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Bandyopadhyay A, Goldstein C. Clinical applications of artificial intelligence in sleep medicine: a sleep clinician's perspective. Sleep Breath 2023; 27:39-55. [PMID: 35262853 PMCID: PMC8904207 DOI: 10.1007/s11325-022-02592-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/25/2022] [Accepted: 03/02/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The past few years have seen a rapid emergence of artificial intelligence (AI)-enabled technology in the field of sleep medicine. AI refers to the capability of computer systems to perform tasks conventionally considered to require human intelligence, such as speech recognition, decision-making, and visual recognition of patterns and objects. The practice of sleep tracking and measuring physiological signals in sleep is widely practiced. Therefore, sleep monitoring in both the laboratory and ambulatory environments results in the accrual of massive amounts of data that uniquely positions the field of sleep medicine to gain from AI. METHOD The purpose of this article is to provide a concise overview of relevant terminology, definitions, and use cases of AI in sleep medicine. This was supplemented by a thorough review of relevant published literature. RESULTS Artificial intelligence has several applications in sleep medicine including sleep and respiratory event scoring in the sleep laboratory, diagnosing and managing sleep disorders, and population health. While still in its nascent stage, there are several challenges which preclude AI's generalizability and wide-reaching clinical applications. Overcoming these challenges will help integrate AI seamlessly within sleep medicine and augment clinical practice. CONCLUSION Artificial intelligence is a powerful tool in healthcare that may improve patient care, enhance diagnostic abilities, and augment the management of sleep disorders. However, there is a need to regulate and standardize existing machine learning algorithms prior to its inclusion in the sleep clinic.
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Affiliation(s)
- Anuja Bandyopadhyay
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Cathy Goldstein
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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Brink-Kjaer A, Leary EB, Sun H, Westover MB, Stone KL, Peppard PE, Lane NE, Cawthon PM, Redline S, Jennum P, Sorensen HBD, Mignot E. Age estimation from sleep studies using deep learning predicts life expectancy. NPJ Digit Med 2022; 5:103. [PMID: 35869169 PMCID: PMC9307657 DOI: 10.1038/s41746-022-00630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/10/2022] [Indexed: 11/11/2022] Open
Abstract
Sleep disturbances increase with age and are predictors of mortality. Here, we present deep neural networks that estimate age and mortality risk through polysomnograms (PSGs). Aging was modeled using 2500 PSGs and tested in 10,699 PSGs from men and women in seven different cohorts aged between 20 and 90. Ages were estimated with a mean absolute error of 5.8 ± 1.6 years, while basic sleep scoring measures had an error of 14.9 ± 6.29 years. After controlling for demographics, sleep, and health covariates, each 10-year increment in age estimate error (AEE) was associated with increased all-cause mortality rate of 29% (95% confidence interval: 20-39%). An increase from -10 to +10 years in AEE translates to an estimated decreased life expectancy of 8.7 years (95% confidence interval: 6.1-11.4 years). Greater AEE was mostly reflected in increased sleep fragmentation, suggesting this is an important biomarker of future health independent of sleep apnea.
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Affiliation(s)
- Andreas Brink-Kjaer
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark.
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Denmark.
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA, USA.
| | - Eileen B Leary
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA, USA
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Katie L Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Paul E Peppard
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Nancy E Lane
- Department of Medicine, University of Davis School of Medicine, Sacramento, CA, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Susan Redline
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Denmark
| | - Helge B D Sorensen
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA, USA.
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Iranzo A, Ramos LA, Novo S. The Isolated Form of Rapid Eye Movement Sleep Behavior Disorder: The Upcoming Challenges. Sleep Med Clin 2021; 16:335-348. [PMID: 33985658 DOI: 10.1016/j.jsmc.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diagnosis of rapid eye movement (REM) sleep behavior disorder (SBD) requires videopolysomnography detection of excessive electromyographic activity during REM sleep, which is time consuming and difficult. An easier, faster, reliable, and reproducible methodology is needed for its diagnosis. The isolated form of RBD represents an early manifestation of the synucleinopathies Parkinson disease and dementia with Lewy bodies. There is a need to find neuroprotective drugs capable of preventing parkinsonism and dementia onset in isolated RBD. Clonazepam and melatonin ameliorate the RBD symptoms, but therapeutic alternatives are needed when these medications fail or show produce side effects.
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Affiliation(s)
- Alex Iranzo
- Neurology Service, Sleep Disorders Center, Hospital Clinic de Barcelona, CIBERNED, IDIBAPS, University of Barcelona, Spain.
| | - Lina Agudelo Ramos
- Neurology Service, Instituto Neurológico de Colombia (INDEC), Calle 55, 46-36, Medellín 050012, Colombia
| | - Sabela Novo
- Instituto de Investigaciones del Sueño, Calle Padre Damián, 44, Madrid 28036, Spain; Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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Teigen LN, Sharp RR, Hirsch JR, Campbell E, Timm PC, Sandness DJ, Feemster JC, Gossard TR, Faber SM, Steele TA, Rivera S, Junna MR, Lipford MC, Tippmann-Peikert M, Kotagal S, Ju YE, Howell M, Schenck CH, Videnovic A, Jennum P, Hogl B, Stefani A, Arnulf I, Heidbreder A, Lewis S, McCarter SJ, Boeve BF, Silber MH, St Louis EK. Specialist approaches to prognostic counseling in isolated REM sleep behavior disorder. Sleep Med 2020; 79:107-112. [PMID: 33486257 PMCID: PMC10075000 DOI: 10.1016/j.sleep.2020.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES/BACKGROUND Most middle-aged and older adult patients with isolated (idiopathic) REM sleep behavior disorder (RBD) eventually develop parkinsonism, dementia with Lewy bodies, or multiple system atrophy. We aimed to describe the current sleep medicine specialist approach toward RBD prognostic counseling, and to determine physician beliefs and characteristics that impact provision of counseling. PATIENTS/METHODS We surveyed 70 sleep medicine physicians with RBD expertise for demographic information, counseling practices, and their beliefs and understandings concerning the association between RBD and synucleinopathies, among other questions. Responses were summarized by descriptive statistics. RESULTS Among the 44 respondents (63% response rate), 41 (93.2%) regularly provided prognostic counseling for most RBD patients, but only 31.8% routinely asked about patient preferences on receiving counseling. 41.8% believed that the risk for developing overt synucleinopathy following RBD diagnosis was >80%, but only 15.9% routinely provided this detailed phenoconversion risk estimate to their patients. Most respondents were concerned that RBD prognostic counseling could adversely impact on the patient's and family's mental health. CONCLUSIONS Most expert RBD sleep clinicians routinely counsel their patients regarding the high risk for phenoconversion to parkinsonism or dementia, yet relatively few routinely ask patients about their preferences for receiving this information, and fewer provide details concerning the known high risk estimates for developing a synucleinopathy. Future research should analyze patients' values and preferences in RBD populations to inform approaches toward shared decision making for RBD prognostic counseling.
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Affiliation(s)
- Luke N Teigen
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jessica R Hirsch
- Biomedical Ethics Research Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Emmaling Campbell
- Biomedical Ethics Research Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; University of South Carolina, USA
| | - Paul C Timm
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - David J Sandness
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - John C Feemster
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Thomas R Gossard
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sarah M Faber
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Tyler A Steele
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; University of Minnesota-Rochester, Rochester, MN, USA
| | - Sonia Rivera
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; University of Minnesota-Rochester, Rochester, MN, USA
| | - Mithri R Junna
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Melissa C Lipford
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Maja Tippmann-Peikert
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Suresh Kotagal
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Yo-El Ju
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Michael Howell
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, And Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Poul Jennum
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgit Hogl
- Department of Neurology, University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, University of Innsbruck, Innsbruck, Austria
| | - Isabelle Arnulf
- Pitie Salpetriere Hopital and Sorbonne University, Paris, France
| | - Anna Heidbreder
- Department of Neurology, University of Innsbruck, Innsbruck, Austria; Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Simon Lewis
- Department of Neurology, University of Sidney, Sidney, Australia
| | - Stuart J McCarter
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michael H Silber
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; Biomedical Ethics Research Program, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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