Obstructive sleep apnea screening from unprocessed ECG signals using statistical modelling

Environmental Benefits of Sleep Apnoea Detection in the Home Environment

Sleep Apnoea (SA) is a common chronic illness that affects nearly 1 billion people around the world, and the number of patients is rising. SA causes a wide range of psychological and physiological ailments that have detrimental effects on a patient’s wellbeing. The high prevalence and negative health effects make SA a public health problem. Whilst the current gold standard diagnostic procedure, polysomnography (PSG), is reliable, it is resource-expensive and can have a negative impact on sleep quality, as well as the environment. With this study, we focus on the environmental impact that arises from resource utilisation during SA detection, and we propose remote monitoring (RM) as a potential solution that can improve the resource efficiency and reduce travel. By reusing infrastructure technology, such as mobile communication, cloud computing, and artificial intelligence (AI), RM establishes SA detection and diagnosis support services in the home environment. However, there are considerable barriers to a widespread adoption of this technology. To gain a better understanding of the available technology and its associated strength, as well as weaknesses, we reviewed scientific papers that used various strategies for RM-based SA detection. Our review focused on 113 studies that were conducted between 2018 and 2022 and that were listed in Google Scholar. We found that just over 50% of the proposed RM systems incorporated real time signal processing and around 20% of the studies did not report on this important aspect. From an environmental perspective, this is a significant shortcoming, because 30% of the studies were based on measurement devices that must travel whenever the internal buffer is full. The environmental impact of that travel might constitute an additional need for changing from offline to online SA detection in the home environment.

A method to detect sleep apnea using residual attention mechanism network from single-lead ECG signal

Sleep apnea is a sleep disorder caused by weakened or suspended breathing during sleep, which seriously affects the work and health of patients. The traditional polysomnography (PSG) detection process is complicated and expensive, which has attracted researchers to explore a rapid detection method based on single-lead ECG signals. However, existing ECG-based sleep apnea detection methods have certain limitations and complexities, mainly relying on human-crafted features. To solve the problem, the paper develops a sleep apnea detection method based on a residual attention mechanism network. The method uses the RR interval signal and the R-peak signal derived from the ECG signal as input, realizes feature extraction through the residual network (ResNet), and adds the SENet attention mechanism to deepen the mining of channel features. Experimental results show that the per-segment accuracy of the proposed method can reach 86.2%. Compared with existing works, its accuracy has increased by 1.1-8.1%. These results show that the proposed residual attention network can effectively use ECG signals to quickly detect sleep apnea. Meanwhile, compared with existing works, the proposed method overcomes the limitations and complexity of human-crafted features in sleep apnea detection research.

Signal Folding for Efficient Classification of Near-Cyclostationary Biological Signals

The classification of biological signals is important in detecting abnormal conditions in observed biological subjects. The classifiers are trained on feature vectors, which often constitute the parameters of the observed time series data models. Since the feature extraction is usually the most time-consuming step in training a classifier, in this paper, signal folding and the associated folding operator are introduced to reduce the variability in near-cyclostationary biological signals so that these signals can be represented by models that have a lower order. This leads to a substantial reduction in computational complexity, so the classifier can be learned an order of magnitude faster and still maintain its decision accuracy. The performance of different classifiers involving signal folding as a pre-processing step is studied for sleep apnea detection in one-lead ECG signals assuming ARIMA modeling of the time series data. It is shown that the R-peak-based folding of ECG segments has superior performance to other more general, similarity based signal folding methods. The folding order can be optimized for the best classification accuracy. However, signal folding requires precise scaling and alignment of the created signal fragments.

AIOSA: An approach to the automatic identification of obstructive sleep apnea events based on deep learning

Obstructive Sleep Apnea Syndrome (OSAS) is the most common sleep-related breathing disorder. It is caused by an increased upper airway resistance during sleep, which determines episodes of partial or complete interruption of airflow. The detection and treatment of OSAS is particularly important in patients who suffered a stroke, because the presence of severe OSAS is associated with higher mortality, worse neurological deficits, worse functional outcome after rehabilitation, and a higher likelihood of uncontrolled hypertension. The gold standard test for diagnosing OSAS is polysomnography (PSG). Unfortunately, performing a PSG in an electrically hostile environment, like a stroke unit, on neurologically impaired patients is a difficult task; moreover, the number of strokes per day vastly outnumbers the availability of polysomnographs and dedicated healthcare professionals. Hence, a simple and automated recognition system to identify OSAS cases among acute stroke patients, relying on routinely recorded vital signs, is highly desirable. The vast majority of the work done so far focuses on data recorded in ideal conditions and highly selected patients, and thus it is hardly exploitable in real-life circumstances, where it would be of actual use. In this paper, we propose a novel convolutional deep learning architecture able to effectively reduce the temporal resolution of raw waveform data, like physiological signals, extracting key features that can be used for further processing. We exploit models based on such an architecture to detect OSAS events in stroke unit recordings obtained from the monitoring of unselected patients. Unlike existing approaches, annotations are performed at one-second granularity, allowing physicians to better interpret the model outcome. Results are considered to be satisfactory by the domain experts. Moreover, through tests run on a widely-used public OSAS dataset, we show that the proposed approach outperforms current state-of-the-art solutions.

ECG Signal Modeling Using Volatility Properties: Its Application in Sleep Apnea Syndrome

This study presents and evaluates the mathematical model to estimate the mean and variance of single-lead ECG signals in sleep apnea syndrome. Our objective is to use the volatility property of the ECG signal for modeling. ECG signal is a stochastic signal whose mean and variance are time-varying. So, we propose to decompose this nonstationarity into two additive components; a homoscedastic Autoregressive Integrated Moving Average (ARIMA) and a heteroscedastic time series in terms of Exponential Generalized Autoregressive Conditional Heteroskedasticity (EGARCH), where the former captures the linearity property and the latter the nonlinear characteristics of the ECG signal. First, ECG signals are segmented into one-minute segments. The heteroskedasticity property is then examined through various tests such as the ARCH/GARCH test, kurtosis, skewness, and histograms. Next, the ARIMA model is applied to signals as a linear model and EGARCH as a nonlinear model. The appropriate orders of models are estimated by using the Bayesian Information Criterion (BIC). We assess the effectiveness of our model in terms of mean square error (MSE), root mean square error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE). The data in this article is obtained from the Physionet Apnea-ECG database. Results show that the ARIMA-EGARCH model performs better than other models for modeling both apneic and normal ECG signals in sleep apnea syndrome.