Analysis and automatic identification of sleep stages using higher order spectra

An enzyme-inspired specificity in deep learning model for sleep stage classification using multi-channel PSG signals input: Separating training approach and its performance on cross-dataset validation for generalizability

Numerous automatic sleep stage classification systems have been developed, but none have become effective assistive tools for sleep technicians due to issues with generalization. Four key factors hinder the generalization of these models are instruments, montage of recording, subject type, and scoring manual factors. This study aimed to develop a deep learning model that addresses generalization problems by integrating enzyme-inspired specificity and employing separating training approaches. Subject type and scoring manual factors were controlled, while the focus was on instruments and montage of recording factors. The proposed model consists of three sets of signal-specific models including EEG-, EOG-, and EMG-specific model. The EEG-specific models further include three sets of channel-specific models. All signal-specific and channel-specific models were established with data manipulation and weighted loss strategies, resulting in three sets of data manipulation models and class-specific models, respectively. These models were CNNs. Additionally, BiLSTM models were applied to EEG- and EOG-specific models to obtain temporal information. Finally, classification task for sleep stage was handled by 'the-last-dense' layer. The optimal sampling frequency for each physiological signal was identified and used during the training process. The proposed model was trained on MGH dataset and evaluated using both within dataset and cross-dataset. For MGH dataset, overall accuracy of 81.05 %, MF1 of 79.05 %, Kappa of 0.7408, and per-class F1-scores: W (84.98 %), N1 (58.06 %), N2 (84.82 %), N3 (79.20 %), and REM (88.17 %) can be achieved. Performances on cross-datasets are as follows: SHHS1 200 records reached 79.54 %, 70.56 %, and 0.7078; SHHS2 200 records achieved 76.77 %, 66.30 %, and 0.6632; Sleep-EDF 153 records gained 78.52 %, 72.13 %, and 0.7031; and BCI-MU (local dataset) 94 records achieved 83.57 %, 82.17 %, and 0.7769 for overall accuracy, MF1, and Kappa respectively. Additionally, the proposed model has approximately 9.3 M trainable parameters and takes around 26 s to process one PSG record. The results indicate that the proposed model demonstrates generalizability in sleep stage classification and shows potential as a feasibility tool for real-world applications. Additionally, enzyme-inspired specificity effectively addresses the challenges posed by varying montage of recording, while the identified optimal frequencies mitigate instrument-related issues.

Efficient Sleep Stage Identification Using Piecewise Linear EEG Signal Reduction: A Novel Algorithm for Sleep Disorder Diagnosis

Sleep is a vital physiological process for human health, and accurately detecting various sleep states is crucial for diagnosing sleep disorders. This study presents a novel algorithm for identifying sleep stages using EEG signals, which is more efficient and accurate than the state-of-the-art methods. The key innovation lies in employing a piecewise linear data reduction technique called the Halfwave method in the time domain. This method simplifies EEG signals into a piecewise linear form with reduced complexity while preserving sleep stage characteristics. Then, a features vector with six statistical features is built using parameters obtained from the reduced piecewise linear function. We used the MIT-BIH Polysomnographic Database to test our proposed method, which includes more than 80 h of long data from different biomedical signals with six main sleep classes. We used different classifiers and found that the K-Nearest Neighbor classifier performs better in our proposed method. According to experimental findings, the average sensitivity, specificity, and accuracy of the proposed algorithm on the Polysomnographic Database considering eight records is estimated as 94.82%, 96.65%, and 95.73%, respectively. Furthermore, the algorithm shows promise in its computational efficiency, making it suitable for real-time applications such as sleep monitoring devices. Its robust performance across various sleep classes suggests its potential for widespread clinical adoption, making significant advances in the knowledge, detection, and management of sleep problems.

ZleepAnlystNet: a novel deep learning model for automatic sleep stage scoring based on single-channel raw EEG data using separating training

Numerous models for sleep stage scoring utilizing single-channel raw EEG signal have typically employed CNN and BiLSTM architectures. While these models, incorporating temporal information for sequence classification, demonstrate superior overall performance, they often exhibit low per-class performance for N1-stage, necessitating an adjustment of loss function. However, the efficacy of such adjustment is constrained by the training process. In this study, a pioneering training approach called separating training is introduced, alongside a novel model, to enhance performance. The developed model comprises 15 CNN models with varying loss function weights for feature extraction and 1 BiLSTM for sequence classification. Due to its architecture, this model cannot be trained using an end-to-end approach, necessitating separate training for each component using the Sleep-EDF dataset. Achieving an overall accuracy of 87.02%, MF1 of 82.09%, Kappa of 0.8221, and per-class F1-socres (W 90.34%, N1 54.23%, N2 89.53%, N3 88.96%, and REM 87.40%), our model demonstrates promising performance. Comparison with sleep technicians reveals a Kappa of 0.7015, indicating alignment with reference sleep stags. Additionally, cross-dataset validation and adaptation through training with the SHHS dataset yield an overall accuracy of 84.40%, MF1 of 74.96% and Kappa of 0.7785 when tested with the Sleep-EDF-13 dataset. These findings underscore the generalization potential in model architecture design facilitated by our novel training approach.

EEG-Based Sleep Stage Classification via Neural Architecture Search

With the improvement of quality of life, people are more and more concerned about the quality of sleep. The electroencephalogram (EEG)-based sleep stage classification is a good guide for sleep quality and sleep disorders. At this stage, most automatic staging neural networks are designed by human experts, and this process is time-consuming and laborious. In this paper, we propose a novel neural architecture search (NAS) framework based on bilevel optimization approximation for EEG-based sleep stage classification. The proposed NAS architecture mainly performs the architectural search through a bilevel optimization approximation, and the model is optimized by search space approximation and search space regularization with parameters shared among cells. Finally, we evaluated the performance of the model searched by NAS on the Sleep-EDF-20, Sleep-EDF-78 and SHHS datasets with an average accuracy of 82.7%, 80.0% and 81.9%, respectively. The experimental results show that the proposed NAS algorithm provides some reference for the subsequent automatic design of networks for sleep classification.

Deep learning-based algorithm accurately classifies sleep stages in preadolescent children with sleep-disordered breathing symptoms and age-matched controls

Introduction

Visual sleep scoring has several shortcomings, including inter-scorer inconsistency, which may adversely affect diagnostic decision-making. Although automatic sleep staging in adults has been extensively studied, it is uncertain whether such sophisticated algorithms generalize well to different pediatric age groups due to distinctive EEG characteristics. The preadolescent age group (10-13-year-olds) is relatively understudied, and thus, we aimed to develop an automatic deep learning-based sleep stage classifier specifically targeting this cohort.

Methods

A dataset (n = 115) containing polysomnographic recordings of Icelandic preadolescent children with sleep-disordered breathing (SDB) symptoms, and age and sex-matched controls was utilized. We developed a combined convolutional and long short-term memory neural network architecture relying on electroencephalography (F4-M1), electrooculography (E1-M2), and chin electromyography signals. Performance relative to human scoring was further evaluated by analyzing intra- and inter-rater agreements in a subset (n = 10) of data with repeat scoring from two manual scorers.

Results

The deep learning-based model achieved an overall cross-validated accuracy of 84.1% (Cohen's kappa κ = 0.78). There was no meaningful performance difference between SDB-symptomatic (n = 53) and control subgroups (n = 52) [83.9% (κ = 0.78) vs. 84.2% (κ = 0.78)]. The inter-rater reliability between manual scorers was 84.6% (κ = 0.78), and the automatic method reached similar agreements with scorers, 83.4% (κ = 0.76) and 82.7% (κ = 0.75).

Conclusion

The developed algorithm achieved high classification accuracy and substantial agreements with two manual scorers; the performance metrics compared favorably with typical inter-rater reliability between manual scorers and performance reported in previous studies. These suggest that our algorithm may facilitate less labor-intensive and reliable automatic sleep scoring in preadolescent children.

Assessment of Obstructive Sleep Apnea-Related Sleep Fragmentation Utilizing Deep Learning-Based Sleep Staging from Photoplethysmography

STUDY OBJECTIVES

To assess the relationship between obstructive sleep apnea (OSA) severity and sleep fragmentation, accurate differentiation between sleep and wakefulness is needed. Sleep staging is usually performed manually using electroencephalography (EEG). This is time-consuming due to complexity of EEG setup and the amount of work in manual scoring. In this study, we aimed to develop an automated deep learning-based solution to assess OSA-related sleep fragmentation based on photoplethysmography (PPG)-signal.

METHODS

A combination of convolutional and recurrent neural networks was used for PPG-based sleep staging. The models were trained using two large clinical datasets from Israel (n=2149) and Australia (n=877) and tested separately on three-class (wake/NREM/REM), four-class (wake/N1+N2/N3/REM), and five-class (wake/N1/N2/N3/REM) classification. The relationship between OSA severity categories and sleep fragmentation was assessed using survival analysis of mean continuous sleep. Overlapping PPG epochs were applied to artificially obtain denser hypnograms for better identification of fragmented sleep.

RESULTS

Automatic PPG-based sleep staging showed accuracy of 83.3% on three-class, 74.1% on four-class, and 68.7% on five-class models. The hazard ratios for decreased mean continuous sleep compared to the non-OSA group obtained with Cox proportional hazards models with 5-second epoch-to-epoch intervals were 1.70, 3.30, and 8.11 for mild, moderate, and severe OSA, respectively. With manually scored EEG-based hypnograms, the corresponding hazard ratios were 1.18, 1.78, and 2.90.

CONCLUSIONS

PPG-based automatic sleep staging can be used to differentiate between OSA severity categories based on sleep continuity. The differences between the OSA severity categories become more apparent when a shorter epoch-to-epoch interval is used.

Nonlinear Modeling of Cortical Responses to Mechanical Wrist Perturbations Using the NARMAX Method

OBJECTIVE

Nonlinear modeling of cortical responses (EEG) to wrist perturbations allows for the quantification of cortical sensorimotor function in healthy and neurologically impaired individuals. A common model structure reflecting key characteristics shared across healthy individuals may provide a reference for future clinical studies investigating abnormal cortical responses associated with sensorimotor impairments. Thus, the goal of our study is to identify this common model structure and therefore to build a nonlinear dynamic model of cortical responses, using nonlinear autoregressive-moving-average model with exogenous inputs (NARMAX).

METHODS

EEG was recorded from ten participants when receiving continuous wrist perturbations. A common model structure detection method was developed for identifying a common NARMAX model structure across all participants, with individualized parameter values. The results were compared to conventional subject-specific models.

RESULTS

The proposed method achieved 93.91% variance accounted for (VAF) when implementing a one-step-ahead prediction and around 50% VAF for a k-step ahead prediction (k = 3), without a substantial drop of VAF as compare to subject-specific models. The estimated common structure suggests that the measured cortical response is a mixed outcome of the nonlinear transformation of external inputs and local neuronal interactions or inherent neuronal dynamics at the cortex.

CONCLUSION

The proposed method well determined the common characteristics across subjects in the cortical responses to wrist perturbations.

SIGNIFICANCE

It provides new insights into the human sensorimotor nervous system in response to somatosensory inputs and paves the way for future translational studies on assessments of sensorimotor impairments using our modeling approach.

Review on Biomedical Sensors, Technologies and Algorithms for Diagnosis of Sleep Disordered Breathing: Comprehensive Survey

This paper provides a comprehensive review of available technologies for measurements of vital physiology related parameters that cause sleep disordered breathing (SDB). SDB is a chronic disease that may lead to several health problems and increase the risk of high blood pressure and even heart attack. Therefore, the diagnosis of SDB at an early stage is very important. The essential primary step before diagnosis is measurement. Vital health parameters related to SBD might be measured through invasive or non-invasive methods. Nowadays, with respect to increase in aging population, improvement in home health management systems is needed more than even a decade ago. Moreover, traditional health parameter measurement techniques such as polysomnography are not comfortable and introduce additional costs to the consumers. Therefore, in modern advanced self-health management devices, electronics and communication science are combined to provide appliances that can be used for SDB diagnosis, by monitoring a patient's physiological parameters with more comfort and accuracy. Additionally, development in machine learning algorithms provides accurate methods of analysing measured signals. This paper provides a comprehensive review of measurement approaches, data transmission, and communication networks, alongside machine learning algorithms for sleep stage classification, to diagnose SDB.

Using a deep recurrent neural network with EEG signal to detect Parkinson's disease

Background

Parkinson's disease (PD) gradually degrades the functionality of the brain. Because of its relevance to the abnormality of the brain, electroencephalogram (EEG) signal is used for the early detection of this disease. This paper introduces a novel computer-aided diagnosis method to detect PD, which is an efficient deep learning method based on a pooling-based deep recurrent neural network (PDRNN). Therefore, the purpose of this study is to detect Parkinson's disease based on deep recurrent neural network of EEG signal.

Methods

The EEG signals of 20 patients with Parkinson's disease and 20 healthy people in Henan Provincial People's Hospital (People's Hospital of Zhengzhou University) were examined, and a PDRNN learning method was applied on the dataset for managing the demand of the traditional feature presentation step.

Results

The suggested DPRNN network gives the precision, sensitivity and specificity of 88.31%, 84.84% and 91.81%, respectively. Nevertheless, 11.28% of the healthy cases are wrongly categorized in Parkinson class. Also, 11.49% percent of Parkinson cases are classified wrongly in the healthy class.

Conclusions

The experimental model has high efficiency and can be used as a reliable tool for clinical PD detection. In future research, more cases should be used to test and develop the proposed model.

The future of sleep health: a data-driven revolution in sleep science and medicine

In recent years, there has been a significant expansion in the development and use of multi-modal sensors and technologies to monitor physical activity, sleep and circadian rhythms. These developments make accurate sleep monitoring at scale a possibility for the first time. Vast amounts of multi-sensor data are being generated with potential applications ranging from large-scale epidemiological research linking sleep patterns to disease, to wellness applications, including the sleep coaching of individuals with chronic conditions. However, in order to realise the full potential of these technologies for individuals, medicine and research, several significant challenges must be overcome. There are important outstanding questions regarding performance evaluation, as well as data storage, curation, processing, integration, modelling and interpretation. Here, we leverage expertise across neuroscience, clinical medicine, bioengineering, electrical engineering, epidemiology, computer science, mHealth and human-computer interaction to discuss the digitisation of sleep from a inter-disciplinary perspective. We introduce the state-of-the-art in sleep-monitoring technologies, and discuss the opportunities and challenges from data acquisition to the eventual application of insights in clinical and consumer settings. Further, we explore the strengths and limitations of current and emerging sensing methods with a particular focus on novel data-driven technologies, such as Artificial Intelligence.

EEG sleep stages identification based on weighted undirected complex networks

BACKGROUND AND OBJECTIVE

Sleep scoring is important in sleep research because any errors in the scoring of the patient's sleep electroencephalography (EEG) recordings can cause serious problems such as incorrect diagnosis, medication errors, and misinterpretations of patient's EEG recordings. The aim of this research is to develop a new automatic method for EEG sleep stages classification based on a statistical model and weighted brain networks.

METHODS

Each EEG segment is partitioned into a number of blocks using a sliding window technique. A set of statistical features are extracted from each block. As a result, a vector of features is obtained to represent each EEG segment. Then, the vector of features is mapped into a weighted undirected network. Different structural and spectral attributes of the networks are extracted and forwarded to a least square support vector machine (LS-SVM) classifier. At the same time the network's attributes are also thoroughly investigated. It is found that the network's characteristics vary with their sleep stages. Each sleep stage is best represented using the key features of their networks.

RESULTS

In this paper, the proposed method is evaluated using two datasets acquired from different channels of EEG (Pz-Oz and C3-A2) according to the R&K and the AASM without pre-processing the original EEG data. The obtained results by the LS-SVM are compared with those by Naïve, k-nearest and a multi-class-SVM. The proposed method is also compared with other benchmark sleep stages classification methods. The comparison results demonstrate that the proposed method has an advantage in scoring sleep stages based on single channel EEG signals.

CONCLUSIONS

An average accuracy of 96.74% is obtained with the C3-A2 channel according to the AASM standard, and 96% with the Pz-Oz channel based on the R&K standard.

Applications of Higher Order Statistics in Electroencephalography Signal Processing: A Comprehensive Survey

Electroencephalography (EEG) is a noninvasive electrophysiological monitoring technique that records the electrical activities of the brain from the scalp using electrodes. EEG is not only an essential tool for diagnosing diseases and disorders affecting the brain, but also helps us to achieve a better understanding of brain's activities and structures. EEG recordings are weak, nonlinear, and nonstationary signals that contain various noise and artifacts. Therefore, for analyzing them, advanced signal processing techniques are required. Second order statistical features are usually sufficient for analyzing most basic signals. However, higher order statistical features possess characteristics that are missing in the second order; characteristics that can be highly beneficial for analysis of more complex signals, such as EEG. The primary goal of this article is to provide a comprehensive survey of the applications of higher order statistics or spectra (HOS) in EEG signal processing. Therefore, we start the survey with a summary of previous studies in EEG analysis followed by a brief mathematical description of HOS. Then, HOS related features and their applications in EEG analysis are presented. These applications are then grouped into three categories, each of which are further explored thoroughly with examples of prior studies. Finally, we provide some specific recommendations based on the literature survey and discuss possible future directions of this field.

Development of a rule-based automatic five-sleep-stage scoring method for rats

Background

Sleep problem or disturbance often exists in pain or neurological/psychiatric diseases. However, sleep scoring is a time-consuming tedious labor. Very few studies discuss the 5-stage (wake/NREM1/NREM2/transition sleep/REM) automatic fine analysis of wake–sleep stages in rodent models. The present study aimed to develop and validate an automatic rule-based classification of 5-stage wake–sleep pattern in acid-induced widespread hyperalgesia model of the rat.

Results

The overall agreement between two experts’ consensus and automatic scoring in the 5-stage and 3-stage analyses were 92.32% (κ = 0.88) and 94.97% (κ = 0.91), respectively. Standard deviation of the accuracy among all rats was only 2.93%. Both frontal–occipital EEG and parietal EEG data showed comparable accuracies. The results demonstrated the performance of the proposed method with high accuracy and reliability. Subtle changes exhibited in the 5-stage wake–sleep analysis but not in the 3-stage analysis during hyperalgesia development of the acid-induced pain model. Compared with existing methods, our method can automatically classify vigilance states into 5-stage or 3-stage wake–sleep pattern with a promising high agreement with sleep experts.

Conclusions

In this study, we have performed and validated a reliable automated sleep scoring system in rats. The classification algorithm is less computation power, a high robustness, and consistency of results. The algorithm can be implanted into a versatile wireless portable monitoring system for real-time analysis in the future.

A review of automated sleep stage scoring based on physiological signals for the new millennia

BACKGROUND AND OBJECTIVE

Sleep is an important part of our life. That importance is highlighted by the multitude of health problems which result from sleep disorders. Detecting these sleep disorders requires an accurate interpretation of physiological signals. Prerequisite for this interpretation is an understanding of the way in which sleep stage changes manifest themselves in the signal waveform. With that understanding it is possible to build automated sleep stage scoring systems. Apart from their practical relevance for automating sleep disorder diagnosis, these systems provide a good indication of the amount of sleep stage related information communicated by a specific physiological signal.

METHODS

This article provides a comprehensive review of automated sleep stage scoring systems, which were created since the year 2000. The systems were developed for Electrocardiogram (ECG), Electroencephalogram (EEG), Electrooculogram (EOG), and a combination of signals.

RESULTS

Our review shows that all of these signals contain information for sleep stage scoring.

CONCLUSIONS

The result is important, because it allows us to shift our research focus away from information extraction methods to systemic improvements, such as patient comfort, redundancy, safety and cost.

An end-to-end framework for real-time automatic sleep stage classification

Sleep staging is a fundamental but time consuming process in any sleep laboratory. To greatly speed up sleep staging without compromising accuracy, we developed a novel framework for performing real-time automatic sleep stage classification. The client–server architecture adopted here provides an end-to-end solution for anonymizing and efficiently transporting polysomnography data from the client to the server and for receiving sleep stages in an interoperable fashion. The framework intelligently partitions the sleep staging task between the client and server in a way that multiple low-end clients can work with one server, and can be deployed both locally as well as over the cloud. The framework was tested on four datasets comprising ≈1700 polysomnography records (≈12000 hr of recordings) collected from adolescents, young, and old adults, involving healthy persons as well as those with medical conditions. We used two independent validation datasets: one comprising patients from a sleep disorders clinic and the other incorporating patients with Parkinson’s disease. Using this system, an entire night’s sleep was staged with an accuracy on par with expert human scorers but much faster (≈5 s compared with 30–60 min). To illustrate the utility of such real-time sleep staging, we used it to facilitate the automatic delivery of acoustic stimuli at targeted phase of slow-sleep oscillations to enhance slow-wave sleep.

A Deep Learning Model for Automated Sleep Stages Classification Using PSG Signals

Sleep disorder is a symptom of many neurological diseases that may significantly affect the quality of daily life. Traditional methods are time-consuming and involve the manual scoring of polysomnogram (PSG) signals obtained in a laboratory environment. However, the automated monitoring of sleep stages can help detect neurological disorders accurately as well. In this study, a flexible deep learning model is proposed using raw PSG signals. A one-dimensional convolutional neural network (1D-CNN) is developed using electroencephalogram (EEG) and electrooculogram (EOG) signals for the classification of sleep stages. The performance of the system is evaluated using two public databases (sleep-edf and sleep-edfx). The developed model yielded the highest accuracies of 98.06%, 94.64%, 92.36%, 91.22%, and 91.00% for two to six sleep classes, respectively, using the sleep-edf database. Further, the proposed model obtained the highest accuracies of 97.62%, 94.34%, 92.33%, 90.98%, and 89.54%, respectively for the same two to six sleep classes using the sleep-edfx dataset. The developed deep learning model is ready for clinical usage, and can be tested with big PSG data.

A Novel Multi-Class EEG-Based Sleep Stage Classification System

Sleep stage classification is one of the most critical steps in effective diagnosis and the treatment of sleep-related disorders. Visual inspection undertaken by sleep experts is a time-consuming and burdensome task. A computer-assisted sleep stage classification system is thus essential for both sleep-related disorders diagnosis and sleep monitoring. In this paper, we propose a system to classify the wake and sleep stages with high rates of sensitivity and specificity. The EEG signals of 25 subjects with suspected sleep-disordered breathing, and the EEG signals of 20 healthy subjects from three data sets are used. Every EEG epoch is decomposed into eight subband epochs each of which has a frequency band pertaining to one EEG rhythm (i.e., delta, theta, alpha, sigma, beta 1, beta 2, gamma 1, or gamma 2). Thirteen features are extracted from each subband epoch. Therefore, 104 features are totally obtained for every EEG epoch. The Kruskal-Wallis test is used to examine the significance of the features. Non-significant features are discarded. The minimal-redundancy-maximal-relevance feature selection algorithm is then used to eliminate redundant and irrelevant features. The features selected are classified by a random forest classifier. To set the system parameters and to evaluate the system performance, nested 5-fold cross-validation and subject cross-validation are performed. The performance of our proposed system is evaluated for different multi-class classification problems. The minimum overall accuracy rates obtained are 95.31% and 86.64% for nested 5-fold and subject cross-validation, respectively. The system performance is promising in terms of the accuracy, sensitivity, and specificity rates compared with the ones of the state-of-the-art systems. The proposed system can be used in health care applications with the aim of improving sleep stage classification.

Parkinson's disease: Cause factors, measurable indicators, and early diagnosis

Parkinson's disease (PD) is a neurodegenerative disease of the central nervous system caused due to the loss of dopaminergic neurons. It is classified under movement disorder as patients with PD present with tremor, rigidity, postural changes, and a decrease in spontaneous movements. Comorbidities including anxiety, depression, fatigue, and sleep disorders are observed prior to the diagnosis of PD. Gene mutations, exposure to toxic substances, and aging are considered as the causative factors of PD even though its genesis is unknown. This paper reviews PD etiologies, progression, and in particular measurable indicators of PD such as neuroimaging and electrophysiology modalities. In addition to gene therapy, neuroprotective, pharmacological, and neural transplantation treatments, researchers are actively aiming at identifying biological markers of PD with the goal of early diagnosis. Neuroimaging modalities used together with advanced machine learning techniques offer a promising path for the early detection and intervention in PD patients.

EEG-Based Automatic Sleep Staging Using Ontology and Weighting Feature Analysis

Sleep staging is considered as an effective indicator for auxiliary diagnosis of sleep diseases and related psychiatric diseases, so it attracts a lot of attention from sleep researchers. Nevertheless, sleep staging based on visual inspection of tradition is subjective, time-consuming, and error-prone due to the large bulk of data which have to be processed. Therefore, automatic sleep staging is essential in order to solve these problems. In this article, an electroencephalogram- (EEG-) based scheme that is able to automatically classify sleep stages is proposed. Firstly, EEG data are preprocessed to remove artifacts, extract features, and normalization. Secondly, the normalized features and other context information are stored using an ontology-based model (OBM). Thirdly, an improved method of self-adaptive correlation analysis is designed to select the most effective EEG features. Based on these EEG features and weighting features analysis, the improved random forest (RF) is considered as the classifier to achieve the classification of sleep stages. To investigate the classification ability of the proposed method, several sets of experiments are designed and conducted to classify the sleep stages into two, three, four, and five states. The accuracy of five-state classification is 89.37%, which is improved compared to the accuracy using unimproved RF (84.37%) or previously reported classifiers. In addition, a set of controlled experiments is executed to verify the effect of the number of sleep segments (epochs) on the classification, and the results demonstrate that the proposed scheme is less affected by the sleep segments.

Sleep apnea: a review of diagnostic sensors, algorithms, and therapies

While public awareness of sleep related disorders is growing, sleep apnea syndrome (SAS) remains a public health and economic challenge. Over the last two decades, extensive controlled epidemiologic research has clarified the incidence, risk factors including the obesity epidemic, and global prevalence of obstructive sleep apnea (OSA), as well as establishing a growing body of literature linking OSA with cardiovascular morbidity, mortality, metabolic dysregulation, and neurocognitive impairment. The US Institute of Medicine Committee on Sleep Medicine estimates that 50-70 million US adults have sleep or wakefulness disorders. Furthermore, the American Academy of Sleep Medicine (AASM) estimates that more than 29 million US adults suffer from moderate to severe OSA, with an estimated 80% of those individuals living unaware and undiagnosed, contributing to more than $149.6 billion in healthcare and other costs in 2015. Although various devices have been used to measure physiological signals, detect apneic events, and help treat sleep apnea, significant opportunities remain to improve the quality, efficiency, and affordability of sleep apnea care. As our understanding of respiratory and neurophysiological signals and sleep apnea physiological mechanisms continues to grow, and our ability to detect and process biomedical signals improves, novel diagnostic and treatment modalities emerge.

OBJECTIVE

This article reviews the current engineering approaches for the detection and treatment of sleep apnea.

APPROACH

It discusses signal acquisition and processing, highlights the current nonsurgical and nonpharmacological treatments, and discusses potential new therapeutic approaches.

MAIN RESULTS

This work has led to an array of validated signal and sensor modalities for acquiring, storing and viewing sleep data; a broad class of computational and signal processing approaches to detect and classify SAS disease patterns; and a set of distinctive therapeutic technologies whose use cases span the continuum of disease severity.

SIGNIFICANCE

This review provides a current perspective of the classes of tools at hand, along with a sense of their relative strengths and areas for further improvement.

A comparative review on sleep stage classification methods in patients and healthy individuals

BACKGROUND AND OBJECTIVE

Proper scoring of sleep stages can give clinical information on diagnosing patients with sleep disorders. Since traditional visual scoring of the entire sleep is highly time-consuming and dependent to experts' experience, automatic schemes based on electroencephalogram (EEG) analysis are broadly developed to solve these problems. This review presents an overview on the most suitable methods in terms of preprocessing, feature extraction, feature selection and classifier adopted to precisely discriminate the sleep stages.

METHODS

This study round up a wide range of research findings concerning the application of the sleep stage classification. The fundamental qualitative methods along with the state-of-the-art quantitative techniques for sleep stage scoring are comprehensively introduced. Moreover, according to the results of the investigated studies, five research papers are chosen and practically implemented on a well-known public available sleep EEG dataset. They are applied to single-channel EEG of 40 subjects containing equal number of healthy and patient individuals. Feature extraction and classification schemes are assessed in terms of accuracy and robustness against noise. Furthermore, an additional implementation phase is added to this research in which all combinations of the implemented features and classifiers are considered to find the best combination for sleep analysis.

RESULTS

According to our achieved results on both groups, entropy of wavelet coefficients along with random forest classifier are chosen as the best feature and classifier, respectively. The mentioned feature and classifier provide 87.06% accuracy on healthy subjects and 69.05% on patient group.

CONCLUSIONS

In this paper, the road map of EEG-base sleep stage scoring methods is clearly sketched. Implementing the state-of-the-art methods and even their combination on both healthy and patient datasets indicates that although the accuracy on healthy subjects are remarkable, the results for the main community (patient group) by the quantitative methods are not promising yet. The reasons rise from adopting non-matched sleep EEG features from other signal processing fields such as communication. As a conclusion, developing sleep pattern-related features deem necessary to enhance the performance of this process.

Cerebrovascular pattern improved by ozone autohemotherapy: an entropy-based study on multiple sclerosis patients

Ozone major autohemotherapy is effective in reducing the symptoms of multiple sclerosis (MS) patients, but its effects on brain are still not clear. In this work, we have monitored the changes in the cerebrovascular pattern of MS patients and normal subjects during major ozone autohemotherapy by using near-infrared spectroscopy (NIRS) as functional and vascular technique. NIRS signals are analyzed using a combination of time, time-frequency analysis and nonlinear analysis of intrinsic mode function signals obtained from empirical mode decomposition technique. Our results show that there is an improvement in the cerebrovascular pattern of all subjects indicated by increasing the entropy of the NIRS signals. Hence, we can conclude that the ozone therapy increases the brain metabolism and helps to recover from the lower activity levels which is predominant in MS patients.

AUTOMATED CLASSIFICATION OF DEPRESSION EEG SIGNALS USING WAVELET ENTROPIES AND ENERGIES

Depression is a mental disorder that relates to a state of sadness and dejection. It also affects the emotional and physical state of a person. Currently, there are no standard diagnostic tests for depression that are able to produce conclusive results and more over the symptoms of depression are hard to diagnose. A lot of people who are suffering from depression are unaware of their illness. The electroencephalographic (EEG) signals can be used to detect the alterations in the brain’s electrochemical potential. The present work is based on the automated classification of the normal and depression EEG signals. Thus, signal processing methods are used to extract hidden information from the EEG signals. In this work, normal and depression EEG signals are used and discrete wavelet transform (DWT) is performed up to two levels. The features (skewness, energy, kurtosis, standard deviation (SD), mean and entropy) are extracted at the various detailed coefficients levels of the DWT. The extracted features then undergo a statistical analysis method, which is the Student’s t-test that determines the significance of differences in the features. Support Vector Machine classifier with Radial Basis Kernel Function (SVM RBF) was used and the classification accuracy results of 88.9237% was obtained. Hence, this proposed automatic classification system can serve as a useful diagnostic and monitoring tool for detection of depression.

Unsupervised Estimation of Mouse Sleep Scores and Dynamics Using a Graphical Model of Electrophysiological Measurements

The proportion, number of bouts, and mean bout duration of different vigilance states (Wake, NREM, REM) are useful indices of dynamics in experimental sleep research. These metrics are estimated by first scoring state, sometimes using an algorithm, based on electrophysiological measurements such as the electroencephalogram (EEG) and electromyogram (EMG), and computing their values from the score sequence. Isolated errors in the scores can lead to large discrepancies in the estimated sleep metrics. But most algorithms score sleep by classifying the state from EEG/EMG features independently in each time epoch without considering the dynamics across epochs, which could provide contextual information. The objective here is to improve estimation of sleep metrics by fitting a probabilistic dynamical model to mouse EEG/EMG data and then predicting the metrics from the model parameters. Hidden Markov models (HMMs) with multivariate Gaussian observations and Markov state transitions were fitted to unlabeled 24-h EEG/EMG feature time series from 20 mice to model transitions between the latent vigilance states; a similar model with unbiased transition probabilities served as a reference. Sleep metrics predicted from the HMM parameters did not deviate significantly from manual estimates except for rapid eye movement sleep (REM) ([Formula: see text]; Wilcoxon signed-rank test). Changes in value from Light to Dark conditions correlated well with manually estimated differences (Spearman’s rho 0.43–0.84) except for REM. HMMs also scored vigilance state with over 90% accuracy. HMMs of EEG/EMG features can therefore characterize sleep dynamics from EEG/EMG measurements, a prerequisite for characterizing the effects of perturbation in sleep monitoring and control applications.

Automatic sleep stage classification based on sparse deep belief net and combination of multiple classifiers

This paper presents an automatic sleep stage method combining a sparse deep belief net and combination of multiple classifiers for electroencephalogram, electrooculogram and electromyogram. The sparse deep belief net was applied to extract features from these signals automatically, and the combination of multiple classifiers, utilizing the extracted features, assigned each 30-s epoch to one of the five possible sleep stages. More importantly, we proposed a new voting principle based on classification entropy to enhance the classification performance further by harnessing the complementary information provided by the individual classifier. Differently from existing methods, our method used unsupervised feature learning to extract features automatically from raw sleep data and classification based on the learned features. The results of automatic and manual scorings were compared on an epoch-by-epoch basis. The accuracies for wake, S1, S2, SWS and REM were 98.49%, 80.05%, 91.2%, 98.22% and 95.31%, respectively, and the total accuracy of sleep stage was 91.31%. The results demonstrated that the sparse deep belief net was an efficient feature extraction method for sleep data, and the combination of multiple classifiers based on classification entropy performed well on sleep stages.

Automatic sleep staging: from young adults to elderly patients using multi-class support vector machine

Aging is a process that is inevitable, and makes our body vulnerable to age-related diseases. Age is the most consistent factor affecting the sleep structure. Therefore, new automatic sleep staging methods, to be used in both of young and elderly patients, are needed. This study proposes an automatic sleep stage detector, which can separate wakefulness, rapid-eye-movement (REM) sleep and non-REM (NREM) sleep using only EEG and EOG. Most sleep events, which define the sleep stages, are reduced with age. This is addressed by focusing on the amplitude of the clinical EEG bands, and not the affected sleep events. The age-related influences are then reduced by robust subject-specific scaling. The classification of the three sleep stages are achieved by a multi-class support vector machine using the one-versus-rest scheme. It was possible to obtain a high classification accuracy of 0.91. Validation of the sleep stage detector in other sleep disorders, such as apnea and narcolepsy, should be considered in future work.

A General Approach for Quantifying Nonlinear Connectivity in the Nervous System Based on Phase Coupling

Interaction between distant neuronal populations is essential for communication within the nervous system and can occur as a highly nonlinear process. To better understand the functional role of neural interactions, it is important to quantify the nonlinear connectivity in the nervous system. We introduce a general approach to measure nonlinear connectivity through phase coupling: the multi-spectral phase coherence (MSPC). Using simulated data, we compare MSPC with existing phase coupling measures, namely n : m synchronization index and bi-phase locking value. MSPC provides a system description, including (i) the order of the nonlinearity, (ii) the direction of interaction, (iii) the time delay in the system, and both (iv) harmonic and (v) intermodulation coupling beyond the second order; which are only partly revealed by other methods. We apply MSPC to analyze data from a motor control experiment, where subjects performed isotonic wrist flexions while receiving movement perturbations. MSPC between the perturbation, EEG and EMG was calculated. Our results reveal directional nonlinear connectivity in the afferent and efferent pathways, as well as the time delay (43 ± 8 ms) between the perturbation and the brain response. In conclusion, MSPC is a novel approach capable to assess high-order nonlinear interaction and timing in the nervous system.

Application of higher order spectra for accurate delineation of atrial arrhythmia

The electrocardiogram (ECG) is being commonly used as a diagnostic tool to distinguish different types of atrial tachyarrhythmias. The inherent complexity and mechanistic and clinical inter-relationships often brings about diagnostic difficulties to treating physicians and primary health care professionals creating frequent misdiagnoses and cross classifications using visual criteria. The current paper presents a methodology for ECG based pattern analysis for detection of atrial flutter, atrial fibrillation and normal sinus rhythm beats. ECG is an inherently non-linear and non-stationary signal; its variation may contain indicators of current disease, or warnings about impending cardiac diseases. Routinely used time domain and frequency domain methods will not be able to capture the hidden information present in the ECG beats. In the present study, we have used non-linear features of higher order spectra (HOS) to differentiate the normal, atrial fibrillation and atrial flutter ECG beats. The bispectrum features were subjected to independent component analysis (ICA) for data reduction. The ICA coefficients were subsequently subjected to K-nearest-neighbor (KNN), classification and regression tree (CART) and neural network (NN) classifiers to evaluate the best automated classifier. We have obtained an average accuracy of 97.65%, sensitivity and specificity of 98.75% and 99.53% respectively using ten-fold cross validation. Overall, the results show that application of higher order spectra statistics is useful for the classification of atrial tachyarrhythmias with reasonably high accuracies. Further validation of the proposed technique will yield acceptable results for clinical implementation.