreased complexity of intracranial pressure coincides with periods of intracranial hypertension in brain injury. This suggests that the complex regulatory mechanisms that govern intracranial pressure may be disrupted during acute periods of intracranial hypertension. This phenomenon of decomplexification of physiologic dynamics may have important clinical implications for intracranial pressure management.

Interpretation of approximate entropy: analysis of intracranial pressure approximate entropy during acute intracranial hypertension

We studied changes in intracranial pressure (ICP) complexity, estimated by the approximate entropy (ApEn) of the ICP signal, as subjects progressed from a state of normal ICP (< 20-25 mmHg) to acutely elevated ICP (an ICP "spike" defined as ICP > 25 mmHg for < or = 5 min). We hypothesized that the measures of intracranial pressure (ICP) complexity and irregularity would decrease during acute elevations in ICP. To test this hypothesis we studied ICP spikes in pediatric subjects with severe traumatic brain injury (TBI). We conclude that decreased complexity of ICP coincides with episodes of intracranial hypertension (ICH) in TBI. This suggests that the complex regulatory mechanisms that govern intracranial pressure are disrupted during acute rises in ICP. Furthermore, we carried out a series of experiments where ApEn was used to analyze synthetic signals of different characteristics with the objective of gaining a better understanding of ApEn itself, especially its interpretation in biomedical signal analysis.

Analysis of regularity in the EEG background activity of Alzheimer's disease patients with Approximate Entropy

OBJECTIVE

The aim of this study was to analyse the regularity of the EEG background activity of Alzheimer's disease (AD) patients to test the hypothesis that the irregularity of the AD patients' EEG is lower than that of age-matched controls.

METHODS

We recorded the EEG from 19 scalp electrodes in 10 AD patients and 8 age-matched controls and estimated the Approximate Entropy (ApEn). ApEn is a non-linear statistic that can be used to quantify the irregularity of a time series. Larger values correspond to more complexity or irregularity. A spectral analysis was also performed.

RESULTS

ApEn was significantly lower in the AD patients at electrodes P3 and P4 (P < 0.01), indicating a decrease of irregularity. We obtained 70% sensitivity and 100% specificity at P3, and 80% sensitivity and 75% specificity at P4. Results seemed to be complementary to spectral analysis.

CONCLUSIONS

The decreased irregularity found in the EEG of AD patients in the parietal region leads us to think that EEG analysis with ApEn could be a useful tool to increase our insight into brain dysfunction in AD. However, caution should be applied due to the small sample size.

SIGNIFICANCE

This article represents a first step in demonstrating the feasibility of ApEn for recognition of EEG changes in AD.

Genetic fuzzy modelling and control of bispectral index (BIS) for general intravenous anaesthesia

Based on an adaptive genetic fuzzy clustering algorithm, a derived fuzzy knowledge model is proposed for quantitatively estimating the systolic arterial pressure (SAP), heart rate (HR), and bispectral index (BIS) using 12 patients and it validates them according to pharmacological reasoning. Also, a genetic proportional integral derivative controller (GPIDC) to adaptive three controller parameters and a genetic fuzzy logic controller (GFLC) to adaptive controller rules using genetic algorithms (GAs) were simulated and compared each other in a patient model using the BIS value as a controlled variable. Each controller was tested using a set of 12 virtual patients undergoing a Gaussian random surgical disturbance repeated with BIS targets set at 40, 50, and 60. Controller performance was assessed using mean absolute error (MAE) of the BIS target, the percentage of time with acceptable BIS control (PTABC), and drug consumption (DC). It was found that the MAE value of the BIS target was significantly lower (P < 0.05) and the values of PTABC and DC of BIS target were significantly higher (P < 0.05) in BIS targets set at 40 than at 50 or 60 in both GPIDC and GFLC. However, when compared with two controllers in terms of the values of MAE, PTABC, and DC each other in BIS targets set at 40, 50, and 60, there were no significant differences (P > 0.05). Furthermore, when the simulation results in these two controllers were compared with routine standard practice of 12 clinical trials (i.e., manual control) in BIS target set at 50, the values of PTABC in both GPIDC and GFLC groups were significantly higher (P < 0.05) than in the manual control group. In contrast, there were no significant differences (P > 0.05) for these three groups in terms of drug consumption. This indicates that either GPIDC or GFLC can control the BIS target set at 50 better than manual control, although the similar drug consumption is used.