Nocturnal awakening and sleep efficiency estimation using unobtrusively measured ballistocardiogram

Effects of Ballistocardiogram Peak Detection Jitters on the Quality of Heart Rate Variability Features: A Simulation-Based Case Study in the Context of Sleep Staging

Heart rate variability (HRV) features support several clinical applications, including sleep staging, and ballistocardiograms (BCGs) can be used to unobtrusively estimate these features. Electrocardiography is the traditional clinical standard for HRV estimation, but BCGs and electrocardiograms (ECGs) yield different estimates for heartbeat intervals (HBIs), leading to differences in calculated HRV parameters. This study examines the viability of using BCG-based HRV features for sleep staging by quantifying the impact of these timing differences on the resulting parameters of interest. We introduced a range of synthetic time offsets to simulate the differences between BCG- and ECG-based heartbeat intervals, and the resulting HRV features are used to perform sleep staging. Subsequently, we draw a relationship between the mean absolute error in HBIs and the resulting sleep-staging performances. We also extend our previous work in heartbeat interval identification algorithms to demonstrate that our simulated timing jitters are close representatives of errors between heartbeat interval measurements. This work indicates that BCG-based sleep staging can produce accuracies comparable to ECG-based techniques such that at an HBI error range of up to 60 ms, the sleep-scoring error could increase from 17% to 25% based on one of the scenarios we examined.

Bed-Based Ballistocardiography: Dataset and Ability to Track Cardiovascular Parameters

BACKGROUND

The goal of this work was to create a sharable dataset of heart-driven signals, including ballistocardiograms (BCGs) and time-aligned electrocardiograms (ECGs), photoplethysmograms (PPGs), and blood pressure waveforms.

METHODS

A custom, bed-based ballistocardiographic system is described in detail. Affiliated cardiopulmonary signals are acquired using a GE Datex CardioCap 5 patient monitor (which collects ECG and PPG data) and a Finapres Medical Systems Finometer PRO (which provides continuous reconstructed brachial artery pressure waveforms and derived cardiovascular parameters).

RESULTS

Data were collected from 40 participants, 4 of whom had been or were currently diagnosed with a heart condition at the time they enrolled in the study. An investigation revealed that features extracted from a BCG could be used to track changes in systolic blood pressure (Pearson correlation coefficient of 0.54 +/- 0.15), dP/dtmax (Pearson correlation coefficient of 0.51 +/- 0.18), and stroke volume (Pearson correlation coefficient of 0.54 +/- 0.17).

CONCLUSION

A collection of synchronized, heart-driven signals, including BCGs, ECGs, PPGs, and blood pressure waveforms, was acquired and made publicly available. An initial study indicated that bed-based ballistocardiography can be used to track beat-to-beat changes in systolic blood pressure and stroke volume.

SIGNIFICANCE

To the best of the authors' knowledge, no other database that includes time-aligned ECG, PPG, BCG, and continuous blood pressure data is available to the public. This dataset could be used by other researchers for algorithm testing and development in this fast-growing field of health assessment, without requiring these individuals to invest considerable time and resources into hardware development and data collection.

Contact-free sensor signals as a new digital biomarker for cardiovascular disease: chances and challenges

Multiple sensor systems are used to monitor physiological parameters, activities of daily living and behaviour. Digital biomarkers can be extracted and used as indicators for health and disease. Signal acquisition is either by object sensors, wearable sensors, or contact-free sensors including cameras, pressure sensors, non-contact capacitively coupled electrocardiogram (cECG), radar, and passive infrared motion sensors. This review summarizes contemporary knowledge of the use of contact-free sensors for patients with cardiovascular disease and healthy subjects following the PRISMA declaration. Chances and challenges are discussed. Thirty-six publications were rated to be of medium (31) or high (5) relevance. Results are best for monitoring of heart rate and heart rate variability using cardiac vibration, facial camera, or cECG; for respiration using cardiac vibration, cECG, or camera; and for sleep using ballistocardiography. Early results from radar sensors to monitor vital signs are promising. Contact-free sensors are little invasive, well accepted and suitable for long-term monitoring in particular in patient's homes. A major problem are motion artefacts. Results from long-term use in larger patient cohorts are still lacking, but the technology is about to emerge the market and we can expect to see more clinical results in the near future.

Portable Sleep Apnea Syndrome Screening and Event Detection Using Long Short-Term Memory Recurrent Neural Network

Obstructive sleep apnea/hypopnea syndrome (OSAHS) is characterized by repeated airflow partial reduction or complete cessation due to upper airway collapse during sleep. OSAHS can induce frequent awake and intermittent hypoxia that is associated with hypertension and cardiovascular events. Full-channel Polysomnography (PSG) is the gold standard for diagnosing OSAHS; however, this PSG evaluation process is unsuitable for home screening. To solve this problem, a measuring module integrating abdominal and thoracic triaxial accelerometers, a pulsed oximeter (SpO2) and an electrocardiogram sensor was devised in this study. Moreover, a long short-term memory recurrent neural network model is proposed to classify four types of sleep breathing patterns, namely obstructive sleep apnea (OSA), central sleep apnea (CSA), hypopnea (HYP) events and normal breathing (NOR). The proposed algorithm not only reports the apnea-hypopnea index (AHI) through the acquired overnight signals but also identifies the occurrences of OSA, CSA, HYP and NOR, which assists in OSAHS diagnosis. In the clinical experiment with 115 participants, the performances of the proposed system and algorithm were compared with those of traditional expert interpretation based on PSG signals. The accuracy of AHI severity group classification was 89.3%, and the AHI difference for PSG expert interpretation was 5.0±4.5. The overall accuracy of detecting abnormal OSA, CSA and HYP events was 92.3%.

Automatic Sleep Disorders Classification Using Ensemble of Bagged Tree Based on Sleep Quality Features

Sleep disorder is a medical disease of the sleep patterns, which commonly suffered by the elderly. Sleep disorders diagnosis and treatment are considered to be challenging due to a time-consuming and inconvenient process for the patient. Moreover, the use of Polysomnography (PSG) in sleep disorder diagnosis is a high-cost process. Therefore, we propose an efficient classification method of sleep disorder by merely using electrocardiography (ECG) signals to simplify the sleep disorders diagnosis process. Different from many current related studies that applied a five-minute epoch to observe the main frequency band of the ECG signal, we perform a pre-processing technique that suitable for the 30-seconds epoch of the ECG signal. By this simplification, the proposed method has a low computational cost so that suitable to be implemented in an embedded hardware device. Structurally, the proposed method consists of five stages: (1) pre-processing, (2) spectral features extraction, (3) sleep stage detection using the Decision-Tree-Based Support Vector Machine (DTB-SVM), (4) assess the sleep quality features, and (5) sleep disorders classification using ensemble of bagged tree classifiers. We evaluate the effectiveness of the proposed method in the task of classifying the sleep disorders into four classes (insomnia, Sleep-Disordered Breathing (SDB), REM Behavior Disorder (RBD), and healthy subjects) from the 51 patients of the Cyclic Alternating Pattern (CAP) sleep data. Based on experimental results, the proposed method presents 84.01% of sensitivity, 94.17% of specificity, 86.27% of overall accuracy, and 0.70 of Cohen’s kappa. This result indicates that the proposed method able to reliably classify the sleep disorders merely using the 30-seconds epoch ECG in order to address the issue of a multichannel signal such as the PSG.

Performance Evaluation of Processing Methods for Ballistocardiogram Peak Detection

Several methods are proposed in the literature to detect ballistocardiogram (BCG) peaks. There is a need to narrow these methods down in terms of their performance under similar conditions. This study reports early results from a systematic performance evaluation. To date, we have replicated three methods from the literature and compared their performance using data from five volunteers. A basic cross-correlation approach was also included as a baseline level of performance. The best-performing method had an average peak-detection success rate of 95.0{%, associated with 0.1090 average false alarms per second and 0.0078 s mean standard deviation between real and detected peaks.

Phyjama

Unobtrusive and continuous monitoring of cardiac and respiratory rhythm, especially during sleeping, can have significant clinical utility. An exciting new possibility for such monitoring is the design of textiles that use all-textile sensors that can be woven or stitched directly into a textile or garment. Our work explores how we can make such monitoring possible by leveraging something that is already familiar, such as pyjama made of cotton/silk fabric, and imperceptibly adapt it to enable sensing of physiological signals to yield natural fitting, comfortable, and less obtrusive smart clothing.

We face several challenges in enabling this vision including requiring new sensor design to measure physiological signals via everyday textiles and new methods to deal with the inherent looseness of normal garments, particularly sleepwear like pyjamas. We design two types of textile-based sensors that obtain a ballistic signal due to cardiac and respiratory rhythm ---the first a novel resistive sensor that leverages pressure between the body and various surfaces and the second is a triboelectric sensor that leverages changes in separation between layers to measure ballistics induced by the heart. We then integrate several instances of such sensors on a pyjama and design a signal processing pipeline that fuses information from the different sensors such that we can robustly measure physiological signals across a range of sleep and stationary postures. We show that the sensor and signal processing pipeline has high accuracy by benchmarking performance both under restricted settings with twenty one users as well as more naturalistic settings with seven users.

The Potential of Wearable Limb Ballistocardiogram in Blood Pressure Monitoring via Pulse Transit Time

The goal of this study was to investigate the potential of wearable limb ballistocardiography (BCG) to enable cuff-less blood pressure (BP) monitoring, by investigating the association between wearable limb BCG-based pulse transit time (PTT) and BP. A wearable BCG-based PTT was calculated using the BCG and photoplethysmogram (PPG) signals acquired by a wristband as proximal and distal timing reference (called the wrist PTT). Its efficacy as surrogate of BP was examined in comparison with PTT calculated using the whole-body BCG acquired by a customized weighing scale (scale PTT) as well as pulse arrival time (PAT) using the experimental data collected from 22 young healthy participants under multiple BP-perturbing interventions. The wrist PTT exhibited close association with both diastolic (group average r = 0.79; mean absolute error (MAE) = 5.1 mmHg) and systolic (group average r = 0.81; MAE = 7.6 mmHg) BP. The efficacy of the wrist PTT was superior to scale PTT and PAT for both diastolic and systolic BP. The association was consistent and robust against diverse BP-perturbing interventions. The wrist PTT showed superior association with BP when calculated with green PPG rather than infrared PPG. In sum, wearable limb BCG has the potential to realize convenient cuff-less BP monitoring via PTT.

Unobtrusive Estimation of Cardiovascular Parameters with Limb Ballistocardiography

This study investigates the potential of the limb ballistocardiogram (BCG) for unobtrusive estimation of cardiovascular (CV) parameters. In conjunction with the reference CV parameters (including diastolic, pulse, and systolic pressures, stroke volume, cardiac output, and total peripheral resistance), an upper-limb BCG based on an accelerometer embedded in a wearable armband and a lower-limb BCG based on a strain gauge embedded in a weighing scale were instrumented simultaneously with a finger photoplethysmogram (PPG). To standardize the analysis, the more convenient yet unconventional armband BCG was transformed into the more conventional weighing scale BCG (called the synthetic weighing scale BCG) using a signal processing procedure. The characteristic features were extracted from these BCG and PPG waveforms in the form of wave-to-wave time intervals, wave amplitudes, and wave-to-wave amplitudes. Then, the relationship between the characteristic features associated with (i) the weighing scale BCG-PPG pair and (ii) the synthetic weighing scale BCG-PPG pair versus the CV parameters, was analyzed using the multivariate linear regression analysis. The results indicated that each of the CV parameters of interest may be accurately estimated by a combination of as few as two characteristic features in the upper-limb or lower-limb BCG, and also that the characteristic features recruited for the CV parameters were to a large extent relevant according to the physiological mechanism underlying the BCG.

Physiological Association between Limb Ballistocardiogram and Arterial Blood Pressure Waveforms: A Mathematical Model-Based Analysis

By virtue of its direct association with the cardiovascular (CV) functions and compatibility to unobtrusive measurement during daily activities, the limb ballistocardiogram (BCG) is receiving an increasing interest as a viable means for ultra-convenient CV health and disease monitoring. However, limited insights on its physical implications have hampered disciplined interpretation of the BCG and systematic development of the BCG-based approaches for CV health monitoring. In this study, a mathematical model that can predict the limb BCG in responses to the arterial blood pressure (BP) waves in the aorta was developed and experimentally validated. The validated mathematical model suggests that (i) the limb BCG waveform reveals the timings and amplitudes associated with the aortic BP waves; (ii) mechanical filtering exerted by the musculoskeletal properties of the body can obscure the manifestation of the arterial BP waves in the limb BCG; and (iii) the limb BCG exhibits meaningful morphological changes in response to the alterations in the CV risk predictors. The physical insights garnered by the analysis of the mathematical model may open up new opportunities toward next generation of the BCG-based CV healthcare techniques embedded with transparency, interpretability, and robustness against the external variability.

Bed-Embedded Heart and Respiration Rates Detection by Longitudinal Ballistocardiography and Pattern Recognition

In this work, a low-cost, off-the-shelf load cell is installed on a typical hospital bed and implemented to measure the longitudinal ballistocardiogram (BCG) in order to evaluate its utility for successful contactless monitoring of heart and respiration rates. The major focus is placed on the beat-to-beat heart rate monitoring task, for which an unsupervised machine learning algorithm is employed, while its performance is compared to an electrocardiogram (ECG) signal that serves as a reference. The algorithm is a modified version of a previously published one, which had successfully detected 49.2% of recorded heartbeats. However, the presented system was tested with seven volunteers and four different lying positions, and obtained an improved overall detection rate of 83.9%.

Mitigation of Instrument-Dependent Variability in Ballistocardiogram Morphology: Case Study on Force Plate and Customized Weighing Scale

The objective of this study was to investigate the measurement instrument-dependent variability in the morphology of the ballistocardiogram (BCG) waveform in human subjects and computational methods to mitigate the variability. The BCG was measured in 22 young healthy subjects using a high-performance force plate and a customized commercial weighing scale under upright standing posture. The timing and amplitude features associated with the major I, J, K waves in the BCG waveforms were extracted and quantitatively analyzed. The results indicated that 1) the I, J, K waves associated with the weighing scale BCG exhibited delay in the timings within the cardiac cycle relative to the ECG R wave as well as attenuation in the absolute amplitudes than the respective force plate counterparts, whereas 2) the time intervals between the I, J, K waves were comparable. Then, two alternative computational methods were conceived in an attempt to mitigate the discrepancy between force plate versus weighing-scale BCG: a transfer function and an amplitude-phase correction. The results suggested that both methods effectively mitigated the discrepancy in the timings and amplitudes associated with the I, J, K waves between the force plate and weighing-scale BCG. Hence, signal processing may serve as a viable solution to the mitigation of the instrument-induced morphological variability in the BCG, thereby facilitating the standardized analysis and interpretation of the timing and amplitude features in the BCG across wide-ranging measurement platforms.

Smart technologies toward sleep monitoring at home

With progress in sensors and communication technologies, the range of sleep monitoring is extending from professional clinics into our usual home environments. Information from conventional overnight polysomnographic recordings can be derived from much simpler devices and methods. The gold standard of sleep monitoring is laboratory polysomnography, which classifies brain states based mainly on EEGs. Single-channel EEGs have been used for sleep stage scoring with accuracies of 84.9%. Actigraphy can estimate sleep efficiency with an accuracy of 86.0%. Sleep scoring based on respiratory dynamics provides accuracies of 89.2% and 70.9% for identifying sleep stages and sleep efficiency, respectively, and a correlation coefficient of 0.94 for apnea-hypopnea detection. Modulation of autonomic balance during the sleep stages are well recognized and widely used for simpler sleep scoring and sleep parameter estimation. This modulation can be recorded by several types of cardiovascular measurements, including ECG, PPG, BCG, and PAT, and the results showed accuracies up to 96.5% and 92.5% for sleep efficiency and OSA severity detection, respectively. Instead of using recordings for the entire night, less than 5 min ECG recordings have used for sleep efficiency and AHI estimation and resulted in high correlations of 0.94 and 0.99, respectively. These methods are based on their own models that relate sleep dynamics with a limited number of biological signals. Parameters representing sleep quality and disturbed breathing are estimated with high accuracies that are close to the results obtained by polysomnography. These unconstrained technologies, making sleep monitoring easier and simpler, will enhance qualities of life by expanding the range of ubiquitous healthcare.

Unobtrusive Detection of Simulated Orthostatic Hypotension and Supine Hypertension Using Ballistocardiogram and Electrocardiogram of Healthy Adults

Effective management of neurogenic orthostatic hypotension and supine hypertension (SH-OH) due autonomic failure requires a frequent and timely adjustment of medication throughout the day to maintain the blood pressure (BP) within the normal range, i.e., an accurate depiction of BP is a key prerequisite of effective management. One of the emerging technologies that provide one’s circadian and long-term physiological status with increased usability is unobtrusive zero-effort monitoring. In this paper, a zero-effort device, a floor tile, was used to develop an unobtrusive BP monitoring technique. Namely, RJ-interval, the time between the J-peak of a ballistocardiogram and the R-peak of an electrocardiogram, was used to develop a classifier that can detect changes in systolic BP (SBP) induced by the Valsalva maneuver on healthy adults (i.e., a simulated SH-OH). A t-test was used to show statistical differences between the mean RJ-intervals of decreased SBP, baseline, and increased SBP. Following the t-test, a classifier that detected a change in SBP was developed based on a naïve Bayes classifier (NBC). The t-test showed a clear statistical difference between the mean RJ-intervals of the increased SBP, baseline, and decreased SBP. The NBC-based classifier was able to detect increased SBP with 89.3% true positive rate (TPR), 100% true negative rate (TNR), and 94% accuracy and detect decreased SBP with 92.3% TPR, 100% TNR, and 95% accuracy. The analysis showed strong potential in using the developed classifier to assist monitoring of people with SH-OH; the algorithm may be used clinically to detect a long-term trend of symptoms of SH-OH.

High-Resolution Seismocardiogram Acquisition and Analysis System

Several devices and measurement approaches have recently been developed to perform ballistocardiogram (BCG) and seismocardiogram (SCG) measurements. The development of a wireless acquisition system (hardware and software), incorporating a novel high-resolution micro-electro-mechanical system (MEMS) accelerometer for SCG and BCG signals acquisition and data treatment is presented in this paper. A small accelerometer, with a sensitivity of up to 0.164 µs/µg and a noise density below 6.5 µg/Hz is presented and used in a wireless acquisition system for BCG and SCG measurement applications. The wireless acquisition system also incorporates electrocardiogram (ECG) signals acquisition, and the developed software enables the real-time acquisition and visualization of SCG and ECG signals (sensor positioned on chest). It then calculates metrics related to cardiac performance as well as the correlation of data from previously performed sessions with echocardiogram (ECHO) parameters. A preliminarily clinical study of over 22 subjects (including healthy subjects and cardiovascular patients) was performed to test the capability of the developed system. Data correlation between this measurement system and echocardiogram exams is also performed. The high resolution of the MEMS accelerometer used provides a better signal for SCG wave recognition, enabling a more consistent study of the diagnostic capability of this technique in clinical analysis.

Multiple Instance Dictionary Learning for Beat-to-Beat Heart Rate Monitoring From Ballistocardiograms

A multiple instance dictionary learning approach, dictionary learning using functions of multiple instances (DL-FUMI), is used to perform beat-to-beat heart rate estimation and to characterize heartbeat signatures from ballistocardiogram (BCG) signals collected with a hydraulic bed sensor. DL-FUMI estimates a "heartbeat concept" that represents an individual's personal ballistocardiogram heartbeat pattern. DL-FUMI formulates heartbeat detection and heartbeat characterization as a multiple instance learning problem to address the uncertainty inherent in aligning BCG signals with ground truth during training. Experimental results show that the estimated heartbeat concept obtained by DL-FUMI is an effective heartbeat prototype and achieves superior performance over comparison algorithms.

Noncontact Pressure-Based Sleep/Wake Discrimination

Poor sleep is increasingly being recognized as an important prognostic parameter of health. For those with suspected sleep disorders, patients are referred to sleep clinics, which guide treatment. However, sleep clinics are not always a viable option due to their high cost, a lack of experienced practitioners, lengthy waiting lists, and an unrepresentative sleeping environment. A home-based noncontact sleep/wake monitoring system may be used as a guide for treatment potentially stratifying patients by clinical need or highlighting longitudinal changes in sleep and nocturnal patterns. This paper presents the evaluation of an undermattress sleep monitoring system for noncontact sleep/wake discrimination. A large dataset of sensor data with concomitant sleep/wake state was collected from both younger and older adults participating in a circadian sleep study. A thorough training/testing/validation procedure was configured and optimized feature extraction and sleep/wake discrimination algorithms evaluated both within and across the two cohorts. An accuracy, sensitivity, and specificity of 74.3%, 95.5%, and 53.2% is reported over all subjects using an external validation dataset (71.9%, 87.9%, and 56% and 77.5%, 98%, and 57% is reported for younger and older subjects, respectively). These results compare favorably with similar research, however this system provides an ambient alternative suitable for long-term continuous sleep monitoring, particularly among vulnerable populations.

Slow-Wave Sleep Estimation for Healthy Subjects and OSA Patients Using R-R Intervals

We developed an automatic slow-wave sleep (SWS) detection algorithm that can be applied to groups of healthy subjects and patients with obstructive sleep apnea (OSA). This algorithm detected SWS based on autonomic activations derived from the heart rate variations of a single sensor. An autonomic stability, which is an SWS characteristic, was evaluated and quantified using R-R intervals from an electrocardiogram (ECG). The thresholds and the heuristic rule to determine SWS were designed based on the physiological backgrounds for sleep process and distribution across the night. The automatic algorithm was evaluated based on a fivefold cross validation using data from 21 healthy subjects and 24 patients with OSA. An epoch-by-epoch (30 s) analysis showed that the overall Cohen's kappa, accuracy, sensitivity, and specificity of our method were 0.56, 89.97%, 68.71%, and 93.75%, respectively. SWS-related information, including SWS duration (min) and percentage (%), were also calculated. A significant correlation in these parameters was found between automatic and polysomnography scorings. Compared with similar methods, the proposed algorithm convincingly discriminated SWS from non-SWS. The simple method using only R-R intervals has the potential to be utilized in mobile and wearable devices that can easily measure this information. Moreover, when combined with other sleep staging methods, the proposed method is expected to be applicable to long-term sleep monitoring at home and ambulatory environments.

Multimodal chest surface motion data for respiratory and cardiovascular monitoring applications

Chest surface motion is of significant importance as it contains information of respiratory and cardiac systems together with the complex coupling between these two systems. Chest surface motion is not only critical in radiotherapy, but also useful in personalized systems for continuous cardiorespiratory monitoring. In this dataset, a multimodal setup is employed to simultaneously acquire cardiorespiratory signals. These signals include high-density trunk surface motion (from 16 distinct locations) with VICON motion capture system, nasal breathing from a thermal sensor, respiratory effort from a strain belt and electrocardiogram in lead-II configuration. This dataset contains 72 trials recorded from 11 participants with a cumulative duration of approximately 215 min under various conditions such as normal breathing, breath-hold, irregular breathing and post-exercise recovery. The presented dataset is not only useful for evaluating prediction algorithms for radiotherapy applications, but can also be employed for the development of techniques to evaluate the cardio-mechanics and hemodynamic parameters of chest surface motion.

REM sleep estimation based on autonomic dynamics using R-R intervals

OBJECTIVE

We developed an automatic algorithm to determine rapid eye movement (REM) sleep on the basis of the autonomic activities reflected in heart rate variations.

APPROACH

The heart rate variability (HRV) parameters were calculated using the R-R intervals from an electrocardiogram (ECG). A major autonomic variation associated with the sleep cycle was extracted from a combination of the obtained parameters. REM sleep was determined with an adaptive threshold applied to the acquired feature. The algorithm was optimized with the data from 26 healthy subjects and obstructive sleep apnea (OSA) patients and was validated with data from a separate group of 25 healthy and OSA subjects.

MAIN RESULTS

According to an epoch-by-epoch (30 s) analysis, the average of Cohen's kappa and the accuracy were respectively 0.63 and 87% for the training set and 0.61 and 87% for the validation set. In addition, the REM sleep-related information extracted from the results of the proposed method revealed a significant correlation with those from polysomnography (PSG).

SIGNIFICANCE

The current algorithm only using R-R intervals can be applied to mobile and wearable devices that acquire heart-rate-related signals; therefore, it is appropriate for sleep monitoring in the home and ambulatory environments. Further, long-term sleep monitoring could provide useful information to clinicians and patients for the diagnosis and treatments of sleep-related disorders and individual health care.

New predictors of sleep efficiency

Sleep efficiency is a commonly and widely used measure to objectively evaluate sleep quality. Monitoring sleep efficiency can provide significant information about health conditions. As an attempt to facilitate less cumbersome monitoring of sleep efficiency, our study aimed to suggest new predictors of sleep efficiency that enable reliable and unconstrained estimation of sleep efficiency during awake resting period. We hypothesized that the autonomic nervous system activity observed before falling asleep might be associated with sleep efficiency. To assess autonomic activity, heart rate variability and breathing parameters were analyzed for 5 min. Using the extracted parameters as explanatory variables, stepwise multiple linear regression analyses and k-fold cross-validation tests were performed with 240 electrocardiographic and thoracic volume change signal recordings to develop the sleep efficiency prediction model. The developed model's sleep efficiency predictability was evaluated using 60 piezoelectric sensor signal recordings. The regression model, established using the ratio of the power of the low- and high-frequency bands of the heart rate variability signal and the average peak inspiratory flow value, provided an absolute error (mean ± SD) of 2.18% ± 1.61% and a Pearson's correlation coefficient of 0.94 (p < 0.01) between the sleep efficiency predictive values and the reference values. Our study is the first to achieve reliable and unconstrained prediction of sleep efficiency without overnight recording. This method has the potential to be utilized for home-based, long-term monitoring of sleep efficiency and to support reasonable decision-making regarding the execution of sleep efficiency improvement strategies.

Contactless on-bed activity sensing using first-reflection echolocation

A novel system capable of detecting on-bed activity during sleep using first-reflection ultrasonic echolocation is described herein. As is employed in many existing solutions, such activity detection may be utilized in the assessment of sleep quality. Compared to current approaches using either wearable devices or sensors collocated on the surface of the bed, the proposed architecture greatly enhances convenience for the end-user by providing minimal disruptions to his or her standard sleep routine. A series of experiments were conducted in order to investigate the capacity of the system to detect activity during sleep. System performance was benchmarked against both a wrist-worn accelerometer as well as a smartphone application placed adjacent to the subject on the bed. Analysis demonstrates a statistically significant correlation between features computed from the system's output and the filtered activity data produced by the application, with maximum p values on the order of 10-3. Comparison with activity estimates formulated from the wrist-worn accelerometer output suggests stronger agreement, as indicated by increased correlation coefficient values.

Temporal correlation between two channels EEG of bipolar lead in the head midline is associated with sleep-wake stages

Whether the temporal correlation between inter-leads Electroencephalogram (EEG) that located on the boundary between left and right brain hemispheres is associated with sleep stages or not is still unknown. The purpose of this paper is to evaluate the role of correlation coefficients between EEG leads Fpz-Cz and Pz-Oz for automatic classification of sleep stages. A total number of 39 EEG recordings (about 20 h each) were selected from the expanded sleep database in European data format for temporal correlation analysis. Original waveform of EEG was decomposed into sub-bands δ (1-4 Hz), θ (4-8 Hz), α (8-13 Hz) and β (13-30 Hz). The correlation coefficient between original EEG leads Fpz-Cz and Pz-Oz within frequency band 0.5-30 Hz was defined as r(EEG) and was calculated every 30 s, while that between the two leads EEG in sub-bands δ, θ, α and β were defined as r(δ), r(θ), r(α) and r(β), respectively. Classification of wakefulness and sleep was processed by fixed threshold that derived from the probability density function of correlation coefficients. There was no correlation between EEG leads Fpz-Cz and Pz-Oz during wakefulness (|r| < 0.1 for r(θ), r(α) and r(β), while 0.3 > r > 0.1 for r(EEG) and r(δ)), while low correlation existed during sleep (r ≈ -0.4 for r(EEG), r(δ), r(θ), r(α) and r(β)). There were significant differences (analysis of variance, P < 0.001) for r(EEG), r(δ), r(θ), r(α) and r(β) during sleep when in comparison with that during wakefulness, respectively. The accuracy for distinguishing states between wakefulness and sleep was 94.2, 93.4, 89.4, 85.2 and 91.4% in terms of r(EEG), r(δ), r(θ), r(α) and r(β), respectively. However, no correlation index between EEG leads Fpz-Cz and Pz-Oz could distinguish all five types of wakefulness, rapid eye movement (REM) sleep, N1 sleep, N2 sleep and N3 sleep. In conclusion, the temporal correlation between EEG bipolar leads Fpz-Cz and Pz-Oz are highly associated with sleep-wake stages. Moreover, high accuracy of sleep-wake classification could be achieved by the temporal correlation within frequency band 0.5-30 Hz between EEG leads Fpz-Cz and Pz-Oz.

Ballistocardiogram of baby during sleep

Ballistocardiogram (BCG), which displays the mechanical activity of heart, has been a subject of interest for several years due to its advantages in taking unobtrusive physiological measurements. In the field of sleep science, researchers actively study sleep architecture and clinically apply various sleep-related conditions through BCG-derived biological information such as the heartbeat, respiration and body movements of subjects. However, most of these studies have involved only adults. This area of research may be even more important with babies to monitor their biological signals without confinement. For this reason, we developed a physiological signal monitoring bed for baby by using a load cell. Heartbeat and respiration information was assessed with average respective performance errors of 1.53% and 2.53% compared to commercial equipment. The results showed the possibility of applying BCG technology to baby. Therefore, we expect that BCG-derived signals can be extensively applied to analyze sleep architecture and clinical applications in baby as they are with adults.

Heart Rate Variability Monitoring during Sleep Based on Capacitively Coupled Textile Electrodes on a Bed

In this study, we developed and tested a capacitively coupled electrocardiogram (ECG) measurement system using conductive textiles on a bed, for long-term healthcare monitoring. The system, which was designed to measure ECG in a bed with no constraints of sleep position and posture, included a foam layer to increase the contact region with the curvature of the body and a cover to ensure durability and easy installation. Nine healthy subjects participated in the experiment during polysomnography (PSG), and the heart rate (HR) coverage and heart rate variability (HRV) parameters were analyzed to evaluate the system. The experimental results showed that the mean of R-peak coverage was 98.0% (95.5%–99.7%), and the normalized errors of HRV time and spectral measures between the Ag/AgCl system and our system ranged from 0.15% to 4.20%. The root mean square errors for inter-beat (RR) intervals and HR were 1.36 ms and 0.09 bpm, respectively. We also showed the potential of our developed system for rapid eye movement (REM) sleep and wake detection as well as for recording of abnormal states.

Ballistocardiography for nonintrusive sleep structure estimation

Based on the its nonintrusive characteristics, ballistocardiography(BCG) has applied in the estimation of sleep structure without attaching any sensors to the subject's body. Loadcell or polyvinylidenefluoride (PVDF) film sensors are installed on the mattress for the monitoring of BCG. BCG peak was detected and heart rate variability parameters are derived. Parameters representing sleep structure and quality are estimated using these parameters. Sleep efficiency, four stages of sleep structure and sleep onset latency are estimated and results are compared with the results derived from polysomnographic recording.