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Alqudah AM, Elwali A, Kupiak B, Hajipour F, Jacobson N, Moussavi Z. Obstructive sleep apnea detection during wakefulness: a comprehensive methodological review. Med Biol Eng Comput 2024; 62:1277-1311. [PMID: 38279078 PMCID: PMC11021303 DOI: 10.1007/s11517-024-03020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/11/2024] [Indexed: 01/28/2024]
Abstract
Obstructive sleep apnea (OSA) is a chronic condition affecting up to 1 billion people, globally. Despite this spread, OSA is still thought to be underdiagnosed. Lack of diagnosis is largely attributed to the high cost, resource-intensive, and time-consuming nature of existing diagnostic technologies during sleep. As individuals with OSA do not show many symptoms other than daytime sleepiness, predicting OSA while the individual is awake (wakefulness) is quite challenging. However, research especially in the last decade has shown promising results for quick and accurate methodologies to predict OSA during wakefulness. Furthermore, advances in machine learning algorithms offer new ways to analyze the measured data with more precision. With a widening research outlook, the present review compares methodologies for OSA screening during wakefulness, and recommendations are made for avenues of future research and study designs.
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Affiliation(s)
- Ali Mohammad Alqudah
- Biomedical Engineering Program, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada
| | - Ahmed Elwali
- Biomedical Engineering Program, Marian University, 3200 Cold Sprint Road, Indianapolis, IN, 46222-1997, USA
| | - Brendan Kupiak
- Electrical and Computer Engineering Department, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada
| | | | - Natasha Jacobson
- Biosystems Engineering Department, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada
| | - Zahra Moussavi
- Biomedical Engineering Program, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada.
- Electrical and Computer Engineering Department, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada.
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Predicting Polysomnography Parameters from Anthropometric Features and Breathing Sounds Recorded during Wakefulness. Diagnostics (Basel) 2021; 11:diagnostics11050905. [PMID: 34069566 PMCID: PMC8160906 DOI: 10.3390/diagnostics11050905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The apnea/hypopnea index (AHI) is the primary outcome of a polysomnography assessment (PSG) for determining obstructive sleep apnea (OSA) severity. However, other OSA severity parameters (i.e., total arousal index, mean oxygen saturation (SpO2%), etc.) are crucial for a full diagnosis of OSA and deciding on a treatment option. PSG assessments and home sleep tests measure these parameters, but there is no screening tool to estimate or predict the OSA severity parameters other than the AHI. In this study, we investigated whether a combination of breathing sounds recorded during wakefulness and anthropometric features could be predictive of PSG parameters. METHODS Anthropometric information and five tracheal breathing sound cycles were recorded during wakefulness from 145 individuals referred to an overnight PSG study. The dataset was divided into training, validation, and blind testing datasets. Spectral and bispectral features of the sounds were evaluated to run correlation and classification analyses with the PSG parameters collected from the PSG sleep reports. RESULTS Many sound and anthropometric features had significant correlations (up to 0.56) with PSG parameters. Using combinations of sound and anthropometric features in a bilinear model for each PSG parameter resulted in correlation coefficients up to 0.84. Using the evaluated models for classification with a two-class random-forest classifier resulted in a blind testing classification accuracy up to 88.8% for predicting the key PSG parameters such as arousal index. CONCLUSIONS These results add new value to the current OSA screening tools and provide a new promising possibility for predicting PSG parameters using only a few seconds of breathing sounds recorded during wakefulness without conducting an overnight PSG study.
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A comparison of regularized logistic regression and random forest machine learning models for daytime diagnosis of obstructive sleep apnea. Med Biol Eng Comput 2020; 58:2517-2529. [PMID: 32803448 DOI: 10.1007/s11517-020-02206-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 05/23/2020] [Indexed: 12/23/2022]
Abstract
A major challenge in big and high-dimensional data analysis is related to the classification and prediction of the variables of interest by characterizing the relationships between the characteristic factors and predictors. This study aims to assess the utility of two important machine-learning techniques to classify subjects with obstructive sleep apnea (OSA) using their daytime tracheal breathing sounds. We evaluate and compare the performance of the random forest (RF) and regularized logistic regression (LR) as feature selection tools and classification approaches for wakefulness OSA screening. Results show that the RF, which is a low-variance committee-based approach, outperforms the regularized LR in terms of blind-testing accuracy, specificity, and sensitivity with 3.5%, 2.4%, and 3.7% improvement, respectively. However, the regularized LR was found to be faster than the RF and resulted in a more parsimonious model. Consequently, both the RF and regularized LR feature reduction and classification approaches are qualified to be applied for the daytime OSA screening studies, depending on the nature of data and applications' purposes. Graphical Abstract.
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Montazeri Ghahjaverestan N, Akbarian S, Hafezi M, Saha S, Zhu K, Gavrilovic B, Taati B, Yadollahi A. Sleep/Wakefulness Detection Using Tracheal Sounds and Movements. Nat Sci Sleep 2020; 12:1009-1021. [PMID: 33235534 PMCID: PMC7680175 DOI: 10.2147/nss.s276107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The current gold standard to detect sleep/wakefulness is based on electroencephalogram, which is inconvenient if included in portable sleep screening devices. Therefore, a challenge in the portable devices is sleeping time estimation. Without sleeping time, sleep parameters such as apnea/hypopnea index (AHI), an index for quantifying sleep apnea severity, can be underestimated. Recent studies have used tracheal sounds and movements for sleep screening and calculating AHI without considering sleeping time. In this study, we investigated the detection of sleep/wakefulness states and estimation of sleep parameters using tracheal sounds and movements. MATERIALS AND METHODS Participants with suspected sleep apnea who were referred for sleep screening were included in this study. Simultaneously with polysomnography, tracheal sounds and movements were recorded with a small wearable device, called the Patch, attached over the trachea. Each 30-second epoch of tracheal data was scored as sleep or wakefulness using an automatic classification algorithm. The performance of the algorithm was compared to the sleep/wakefulness scored blindly based on the polysomnography. RESULTS Eighty-eight subjects were included in this study. The accuracy of sleep/wakefulness detection was 82.3±8.66% with a sensitivity of 87.8±10.8 % (sleep), specificity of 71.4±18.5% (awake), F1 of 88.1±9.3% and Cohen's kappa of 0.54. The correlations between the estimated and polysomnography-based measures for total sleep time and sleep efficiency were 0.78 (p<0.001) and 0.70 (p<0.001), respectively. CONCLUSION Sleep/wakefulness periods can be detected using tracheal sound and movements. The results of this study combined with our previous studies on screening sleep apnea with tracheal sounds provide strong evidence that respiratory sounds analysis can be used to develop robust, convenient and cost-effective portable devices for sleep apnea monitoring.
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Affiliation(s)
- Nasim Montazeri Ghahjaverestan
- Kite - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Sina Akbarian
- Kite - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Maziar Hafezi
- Kite - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Shumit Saha
- Kite - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Kaiyin Zhu
- Kite - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Bojan Gavrilovic
- Kite - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Babak Taati
- Kite - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Computer Science, University of Toronto, Toronto, ON, Canada
| | - Azadeh Yadollahi
- Kite - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Regularized logistic regression for obstructive sleep apnea screening during wakefulness using daytime tracheal breathing sounds and anthropometric information. Med Biol Eng Comput 2019; 57:2641-2655. [PMID: 31696438 DOI: 10.1007/s11517-019-02052-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/27/2019] [Indexed: 12/23/2022]
Abstract
Obstructive sleep apnea (OSA) is a prevalent health problem. Developing a technology for quick OSA screening is momentous. In this study, we used regularized logistic regression to predict the OSA severity level of 199 individuals (116 males) with apnea/hypopnea index (AHI) ≥ 15 (moderate/severe OSA) and AHI < 5 (non-OSA) using their tracheal breathing sounds (TBS) recorded during daytime, while they were awake. The participants were guided to breathe through their nose, and then through their mouth at their deep breathing rate. The least absolute shrinkage and selection operator (LASSO) feature selection approach was used to select the discriminative features from the power spectra of the TBS and the anthropometric information. Using a five-fold cross-validation procedure, five different training sets and their corresponding blind-testing sets were formed. The average blind-testing classification accuracy over the five different folds was found to be 79.3% ± 6.1 with the sensitivity (specificity) of 82.2% ± 7.2% (75.8% ± 9.9%). The accuracy for the entire dataset was found to be 81.1% with sensitivity (specificity) of 84.4% (77.0%). The feature selection and classification procedures were intelligible and fast. The selected features were physiologically meaningful. Overall, the results show that TBS analysis can be used as a quick and reliable prediction of the presence and severity of OSA during wakefulness without a sleep study. Graphical abstract Wakefulness screening of obstructive sleep apnea using tracheal breathing sounds and anthropometric information by means of regularized logistic regression with the least absolute shrinkage and selection operator approach for feature selection and classification.
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Elwali A, Moussavi Z. A Novel Decision Making Procedure during Wakefulness for Screening Obstructive Sleep Apnea using Anthropometric Information and Tracheal Breathing Sounds. Sci Rep 2019; 9:11467. [PMID: 31391528 PMCID: PMC6685971 DOI: 10.1038/s41598-019-47998-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/18/2019] [Indexed: 11/19/2022] Open
Abstract
Obstructive sleep apnea (OSA) is an underdiagnosed common disorder. Undiagnosed OSA, in particular, increases the perioperative morbidity and mortality risks for OSA patients undergoing surgery requiring full anesthesia. OSA screening using the gold standard, Polysomnography (PSG), is expensive and time-consuming. This study offers an objective and accurate tool for screening OSA during wakefulness by a few minutes of breathing sounds recording. Our proposed algorithm (AWakeOSA) extracts an optimized set (3-4) of breathing sound features specific to each anthropometric feature (i.e. age, sex, etc.) for each subject. These personalized group (e.g. age) classification features are then used to determine OSA severity in the test subject for that anthropomorphic parameter. Each of the anthropomorphic parameter classifications is weighted and summed to produce a final OSA severity classification. The tracheal breathing sounds of 199 individuals (109 with apnea/hypopnea index (AHI) < 15 as non-OSA and 90 with AHI ≥ 15 as moderate/severe-OSA) were recorded during wakefulness in the supine position. The sound features sensitive to OSA were extracted from a training set (n = 100). The rest were used as a blind test dataset. Using Random-Forest classification, the training dataset was shuffled 1200-6000 times to avoid any training bias. This routine resulted in 81.4%, 80.9%, and 82.1% classification accuracy, sensitivity, and specificity, respectively, on the blind-test dataset which was similar to the results for the out-of-bag-validation applied to the training dataset. These results provide a proof of concept for AWakeOSA algorithm as an accurate, reliable and quick OSA screening tool that can be done in less than 10 minutes during wakefulness.
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Affiliation(s)
- Ahmed Elwali
- Biomedical Engineering, University of Manitoba, Winnipeg, Canada
| | - Zahra Moussavi
- Biomedical Engineering, University of Manitoba, Winnipeg, Canada.
- Electrical and Computer Engineering, University of Manitoba, Winnipeg, Canada.
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Elwali A, Moussavi Z. Determining Breathing Sound Features Representative of Obstructive Sleep Apnea During Wakefulness with Least Sensitivity to Other Risk Factors. J Med Biol Eng 2018. [DOI: 10.1007/s40846-018-0410-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
Tracheal sounds have been the subject of many research studies. In this review, we describe the state of the art, original work relevant to upper airways obstruction during sleep, and ongoing research concerning the methods used when analysing tracheal sounds. Tracheal sound sensors are a simple and noninvasive means of measurement and are more reliable than other breathing sensors. Developments in acoustic processing techniques and enhancements in tracheal sound signals over the past decade have led to improvements in the accuracy and clinical relevance of diagnoses based on this technology. Past and current research suggests that they may have a significant role in the diagnosis of obstructive sleep apnoea. Tracheal sounds analysis may have a significant role in the diagnosis of obstructive sleep apnoeahttp://ow.ly/f7ax30cAcnP
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Affiliation(s)
- Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Jung DW, Hwang SH, Lee YJ, Jeong DU, Park KS. Apnea–Hypopnea Index Prediction Using Electrocardiogram Acquired During the Sleep-Onset Period. IEEE Trans Biomed Eng 2017; 64:295-301. [DOI: 10.1109/tbme.2016.2554138] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Espinoza-Cuadros F, Fernández-Pozo R, Toledano DT, Alcázar-Ramírez JD, López-Gonzalo E, Hernández-Gómez LA. Speech Signal and Facial Image Processing for Obstructive Sleep Apnea Assessment. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:489761. [PMID: 26664493 PMCID: PMC4664800 DOI: 10.1155/2015/489761] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/15/2015] [Accepted: 10/20/2015] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder characterized by recurring breathing pauses during sleep caused by a blockage of the upper airway (UA). OSA is generally diagnosed through a costly procedure requiring an overnight stay of the patient at the hospital. This has led to proposing less costly procedures based on the analysis of patients' facial images and voice recordings to help in OSA detection and severity assessment. In this paper we investigate the use of both image and speech processing to estimate the apnea-hypopnea index, AHI (which describes the severity of the condition), over a population of 285 male Spanish subjects suspected to suffer from OSA and referred to a Sleep Disorders Unit. Photographs and voice recordings were collected in a supervised but not highly controlled way trying to test a scenario close to an OSA assessment application running on a mobile device (i.e., smartphones or tablets). Spectral information in speech utterances is modeled by a state-of-the-art low-dimensional acoustic representation, called i-vector. A set of local craniofacial features related to OSA are extracted from images after detecting facial landmarks using Active Appearance Models (AAMs). Support vector regression (SVR) is applied on facial features and i-vectors to estimate the AHI.
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Affiliation(s)
| | - Rubén Fernández-Pozo
- GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Doroteo T. Toledano
- ATVS Biometric Recognition Group, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Eduardo López-Gonzalo
- GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Luis A. Hernández-Gómez
- GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, 28040 Madrid, Spain
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Moussavi Z, Elwali A, Soltanzadeh R, MacGregor CA, Lithgow B. Breathing sounds characteristics correlate with structural changes of upper airway due to obstructive sleep apnea. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:5956-5959. [PMID: 26737648 DOI: 10.1109/embc.2015.7319748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper reports on a pilot study of acoustic properties of respiratory sounds in relation to obstructive sleep apnea (OSA). Data were breathing sounds of 60 individuals in three groups of non-, Moderate and Severe OSA using the apnea/hypopnea index (AHI) (20 in each group). The sounds power spectral energy and phase responses were calculated for each respiratory phase, and investigated among the groups. The results of power spectral analysis, congruent with imaging studies' findings, suggest a regional narrowing in upper airway that shows its effect in low and high frequencies as an opposite pattern between the OSA and non-OSA groups. The results of phase analysis also support an increased nonlinearity in high frequencies that is speculated to be related to the regional narrowing and thus regional elasticity of the airway during wakefulness.
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