A State Space and Density Estimation Framework for Sleep Staging in Obstructive Sleep Apnea

A temporal multi-scale hybrid attention network for sleep stage classification

Sleep is crucial for human health. Automatic sleep stage classification based on polysomnogram (PSG) is meaningful for the diagnosis of sleep disorders, which has attracted extensive attention in recent years. Most existing methods could not fully consider the different transitions of sleep stages and fit the visual inspection of sleep experts simultaneously. To this end, we propose a temporal multi-scale hybrid attention network, namely TMHAN, to automatically achieve sleep staging. The temporal multi-scale mechanism incorporates short-term abrupt and long-term periodic transitions of the successive PSG epochs. Furthermore, the hybrid attention mechanism includes 1-D local attention, 2-D global attention, and 2-D contextual sparse multi-head self-attention for three kinds of sequence-level representations. The concatenated representation is subsequently fed into a softmax layer to train an end-to-end model. Experimental results on two benchmark sleep datasets show that TMHAN obtains the best performance compared with several baselines, demonstrating the effectiveness of our model. In general, our work not only provides good classification performance, but also fits the actual sleep staging processes, which makes contribution for the combination of deep learning and sleep medicine.

Current status and prospects of automatic sleep stages scoring: Review

The scoring of sleep stages is one of the essential tasks in sleep analysis. Since a manual procedure requires considerable human and financial resources, and incorporates some subjectivity, an automated approach could result in several advantages. There have been many developments in this area, and in order to provide a comprehensive overview, it is essential to review relevant recent works and summarise the characteristics of the approaches, which is the main aim of this article. To achieve it, we examined articles published between 2018 and 2022 that dealt with the automated scoring of sleep stages. In the final selection for in-depth analysis, 125 articles were included after reviewing a total of 515 publications. The results revealed that automatic scoring demonstrates good quality (with Cohen's kappa up to over 0.80 and accuracy up to over 90%) in analysing EEG/EEG + EOG + EMG signals. At the same time, it should be noted that there has been no breakthrough in the quality of results using these signals in recent years. Systems involving other signals that could potentially be acquired more conveniently for the user (e.g. respiratory, cardiac or movement signals) remain more challenging in the implementation with a high level of reliability but have considerable innovation capability. In general, automatic sleep stage scoring has excellent potential to assist medical professionals while providing an objective assessment.

Sleep Signal Analysis for Early Detection of Alzheimer's Disease and Related Dementia (ADRD)

OBJECTIVE

Alzheimer's Disease and Related Dementia (ADRD) is growing at alarming rates, putting research and development of diagnostic methods at the forefront of the biomedical research community. Sleep disorder has been proposed as an early sign of Mild Cognitive Impairment (MCI) in Alzheimer's disease. Although several clinical studies have been conducted to assess sleep and association with early MCI, reliable and efficient algorithms to detect MCI in home-based sleep studies are needed in order to address both healthcare costs and patient discomfort in hospital/lab-based sleep studies.

METHODS

In this paper, an innovative MCI detection method is proposed using an overnight recording of movements associated with sleep combined with advanced signal processing and artificial intelligence. A new diagnostic parameter is introduced which is extracted from the correlation between high frequency, sleep-related movements and respiratory changes during sleep. The newly defined parameter, Time-Lag (TL), is proposed as a distinguishing criterion that indicates movement stimulation of brainstem respiratory regulation that may modulate hypoxemia risk during sleep and serve as an effective parameter for early detection of MCI in ADRD. By implementing Neural Networks (NN) and Kernel algorithms with choosing TL as the principle component in MCI detection, high sensitivity (86.75% for NN and 65% for Kernel method), specificity (89.25% and 100%), and accuracy (88% and 82.5%) have been achieved.

Sleep stage classification in EEG signals using the clustering approach based probability distribution features coupled with classification algorithms

Sleep scoring is one of the primary tasks for the classification of sleep stages in Electroencephalogram (EEG) signals. Manual visual scoring of sleep stages is time-consuming as well as being dependent on the experience of a highly qualified sleep expert. This paper aims to address these issues by developing a new method to automatically classify sleep stages in EEG signals. In this research, a robust method has been presented based on the clustering approach, coupled with probability distribution features, to identify six sleep stages with the use of EEG signals. Using this method, each 30-second EEG signal is firstly segmented into small epochs and then each epoch is divided into 60 sub-segments. Each sub-segment is decomposed into five levels by using a discrete wavelet transform (DWT) to obtain the approximation and detailed coefficient. The wavelet coefficient of each level is clustered using the k-means algorithm. Subsequently, features are extracted based on the probability distribution for each wavelet coefficient. The extracted features then are forwarded to the least squares support vector machine classifier (LS-SVM) to identify sleep stages. Comparisons with several existing methods are also made in this study. The proposed method for the classification of the sleep stages achieves an average accuracy rate of 97.4%. It can be an effective tool for sleep stages classification and can be useful for doctors and neurologists for diagnosing sleep disorders.

Methodologies and Wearable Devices to Monitor Biophysical Parameters Related to Sleep Dysfunctions: An Overview

Sleep is crucial for human health from metabolic, mental, emotional, and social points of view; obtaining good sleep in terms of quality and duration is fundamental for maintaining a good life quality. Over the years, several systems have been proposed in the scientific literature and on the market to derive metrics used to quantify sleep quality as well as detect sleep disturbances and disorders. In this field, wearable systems have an important role in the discreet, accurate, and long-term detection of biophysical markers useful to determine sleep quality. This paper presents the current state-of-the-art wearable systems and software tools for sleep staging and detecting sleep disorders and dysfunctions. At first, the paper discusses sleep's functions and the importance of monitoring sleep to detect eventual sleep disturbance and disorders. Afterward, an overview of prototype and commercial headband-like wearable devices to monitor sleep is presented, both reported in the scientific literature and on the market, allowing unobtrusive and accurate detection of sleep quality markers. Furthermore, a survey of scientific works related the effect of the COVID-19 pandemic on sleep functions, attributable to both infection and lifestyle changes. In addition, a survey of algorithms for sleep staging and detecting sleep disorders is introduced based on an analysis of single or multiple biosignals (EEG-electroencephalography, ECG-electrocardiography, EMG-electromyography, EOG-electrooculography, etc.). Lastly, comparative analyses and insights are provided to determine the future trends related to sleep monitoring systems.

Statistical uncertainty quantification to augment clinical decision support: a first implementation in sleep medicine

Machine learning has the potential to change the practice of medicine, particularly in areas that require pattern recognition (e.g. radiology). Although automated classification is unlikely to be perfect, few modern machine learning tools have the ability to assess their own classification confidence to recognize uncertainty that might need human review. Using automated single-channel sleep staging as a first implementation, we demonstrated that uncertainty information (as quantified using Shannon entropy) can be utilized in a "human in the loop" methodology to promote targeted review of uncertain sleep stage classifications on an epoch-by-epoch basis. Across 20 sleep studies, this feedback methodology proved capable of improving scoring agreement with the gold standard over automated scoring alone (average improvement in Cohen's Kappa of 0.28), in a fraction of the scoring time compared to full manual review (60% reduction). In summary, our uncertainty-based clinician-in-the-loop framework promotes the improvement of medical classification accuracy/confidence in a cost-effective and economically resourceful manner.

Adaptive latent state modeling of brain network dynamics with real-time learning rate optimization

Objective. Dynamic latent state models are widely used to characterize the dynamics of brain network activity for various neural signal types. To date, dynamic latent state models have largely been developed for stationary brain network dynamics. However, brain network dynamics can be non-stationary for example due to learning, plasticity or recording instability. To enable modeling these non-stationarities, two problems need to be resolved. First, novel methods should be developed that can adaptively update the parameters of latent state models, which is difficult due to the state being latent. Second, new methods are needed to optimize the adaptation learning rate, which specifies how fast new neural observations update the model parameters and can significantly influence adaptation accuracy.Approach. We develop a Rate Optimized-adaptive Linear State-Space Modeling (RO-adaptive LSSM) algorithm that solves these two problems. First, to enable adaptation, we derive a computation- and memory-efficient adaptive LSSM fitting algorithm that updates the LSSM parameters recursively and in real time in the presence of the latent state. Second, we develop a real-time learning rate optimization algorithm. We use comprehensive simulations of a broad range of non-stationary brain network dynamics to validate both algorithms, which together constitute the RO-adaptive LSSM.Main results. We show that the adaptive LSSM fitting algorithm can accurately track the broad simulated non-stationary brain network dynamics. We also find that the learning rate significantly affects the LSSM fitting accuracy. Finally, we show that the real-time learning rate optimization algorithm can run in parallel with the adaptive LSSM fitting algorithm. Doing so, the combined RO-adaptive LSSM algorithm rapidly converges to the optimal learning rate and accurately tracks non-stationarities.Significance. These algorithms can be used to study time-varying neural dynamics underlying various brain functions and enhance future neurotechnologies such as brain-machine interfaces and closed-loop brain stimulation systems.

Adaptive Multi-Channel Event Segmentation and Feature Extraction for Monitoring Health Outcomes

OBJECTIVE

To develop a multi-channel device event segmentation and feature extraction algorithm that is robust to changes in data distribution.

METHODS

We introduce an adaptive transfer learning algorithm to classify and segment events from non-stationary multi-channel temporal data. Using a multivariate hidden Markov model (HMM) and Fisher's linear discriminant analysis (FLDA) the algorithm adaptively adjusts to shifts in distribution over time. The proposed algorithm is unsupervised and learns to label events without requiring a priori information about true event states. The procedure is illustrated on experimental data collected from a cohort in a human viral challenge (HVC) study, where certain subjects have disrupted wake and sleep patterns after exposure to an H1N1 influenza pathogen.

RESULTS

Simulations establish that the proposed adaptive algorithm significantly outperforms other event classification methods. When applied to early time points in the HVC data, the algorithm extracts sleep/wake features that are predictive of both infection and infection onset time.

CONCLUSION

The proposed transfer learning event segmentation method is robust to temporal shifts in data distribution and can be used to produce highly discriminative event-labeled features for health monitoring.

SIGNIFICANCE

Our integrated multisensor signal processing and transfer learning method is applicable to many ambulatory monitoring applications.

An Automatic Sleep Stage Classification Algorithm Using Improved Model Based Essence Features

The automatic sleep stage classification technique can facilitate the diagnosis of sleep disorders and release the medical expert from labor-consumption work. In this paper, novel improved model based essence features (IMBEFs) were proposed combining locality energy (LE) and dual state space models (DSSMs) for automatic sleep stage detection on single-channel electroencephalograph (EEG) signals. Firstly, each EEG epoch is decomposed into low-level sub-bands (LSBs) and high-level sub-bands (HSBs) by wavelet packet decomposition (WPD), separately. Then, the DSSMs are estimated by the LSBs and the LE calculation is carried out on HSBs. Thirdly, the IMBEFs extracted from the DSSM and LE are fed into the appropriate classifier for sleep stage classification. The performance of the proposed method was evaluated on three public sleep databases. The experimental results show that under the Rechtschaffen's and Kale's (R&K) standard, the sleep stage classification accuracies of six classes on the Sleep EDF database and the Dreams Subjects database are 92.04% and 78.92%, respectively. Under the American Academy of Sleep Medicine (AASM) standard, the classification accuracies of five classes in the Dreams Subjects database and the ISRUC database reached 79.90% and 81.65%. The proposed method can be used for reliable sleep stage classification with high accuracy compared with state-of-the-art methods.

Automated multi-model deep neural network for sleep stage scoring with unfiltered clinical data

Purpose

To develop an automated framework for sleep stage scoring from PSG via a deep neural network.

Methods

An automated deep neural network was proposed by using a multi-model integration strategy with multiple signal channels as input. All of the data were collected from one single medical center from July 2017 to April 2019. Model performance was evaluated by overall classification accuracy, precision, recall, weighted F1 score, and Cohen’s Kappa.

Results

Two hundred ninety-four sleep studies were included in this study; 122 composed the training dataset, 20 composed the validation dataset, and 152 were used in the testing dataset. The network achieved human-level annotation performance with an average accuracy of 0.8181, weighted F1 score of 0.8150, and Cohen’s Kappa of 0.7276. Top-2 accuracy (the proportion of test samples for which the true label is among the two most probable labels given by the model) was significantly improved compared to the overall classification accuracy, with the average being 0.9602. The number of arousals affected the model’s performance.

Conclusion

This research provides a robust and reliable model with the inter-rater agreement nearing that of human experts. Determining the most appropriate evaluation parameters for sleep staging is a direction for future research.

Electronic supplementary material

The online version of this article (10.1007/s11325-019-02008-w) contains supplementary material, which is available to authorized users.

Sleep stage classification using covariance features of multi-channel physiological signals on Riemannian manifolds

BACKGROUND AND OBJECTIVE

The recognition of many sleep related pathologies highly relies on an accurate classification of sleep stages. Clinically, sleep stages are usually labelled by sleep experts through visually inspecting the whole-night polysomnography (PSG) recording of patients, wherein electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG) play the dominant role. Developing an automatic sleep staging system based on multi-channel physiological signals could relieve the burden of manual labeling by experts, and obtain reliable and repeatable recognition results as well.

METHODS

In this work, we find the correlation between the spatial covariance matrices of multi-channel signals and their corresponding sleep stages. Based on that, we propose two novel sleep stage classification methods based on the features extracted from the covariance matrices of multi-channel signals. Sleep stages are classified using a minimum distance classifier according to their corresponding covariance matrices mapped on Riemannian manifolds. An alternative way to classify these covariance matrices is to represent the features of covariance matrices on the tangent space of Riemannian manifolds and classify them with an ensemble learning classifier. After any of these classification methods, a rule-free refinement process is utilized to further optimize the classification results.

RESULTS

On the MASS dataset that includes 61 whole-night PSG recordings, both two methods provide satisfactory classification results while the one based on tangent space projection has better performance. On average, an accuracy of 0.812 and a Cohen's Kappa coefficient of 0.722 are obtained under leave-one-subject-out cross validation, using EEG, EOG and EMG signals. Meanwhile, the most effective combinations of EEG channels for sleep staging have been found in this work.

CONCLUSIONS

The correlation between spatial covariance matrices of multi-channel signals and their corresponding sleep stages have been found. Features based on that are used for sleep stage classification, and experimental results show the superior performance of proposed methods compared to state-of-the-art works. Results of this work are expected to provide a new vision for dealing with multi-channel or multi-modal signal processing tasks in various applications.

Development of a human-computer collaborative sleep scoring system for polysomnography recordings

The overnight polysomnographic (PSG) recordings of patients were scored by an expert to diagnose sleep disorders. Visual sleep scoring is a time-consuming and subjective process. Automatic sleep staging methods can help; however, the mechanism and reliability of these methods are not fully understood. Therefore, experts often need to rescore the recordings to obtain reliable results. Here, we propose a human-computer collaborative sleep scoring system. It is a rule-based automatic sleep scoring method that follows the American Academy of Sleep Medicine (AASM) guidelines to perform an initial scoring. Then, the reliability level of each epoch is analyzed based on physiological patterns during sleep and the characteristics of various stage changes. Finally, experts would only need to rescore epochs with a low-reliability level. The experimental results show that the average agreement rate between our system and fully manual scorings can reach 90.42% with a kappa coefficient of 0.85. Over 50% of the manual scoring time can be reduced. Due to the demonstrated robustness and applicability, the proposed approach can be integrated with various PSG systems or automatic sleep scoring methods for sleep monitoring in clinical or homecare applications in the future.

Developing a personalized closed-loop controller of medically-induced coma in a rodent model

OBJECTIVE

Personalized automatic control of medically-induced coma, a critical multi-day therapy in the intensive care unit, could greatly benefit clinical care and further provide a novel scientific tool for investigating how the brain response to anesthetic infusion rate changes during therapy. Personalized control would require real-time tracking of inter- and intra-subject variabilities in the brain response to anesthetic infusion rate while simultaneously delivering the therapy, which has not been achieved. Current control systems for medically-induced coma require a separate offline model fitting experiment to deal with inter-subject variabilities, which would lead to therapy interruption. Removing the need for these offline interruptions could help facilitate clinical feasbility. In addition, current systems do not track intra-subject variabilities. Tracking intra-subject variabilities is essential for studying whether or how the brain response to anesthetic infusion rate changes during therapy. Further, such tracking could enhance control precison and thus help facilitate clinical feasibility.

APPROACH

Here we develop a personalized closed-loop anesthetic delivery (CLAD) system in a rodent model that tracks both inter- and intra-subject variabilities in real time while simultaneously controlling the anesthetic in closed loop. We tested the CLAD in rats by administrating propofol to control the electroencephalogram (EEG) burst suppression. We first examined whether the CLAD can remove the need for offline model fitting interruption. We then used the CLAD as a tool to study whether and how the brain response to anesthetic infusion rate changes as a function of changes in the depth of medically-induced coma. Finally, we studied whether the CLAD can enhance control compared with prior systems by tracking intra-subject variabilities.

MAIN RESULTS

The CLAD precisely controlled the EEG burst suppression in each rat without performing offline model fitting experiments. Further, using the CLAD, we discovered that the brain response to anesthetic infusion rate varied during control, and that these variations correlated with the depth of medically-induced coma in a consistent manner across individual rats. Finally, tracking these variations reduced control bias and error by more than 70% compared with prior systems.

SIGNIFICANCE

This personalized CLAD provides a new tool to study the dynamics of brain response to anesthetic infusion rate and has significant implications for enabling clinically-feasible automatic control of medically-induced coma.