Sleep and wake classification with actigraphy and respiratory effort using dynamic warping

Central venous pressure waveform analysis during sleep/rest: a novel approach to enhance intensive care unit post-extubation monitoring of extubation failure

This pilot study aimed to investigate the relation between cardio-respiratory parameters derived from Central Venous Pressure (CVP) waveform and Extubation Failure (EF) in mechanically ventilated ICU patients during post-extubation period. This study also proposes a new methodology for analysing these parameters during rest/sleep periods to try to improve the identification of EF. We conducted a prospective observational study, computing CVP-derived parameters including breathing effort, spectral analyses, and entropy in twenty critically ill patients post-extubation. The Dynamic Warping Index (DWi) was calculated from the respiratory component extracted from the CVP signal to identify rest/sleep states. The obtained parameters from EF patients and patients without EF were compared both during arbitrary periods and during reduced DWi (rest/sleep). We have analysed data from twenty patients of which nine experienced EF. Our findings may suggest significantly increased respiratory effort in EF patients compared to those successfully extubated. Our study also suggests the occurrence of significant change in the frequency dispersion of the cardiac signal component. We also identified a possible improvement in the differentiation between the two groups of patients when assessed during rest/sleep states. Although with caveats regarding the sample size, the results of this pilot study may suggest that CVP-derived cardio-respiratory parameters are valuable for monitoring respiratory failure during post-extubation, which could aid in managing non-invasive interventions and possibly reduce the incidence of EF. Our findings also indicate the possible importance of considering sleep/rest state when assessing cardio-respiratory parameters, which could enhance respiratory failure detection/monitoring.

Multisensor Integrated Platform Based on MEMS Charge Variation Sensing Technology for Biopotential Acquisition

We propose a new methodology for long-term biopotential recording based on an MEMS multisensor integrated platform featuring a commercial electrostatic charge-transfer sensor. This family of sensors was originally intended for presence tracking in the automotive industry, so the existing setup was engineered for the acquisition of electrocardiograms, electroencephalograms, electrooculograms, and electromyography, designing a dedicated front-end and writing proper firmware for the specific application. Systematic tests on controls and nocturnal acquisitions from patients in a domestic environment will be discussed in detail. The excellent results indicate that this technology can provide a low-power, unexplored solution to biopotential acquisition. The technological breakthrough is in that it enables adding this type of functionality to existing MEMS boards at near-zero additional power consumption. For these reasons, it opens up additional possibilities for wearable sensors and strengthens the role of MEMS technology in medical wearables for the long-term synchronous acquisition of a wide range of signals.

Combining Cardiorespiratory Signals and Video-Based Actigraphy for Classifying Preterm Infant Sleep States

The classification of sleep state in preterm infants, particularly in distinguishing between active sleep (AS) and quiet sleep (QS), has been investigated using cardiorespiratory information such as electrocardiography (ECG) and respiratory signals. However, accurately differentiating between AS and wake remains challenging; therefore, there is a pressing need to include additional information to further enhance the classification performance. To address the challenge, this study explores the effectiveness of incorporating video-based actigraphy analysis alongside cardiorespiratory signals for classifying the sleep states of preterm infants. The study enrolled eight preterm infants, and a total of 91 features were extracted from ECG, respiratory signals, and video-based actigraphy. By employing an extremely randomized trees (ET) algorithm and leave-one-subject-out cross-validation, a kappa score of 0.33 was achieved for the classification of AS, QS, and wake using cardiorespiratory features only. The kappa score significantly improved to 0.39 when incorporating eight video-based actigraphy features. Furthermore, the classification performance of AS and wake also improved, showing a kappa score increase of 0.21. These suggest that combining video-based actigraphy with cardiorespiratory signals can potentially enhance the performance of sleep-state classification in preterm infants. In addition, we highlighted the distinct strengths and limitations of video-based actigraphy and cardiorespiratory data in classifying specific sleep states.

Age-integrated artificial intelligence framework for sleep stage classification and obstructive sleep apnea screening

Introduction

Sleep is an essential function to sustain a healthy life, and sleep dysfunction can cause various physical and mental issues. In particular, obstructive sleep apnea (OSA) is one of the most common sleep disorders and, if not treated in a timely manner, OSA can lead to critical problems such as hypertension or heart disease.

Methods

The first crucial step in evaluating individuals' quality of sleep and diagnosing sleep disorders is to classify sleep stages using polysomnographic (PSG) data including electroencephalography (EEG). To date, such sleep stage scoring has been mainly performed manually via visual inspection by experts, which is not only a time-consuming and laborious process but also may yield subjective results. Therefore, we have developed a computational framework that enables automatic sleep stage classification utilizing the power spectral density (PSD) features of sleep EEG based on three different learning algorithms: support vector machine, k-nearest neighbors, and multilayer perceptron (MLP). In particular, we propose an integrated artificial intelligence (AI) framework to further inform the risk of OSA based on the characteristics in automatically scored sleep stages. Given the previous finding that the characteristics of sleep EEG differ by age group, we employed a strategy of training age-specific models (younger and older groups) and a general model and comparing their performance.

Results

The performance of the younger age-specific group model was similar to that of the general model (and even higher than the general model at certain stages), but the performance of the older age-specific group model was rather low, suggesting that bias in individual variables, such as age bias, should be considered during model training. Our integrated model yielded an accuracy of 73% in sleep stage classification and 73% in OSA screening when MLP algorithm was applied, which indicates that patients with OSA could be screened with the corresponding accuracy level only with sleep EEG without respiration-related measures.

Discussion

The current outcomes demonstrate the feasibility of AI-based computational studies that when combined with advances in wearable devices and relevant technologies could contribute to personalized medicine by not only assessing an individuals' sleep status conveniently at home but also by alerting them to the risk of sleep disorders and enabling early intervention.

An automated heart rate-based algorithm for sleep stage classification: Validation using conventional polysomnography and an innovative wearable electrocardiogram device

Background

The rapid advancement in wearable solutions to monitor and score sleep staging has enabled monitoring outside of the conventional clinical settings. However, most of the devices and algorithms lack extensive and independent validation, a fundamental step to ensure robustness, stability, and replicability of the results beyond the training and testing phases. These systems are thought not to be feasible and reliable alternatives to the gold standard, polysomnography (PSG).

Materials and methods

This validation study highlights the accuracy and precision of the proposed heart rate (HR)-based deep-learning algorithm for sleep staging. The illustrated solution can perform classification at 2-levels (Wake; Sleep), 3-levels (Wake; NREM; REM) or 4- levels (Wake; Light; Deep; REM) in 30-s epochs. The algorithm was validated using an open-source dataset of PSG recordings (Physionet CinC dataset, n = 994 participants, 994 recordings) and a proprietary dataset of ECG recordings (Z3Pulse, n = 52 participants, 112 recordings) collected with a chest-worn, wireless sensor and simultaneous PSG collection using SOMNOtouch.

Results

We evaluated the performance of the models in both datasets in terms of Accuracy (A), Cohen's kappa (K), Sensitivity (SE), Specificity (SP), Positive Predictive Value (PPV), and Negative Predicted Value (NPV). In the CinC dataset, the highest value of accuracy was achieved by the 2-levels model (0.8797), while the 3-levels model obtained the best value of K (0.6025). The 4-levels model obtained the lowest SE (0.3812) and the highest SP (0.9744) for the classification of Deep sleep segments. AHI and biological sex did not affect scoring, while a significant decrease of performance by age was reported across the models. In the Z3Pulse dataset, the highest value of accuracy was achieved by the 2-levels model (0.8812), whereas the 3-levels model obtained the best value of K (0.611). For classification of the sleep states, the lowest SE (0.6163) and the highest SP (0.9606) were obtained for the classification of Deep sleep segment.

Conclusion

The results of the validation procedure demonstrated the feasibility of accurate HR-based sleep staging. The combination of the proposed sleep staging algorithm with an inexpensive HR device, provides a cost-effective and non-invasive solution deployable in the home environment and robust across age, sex, and AHI scores.

Objective sleep assessments for healthy people in environmental research: A literature review

To date, although many studies had focused on the impact of environmental factors on sleep, how to choose the proper assessment method for objective sleep quality was often ignored, especially for healthy subjects in bedroom environment. In order to provide methodological guidance for future research, this paper reviewed the assessments of objective sleep quality applied in environmental researches, compared them from the perspective of accuracy and interference, and statistically analyzed the impact of experimental type and subjects' information on method selection. The review results showed that, in contrast to polysomnography (PSG), the accuracy of actigraphy (ACT), respiratory monitoring-oxygen saturation monitoring (RM-OSM), and electrocardiograph (ECG) could reach up to 97%, 80.38%, and 79.95%, respectively. In terms of sleep staging, PSG and ECG performed the best, ACT the second, and RM-OSM the worst; as compared to single methods, mix methods were more accurate and better at sleep staging. PSG interfered with sleep a great deal, while ECG and ACT could be non-contact, and thus, the least interference with sleep was present. The type of experiment significantly influenced the choice of assessment method (p < 0.001), 85.3% of researchers chose PSG in laboratory study while 82.5% ACT in field study; moreover, PSG was often used in a relatively small number of young subjects, while ACT had a wide applicable population. In general, researchers need to pay more attention at selection of assessments in future studies, and this review can be used as a reliable reference for experimental design.

A jerk-based algorithm ACCEL for the accurate classification of sleep–wake states from arm acceleration

Arm acceleration data have been used to measure sleep–wake rhythmicity. Although several methods have been developed for the accurate classification of sleep–wake episodes, a method with both high sensitivity and specificity has not been fully established. In this study, we developed an algorithm, named ACceleration-based Classification and Estimation of Long-term sleep–wake cycles (ACCEL) that classifies sleep and wake episodes using only raw accelerometer data, without relying on device-specific functions. The algorithm uses a derivative of triaxial acceleration (jerk), which can reduce individual differences in the variability of acceleration data. Applying a machine learning algorithm to the jerk data achieved sleep–wake classification with a high sensitivity (>90%) and specificity (>80%). A jerk-based analysis also succeeded in recording periodic activities consistent with pulse waves. Therefore, the ACCEL algorithm will be a useful method for large-scale sleep measurement using simple accelerometers in real-world settings.

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An algorithm for sleep-wake classification based on arm acceleration is presented

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The algorithm only uses a derivative of triaxial arm acceleration (jerk)

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The algorithm can accurately detect temporal awake during sleep

Validation of actigraphy for sleep measurement in children with cerebral palsy

Objectives:

Sleep issues are common in children with cerebral palsy (CP), although there are challenges in obtaining objective data about their sleep patterns. Actigraphs measure movement to quantify sleep but their accuracy in children with CP is unknown. Our goals were to validate actigraphy for sleep assessment in children with CP and to study their sleep patterns in a cross-sectional cohort study. Methods: We recruited children with (N = 13) and without (N = 13) CP aged 2–17 years (mean age 9 y 11mo [SD 4 y 10mo] range 4–17 y; 17 males, 9 females; 54% spastic quadriplegic, 23% spastic diplegic, 15% spastic hemiplegic, 8% unclassified CP). We obtained wrist and forehead actigraphy with concurrent polysomnography for one night, and home wrist actigraphy for one week. We developed actigraphy algorithms and evaluated their accuracy (agreement with polysomnography-determined sleep versus wake staging), sensitivity (sleep detection), and specificity (wake detection).

Results:

Our actigraphy algorithms had median 72–80% accuracy, 87–91% sensitivity, and 60–71% specificity in children with CP and 86–89% accuracy, 88–92% sensitivity, and 70–75% specificity in children without CP, with similar accuracies in wrist and forehead locations. Our algorithms had increased specificity and accuracy compared to existing algorithms, facilitating detection of sleep disruption. Children with CP showed lower sleep efficiency and duration than children without CP.

Conclusions:

Actigraphy is a valid tool for sleep assessment in children with CP. Children with CP have worse sleep efficiency and duration.

Wavelet-Based Biphase Analysis of Brain Rhythms in Automated Wake-Sleep Classification

Many studies in the field of sleep have focused on connectivity and coherence. Still, the nonstationary nature of electroencephalography (EEG) makes many of the previous methods unsuitable for automatic sleep detection. Time-frequency representations and high-order spectra are applied to nonstationary signal analysis and nonlinearity investigation, respectively. Therefore, combining wavelet and bispectrum, wavelet-based bi-phase (Wbiph) was proposed and used as a novel feature for sleep-wake classification. The results of the statistical analysis with emphasis on the importance of the gamma rhythm in sleep detection show that the Wbiph is more potent than coherence in the wake-sleep classification. The Wbiph has not been used in sleep studies before. However, the results and inherent advantages, such as the use of wavelet and bispectrum in its definition, suggest it as an excellent alternative to coherence. In the next part of this paper, a convolutional neural network (CNN) classifier was applied for the sleep-wake classification by Wbiph. The classification accuracy was 97.17% in nonLOSO and 95.48% in LOSO cross-validation, which is the best among previous studies on sleep-wake classification.

An Attention Based CNN-LSTM Approach for Sleep-Wake Detection With Heterogeneous Sensors

In this article, we propose an attention based convolutional neural network long short-term memory (CNN-LSTM) approach for sleep-wake detection with heterogeneous sensor data, i.e., acceleration and heart rate variability (HRV). Since the three-dimensional acceleration data was sampled with a high frequency, we firstly design a CNN-LSTM structure to effectively learn latent features from the acceleration. Meanwhile, considering the unique format of the HRV data, some effective features are extracted based on domain knowledge. Next, we design a unified architecture to efficiently merge the features learned by CNN-LSTM approach from the acceleration and the extracted features from the HRV, which enables us to make full use of all the available information from these two heterogeneous sources. Taking into consideration that these two heterogeneous sources may have distinct contributions for the sleep and wake states, we propose an attention network to dynamically adjust the importance of features from the two sources. Real-world experiments have been conducted to verify the effectiveness of the proposed approach for sleep-wake detection. The results demonstrate that the proposed method outperforms all existing approaches for sleep-wake classification. In the evaluation of leave-one-subject-out (LOSO) cross-validation which is more challenging and practical, the proposed method achieves remarkable improvements ranging from 5% to 46% over the benchmark approaches.

A Systematic Review of Sensing Technologies for Wearable Sleep Staging

Designing wearable systems for sleep detection and staging is extremely challenging due to the numerous constraints associated with sensing, usability, accuracy, and regulatory requirements. Several researchers have explored the use of signals from a subset of sensors that are used in polysomnography (PSG), whereas others have demonstrated the feasibility of using alternative sensing modalities. In this paper, a systematic review of the different sensing modalities that have been used for wearable sleep staging is presented. Based on a review of 90 papers, 13 different sensing modalities are identified. Each sensing modality is explored to identify signals that can be obtained from it, the sleep stages that can be reliably identified, the classification accuracy of systems and methods using the sensing modality, as well as the usability constraints of the sensor in a wearable system. It concludes that the two most common sensing modalities in use are those based on electroencephalography (EEG) and photoplethysmography (PPG). EEG-based systems are the most accurate, with EEG being the only sensing modality capable of identifying all the stages of sleep. PPG-based systems are much simpler to use and better suited for wearable monitoring but are unable to identify all the sleep stages.

Multimodal Signal Analysis for Pain Recognition in Physiotherapy Using Wavelet Scattering Transform

Fascial therapy is an effective, yet painful, procedure. Information about pain level is essential for the physiotherapist to adjust the therapy course and avoid potential tissue damage. We have developed a method for automatic pain-related reaction assessment in physiotherapy due to the subjectivity of a self-report. Based on a multimodal data set, we determine the feature vector, including wavelet scattering transforms coefficients. The AdaBoost classification model distinguishes three levels of reaction (no-pain, moderate pain, and severe pain). Because patients vary in pain reactions and pain resistance, our survey assumes a subject-dependent protocol. The results reflect an individual perception of pain in patients. They also show that multiclass evaluation outperforms the binary recognition.

A review on current trends in automatic sleep staging through bio-signal recordings and future challenges

Sleep staging is a vital process conducted in order to analyze polysomnographic data. To facilitate prompt interpretation of these recordings, many automatic sleep staging methods have been proposed. These methods rely on bio-signal recordings, which include electroencephalography, electrocardiography, electromyography, electrooculography, respiratory, pulse oximetry and others. However, advanced, uncomplicated and swift sleep-staging-evaluation is still needed in order to improve the existing polysomnographic data interpretation. The present review focuses on automatic sleep staging methods through bio-signal recording including current and future challenges.

Wearable monitoring of sleep-disordered breathing: estimation of the apnea-hypopnea index using wrist-worn reflective photoplethysmography

A large part of the worldwide population suffers from obstructive sleep apnea (OSA), a disorder impairing the restorative function of sleep and constituting a risk factor for several cardiovascular pathologies. The standard diagnostic metric to define OSA is the apnea-hypopnea index (AHI), typically obtained by manually annotating polysomnographic recordings. However, this clinical procedure cannot be employed for screening and for long-term monitoring of OSA due to its obtrusiveness and cost. Here, we propose an automatic unobtrusive AHI estimation method fully based on wrist-worn reflective photoplethysmography (rPPG), employing a deep learning model exploiting cardiorespiratory and sleep information extracted from the rPPG signal trained with 250 recordings. We tested our method with an independent set of 188 heterogeneously disordered clinical recordings and we found it estimates the AHI with a good agreement to the gold standard polysomnography reference (correlation = 0.61, estimation error = 3±10 events/h). The estimated AHI was shown to reliably assess OSA severity (weighted Cohen's kappa = 0.51) and screen for OSA (ROC-AUC = 0.84/0.86/0.85 for mild/moderate/severe OSA). These findings suggest that wrist-worn rPPG measurements that can be implemented in wearables such as smartwatches, have the potential to complement standard OSA diagnostic techniques by allowing unobtrusive sleep and respiratory monitoring.

Respiratory activity extracted from wrist-worn reflective photoplethysmography in a sleep-disordered population

OBJECTIVE

Respiratory activity is an essential parameter to monitor healthy and disordered sleep, and unobtrusive measurement methods have important clinical applications in diagnostics of sleep-related breathing disorders. We propose a respiratory activity surrogate extracted from wrist-worn reflective photoplethysmography validated on a heterogeneous dataset of 389 sleep recordings.

APPROACH

The surrogate was extracted by interpolating the amplitude of the PPG pulses after evaluation of pulse morphological quality. Subsequent multistep post-processing was applied to remove parts of the surrogate with low quality and high motion levels. In addition to standard respiration rate performance, we evaluated the similarity between surrogate respiratory activity and reference inductance plethysmography of the thorax, using Spearman's correlations and spectral coherence, and assessed the influence of PPG signal quality, motion levels, sleep stages and obstructive sleep apnea.

MAIN RESULTS

Prior to post-processing, the surrogate already had a strong similarity with the reference (correlation = 0.54, coherence = 0.81), and reached respiration rate estimation performance in line with the literature (estimation error = 0.76± 2.11 breaths/min). Detrimental effects of low PPG quality, high motion levels and sleep-dependent physiological phenomena were significantly mitigated by the proposed post-processing steps (correlation = 0.62, coherence = 0.88, estimation error = 0.53± 1.85 breaths/min).

SIGNIFICANCE

Wrist-worn PPG can be used to extract respiratory activity, thus allowing respiration monitoring in real-world sleep medicine applications using (consumer) wearable devices.

Non-REM Sleep Marker for Wearable Monitoring: Power Concentration of Respiratory Heart Rate Fluctuation

A variety of heart rate variability (HRV) indices have been reported to estimate sleep stages, but the associations are modest and lacking solid physiological basis. Non-REM (NREM) sleep is associated with increased regularity of respiratory frequency, which results in the concentration of high frequency (HF) HRV power into a narrow frequency range. Using this physiological feature, we developed a new HRV sleep index named Hsi to quantify the degree of HF power concentration. We analyzed 11,636 consecutive 5-min segments of electrocardiographic (ECG) signal of polysomnographic data in 141 subjects and calculated Hsi and conventional HRV indices for each segment. Hsi was greater during NREM (mean [SD], 75.1 [8.3]%) than wake (61.0 [10.3]%) and REM (62.0 [8.4]%) stages. Receiver-operating characteristic curve analysis revealed that Hsi discriminated NREM from wake and REM segments with an area under the curve of 0.86, which was greater than those of heart rate (0.642), peak HF power (0.75), low-to-high frequency ratio (0.77), and scaling exponent α (0.77). With a cutoff >70%, Hsi detected NREM segments with 77% sensitivity, 80% specificity, and a Cohen’s kappa coefficient of 0.57. Hsi may provide an accurate NREM sleep maker for ECG and pulse wave signals obtained from wearable sensors.

Emotional State Recognition from Peripheral Physiological Signals Using Fused Nonlinear Features and Team-Collaboration Identification Strategy

Emotion recognition realizing human inner perception has a very important application prospect in human-computer interaction. In order to improve the accuracy of emotion recognition, a novel method combining fused nonlinear features and team-collaboration identification strategy was proposed for emotion recognition using physiological signals. Four nonlinear features, namely approximate entropy (ApEn), sample entropy (SaEn), fuzzy entropy (FuEn) and wavelet packet entropy (WpEn) are employed to reflect emotional states deeply with each type of physiological signal. Then the features of different physiological signals are fused to represent the emotional states from multiple perspectives. Each classifier has its own advantages and disadvantages. In order to make full use of the advantages of other classifiers and avoid the limitation of single classifier, the team-collaboration model is built and the team-collaboration decision-making mechanism is designed according to the proposed team-collaboration identification strategy which is based on the fusion of support vector machine (SVM), decision tree (DT) and extreme learning machine (ELM). Through analysis, SVM is selected as the main classifier with DT and ELM as auxiliary classifiers. According to the designed decision-making mechanism, the proposed team-collaboration identification strategy can effectively employ different classification methods to make decision based on the characteristics of the samples through SVM classification. For samples which are easy to be identified by SVM, SVM directly determines the identification results, whereas SVM-DT-ELM collaboratively determines the identification results, which can effectively utilize the characteristics of each classifier and improve the classification accuracy. The effectiveness and universality of the proposed method are verified by Augsburg database and database for emotion analysis using physiological (DEAP) signals. The experimental results uniformly indicated that the proposed method combining fused nonlinear features and team-collaboration identification strategy presents better performance than the existing methods.

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.

Video-Based Actigraphy for Monitoring Wake and Sleep in Healthy Infants: A Laboratory Study

Prolonged monitoring of infant sleep is paramount for parents and healthcare professionals for interpreting and evaluating infants’ sleep quality. Wake-sleep patterns are often studied to assess this. Video cameras have received a lot of attention in infant sleep monitoring because they are unobtrusive and easy to use at home. In this paper, we propose a method using motion data detected from infrared video frames (video-based actigraphy) to identify wake and sleep states. The motion, mostly caused by infant body movement, is known to be substantially associated with infant wake and sleep states. Two features were calculated from the video-based actigraphy, and a Bayesian-based linear discriminant classification model was employed to classify the two states. Leave-one-subject-out cross validation was performed to validate our proposed wake and sleep classification model. From a total of 11.6 h of infrared video recordings of 10 healthy term infants in a laboratory pilot study, we achieved a reliable classification performance with a Cohen’s kappa coefficient of 0.733 ± 0.204 (mean ± standard deviation) and an overall accuracy of 92.0% ± 4.6%.

Automated sleep stage classification based on tracheal body sound and actigraphy

The current gold standard for assessment of most sleep disorders is the in-laboratory polysomnography (PSG). This approach produces high costs and inconveniences for the patients. An accessible and simple preliminary screening method to diagnose the most common sleep disorders and to decide whether a PSG is necessary or not is therefore desirable. A minimalistic type-4 monitoring system which utilized tracheal body sound and actigraphy to accurately diagnose the obstructive sleep apnea syndrome was previously developed. To further improve the diagnostic ability of said system, this study aims to examine if it is possible to perform automated sleep staging utilizing body sound to extract cardiorespiratory features and actigraphy to extract movement features.

A linear discriminant classifier based on those features was used for automated sleep staging using the type-4 sleep monitor. For validation 53 subjects underwent a full-night screening at Ulm University Hospital using the developed sleep monitor in addition to polysomnography. To assess sleep stages from PSG, a trained technician manually evaluated EEG, EOG, and EMG recordings.

The classifier reached 86.9% accuracy and a Kappa of 0.69 for sleep/wake classification, 76.3% accuracy and a Kappa of 0.42 for Wake/REM/NREM classification, and 56.5% accuracy and a Kappa of 0.36 for Wake/REM/light sleep/deep sleep classification. For the calculation of sleep efficiency (SE), a coefficient of determination r² of 0.78 is reached. Additionally, subjects were classified into groups of SEs (SE≥40%, SE≥60% and SE≥80%). A Cohen’s Kappa >0.61 was reached for all groups, which is considered as substantial agreement.

The presented method provides satisfactory performance in sleep/wake and wake/REM/NREM sleep staging while maintaining a simple setup and offering high comfort. This minimalistic approach may address the need for a simple yet reliable preliminary sleep screening in an ambulatory setting.

Feature Extraction and Similarity of Movement Detection during Sleep, Based on Higher Order Spectra and Entropy of the Actigraphy Signal: Results of the Hispanic Community Health Study/Study of Latinos

The aim of this work was to develop a new unsupervised exploratory method of characterizing feature extraction and detecting similarity of movement during sleep through actigraphy signals. We here propose some algorithms, based on signal bispectrum and bispectral entropy, to determine the unique features of independent actigraphy signals. Experiments were carried out on 20 randomly chosen actigraphy samples of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) database, with no information other than their aperiodicity. The Pearson correlation coefficient matrix and the histogram correlation matrix were computed to study the similarity of movements during sleep. The results obtained allowed us to explore the connections between certain sleep actigraphy patterns and certain pathologies.

Real-Time Burst Detection in District Metering Areas in Water Distribution System Based on Patterns of Water Demand with Supervised Learning

This paper proposes a new method to detect bursts in District Metering Areas (DMAs) in water distribution systems. The methodology is divided into three steps. Firstly, Dynamic Time Warping was applied to study the similarity of daily water demand, extract different patterns of water demand, and remove abnormal patterns. In the second stage, according to different water demand patterns, a supervised learning algorithm was adopted for burst detection, which established a leakage identification model for each period of time, respectively, using a sliding time window. Finally, the detection process was performed by calculating the abnormal probability of flow during a certain period by the model and identifying whether a burst occurred according to the set threshold. The method was validated on a case study involving a DMA with engineered pipe-burst events. The results obtained demonstrate that the proposed method can effectively detect bursts, with a low false-alarm rate and high accuracy.

Frequency Network Analysis of Heart Rate Variability for Obstructive Apnea Patient Detection

Obstructive sleep apnea (OSA) is a popular sleep disorder. Traditional OSA diagnosis methods are cumbersome and expensive, which bring inconvenience for patient diagnosis and heavy workload for physician. Automatically identifying OSA patients from electrocardiogram (ECG) records is important for clinical diagnosis and treatment. In this paper, a new method based on the frequency and network domains is proposed to automatically recognize OSA patients with nocturnal ECG records. First, each RR-interval (beat to beat heart rate) series was divided into segments. By calculating the power spectral density (PSD) of heart rate variability segment with Lomb-Scargle method, the dynamic time warping (DTW) distance was used to evaluate the similarity (dissimilarity) of the lower frequency in the PSD series, then the DTW distance matrix was transformed to a binary matrix, and then network metrics were calculated to discriminate OSA patients with healthy subjects. The new method was tested with data of 389 subjects collected from two public databases that consist of normal subjects without OSA (apnea-hypopnea index, AHI 5) and OSA patients (AHI 5). Results show that a single network metric (local clustering coefficient) can recognize OSA patients with 90.1% accuracy, 88.29% sensitivity, and 90.5% specificity, and confirm the potential of using the ECG records for OSA patients recognition.

A Hidden Semi-Markov Model based approach for rehabilitation exercise assessment

In this paper, a Hidden Semi-Markov Model (HSMM) based approach is proposed to evaluate and monitor body motion during a rehabilitation training program. The approach extracts clinically relevant motion features from skeleton joint trajectories, acquired by the RGB-D camera, and provides a score for the subject's performance. The approach combines different aspects of rule and template based methods. The features have been defined by clinicians as exercise descriptors and are then assessed by a HSMM, trained upon an exemplar motion sequence. The reliability of the proposed approach is studied by evaluating its correlation with both a clinical assessment and a Dynamic Time Warping (DTW) algorithm, while healthy and neurological disabled people performed physical exercises. With respect to the discrimination between healthy and pathological conditions, the HSMM based method correlates better with the physician's score than DTW. The study supports the use of HSMMs to assess motor performance providing a quantitative feedback to physiotherapist and patients. This result is particularly appropriate and useful for a remote assessment in the home.

Noncontact Pressure-Based Sleep/Wake Discrimination

Poor sleep is increasingly being recognized as an important prognostic parameter of health. For those with suspected sleep disorders, patients are referred to sleep clinics, which guide treatment. However, sleep clinics are not always a viable option due to their high cost, a lack of experienced practitioners, lengthy waiting lists, and an unrepresentative sleeping environment. A home-based noncontact sleep/wake monitoring system may be used as a guide for treatment potentially stratifying patients by clinical need or highlighting longitudinal changes in sleep and nocturnal patterns. This paper presents the evaluation of an undermattress sleep monitoring system for noncontact sleep/wake discrimination. A large dataset of sensor data with concomitant sleep/wake state was collected from both younger and older adults participating in a circadian sleep study. A thorough training/testing/validation procedure was configured and optimized feature extraction and sleep/wake discrimination algorithms evaluated both within and across the two cohorts. An accuracy, sensitivity, and specificity of 74.3%, 95.5%, and 53.2% is reported over all subjects using an external validation dataset (71.9%, 87.9%, and 56% and 77.5%, 98%, and 57% is reported for younger and older subjects, respectively). These results compare favorably with similar research, however this system provides an ambient alternative suitable for long-term continuous sleep monitoring, particularly among vulnerable populations.

Estimating sleep parameters using nasal pressure signals applicable to continuous positive airway pressure devices

OBJECTIVE

This paper proposes a method for classifying sleep-wakefulness and estimating sleep parameters using nasal pressure signals applicable to a continuous positive airway pressure (CPAP) device.

APPROACH

In order to classify the sleep-wakefulness states of patients with sleep-disordered breathing (SDB), apnea-hypopnea and snoring events are first detected. Epochs detected as SDB are classified as sleep, and time-domain- and frequency-domain-based features are extracted from the epochs that are detected as normal breathing. Subsequently, sleep-wakefulness is classified using a support vector machine (SVM) classifier in the normal breathing epoch. Finally, four sleep parameters-sleep onset, wake after sleep onset, total sleep time and sleep efficiency-are estimated based on the classified sleep-wakefulness. In order to develop and test the algorithm, 110 patients diagnosed with SDB participated in this study. Ninety of the subjects underwent full-night polysomnography (PSG) and twenty underwent split-night PSG. The subjects were divided into 50 patients of a training set (full/split: 42/8), 30 of a validation set (full/split: 24/6) and 30 of a test set (full/split: 24/6).

MAIN RESULTS

In the experiments conducted, sleep-wakefulness classification accuracy was found to be 83.2% in the test set, compared with the PSG scoring results of clinical experts. Furthermore, all four sleep parameters showed higher correlations than the results obtained via PSG (r  ⩾  0.84, p  <  0.05). In order to determine whether the proposed method is applicable to CPAP, sleep-wakefulness classification performances were evaluated for each CPAP in the split-night PSG data. The results indicate that the accuracy and sensitivity of sleep-wakefulness classification by CPAP variation shows no statistically significant difference (p  <  0.05).

SIGNIFICANCE

The contributions made in this study are applicable to the automatic classification of sleep-wakefulness states in CPAP devices and evaluation of the quality of sleep.

Bioradiolocation-based sleep stage classification

This paper presents a method for classifying wakefulness, REM, light and deep sleep based on the analysis of respiratory activity and body motions acquired by a bioradar. The method was validated using data of 32 subjects without sleep-disordered breathing, who underwent a polysomnography study in a sleep laboratory. We achieved Cohen's kappa of 0.49 in the wake-REM-light-deep sleep classification, 0.55 for the wake-REM-NREM classification and 0.57 for the sleep/wakefulness determination. The results might be useful for the development of unobtrusive sleep monitoring systems for diagnostics, prevention, and management of sleep disorders.

Screening Sleep Disordered Breathing with Noncontact Measurement in a Clinical Site

[abstFig src='/00290002/06.jpg' width='300' text='Respiratory rate from simulator and Kinect' ]<span class=”bold”>Background and purpose:</span>It has been considered that sleep-disordered breathing disorders, such as sleep apnea syndrome (SAS), cause an increase in the risk of cardiovascular disease or traffic accident risk, and thus early detection of SAS is important. It has been also important for medical workers at clinical sites to quantitatively evaluate the respiratory condition of hospitalized patients who are asleep in a simple method. A noncontact-type system was proposed to monitor the respiratory condition of sleeping patients and minimized patient-related stress such that medical workers could use the system for SAS screening and perform a preliminary check prior to definite diagnosis.<span class=”bold”>Method:</span>The system included Microsoft Kinect™ for windows® (Kinect), a tripod, and a PC. A depth sensor of Kinect was used to measure movement in the thorax motion. Data obtained from periodic waveforms were divided with the intervals of 1 min, and the number of peaks was used to obtain the respiratory rate. Additionally, a frequency analysis was performed to calculate the respiratory frequency from a frequency at which the maximum amplitude was observed. In Experiment 1), a METI-man® PatientSimulator (CAE healthcare) (simulator) was used to study the respiratory rate and frequency calculated from the Kinect data by gradually changing the designated respiratory rate. In Experiment 2), the respiratory condition of four sleeping subjects was monitored to calculate their respiratory rate and frequencies. Furthermore, a video camera was used to confirm periodic waveforms and spectrum features of body movements during sleep.<span class=”bold”>Results:</span>In Experiment 1), the results indicated that both the respiratory rate and frequency corresponded to the designated respiratory rate in each time zone. In Experiment 2), the results indicated that the respiratory rate of examines 1, 2, 3, and 4 corresponded to 12.79±2.44 times/min (average ± standard deviation), 16.46±4.33 times/min, 28.24±2.79 times/min, and 13.05±2.64 times/min, respectively. The findings also indicated that the frequency of examines 1, 2, 3, and 4 corresponded to 0.20±0.04 Hz, 0.26±0.06 Hz, 0.45±0.12 Hz, and 0.22±0.06 Hz, respectively. The periodic waveforms and amplitude spectra were enhanced with respect to body movements although regular waveform data were obtained after the body movement occurred.<span class=”bold”>Discussions:</span>The results indicated that body movement and posture temporarily affected monitoring of the system. However, the findings also revealed that it was possible to calculate the respiratory rate and frequency, and thus it was considered that the system was useful for monitoring the respiration confirm with the non-contact or SAS screening of patients in clinical site.

SleepSense: A Noncontact and Cost-Effective Sleep Monitoring System

Quality of sleep is an important indicator of health and well being. Recent developments in the field of in-home sleep monitoring have the potential to enhance a person's sleeping experience and contribute to an overall sense of well being. Existing in-home sleep monitoring devices either fail to provide adequate sleep information or are obtrusive to use. To overcome these obstacles, a noncontact and cost-effective sleep monitoring system, named SleepSense, is proposed for continuous recognition of the sleep status, including on-bed movement, bed exit, and breathing section. SleepSense consists of three parts: a Doppler radar-based sensor, a robust automated radar demodulation module, and a sleep status recognition framework. Herein, several time-domain and frequency-domain features are extracted for the sleep recognition framework. A prototype of SleepSense is presented and evaluated using two sets of experiments. In the short-term controlled experiment, the SleepSense achieves an overall 95.1% accuracy rate in identifying various sleep status. In the 75-minute sleep study, SleepSense demonstrates wide usability in real life. The error rate for breathing rate extraction in this study is only 6.65%. These experimental results indicate that SleepSense is an effective and promising solution for in-home sleep monitoring.

Dynamic Hilbert warping, a new measure of RR-interval signals evaluated in the cognitive load estimation

RR interval (RRI) signals represent the time intervals between successive heart R-waves. These signals are influenced by many cognitive and psychological processes. In this study, a new technique based on the combination of empirical mode decomposition and dynamic Hilbert warping (DHW) was proposed to inference cognitive states from measured RRI signals. Moreover, a set of entropic and statistical measures was extracted to characterize the regularity and temporal distribution in the phase spectra and amplitude envelope of the analytic signals. The discriminating capability of the proposed method was studied in 45 healthy subjects. They performed an arithmetic task with five levels of difficulty. The study indicated the importance of phase information in cognitive load estimation (CLE). The new phase characteristics were able to extract hidden information from the RRI signals. The results revealed a striking decrease in DHW value with increasing load level. The entropic measures of analytic signal also showed an increasing trend as the mental load increased. Although, phase information had an ability to discriminate between more distinct levels as well as between more similar ones, amplitude information was effective only in discriminating between more distinct levels.

A method of REM-NREM sleep distinction using ECG signal for unobtrusive personal monitoring

Computers are used extensively in sleep labs for polysomnography and for assistance in sleep staging. However, the test is highly inconvenient to the patient and requires availability of specially equipped sleep labs. Alternative approaches that enable unobtrusive in-home sleep staging with ECG or other signals are highly desirable. In this paper we describe a method that can be used for distinction of REM and NREM sleep stages using spectral and non-linear features of ECG derived RR interval series. To test the accuracy of the system, we extracted the RR interval series from sleep studies of 20 young healthy individuals. Time domain, spectral and non-linear features were computed and tested for discriminability. Features showing high degree of discrimination were selected. A polynomial support vector machine was trained with selected features - percent power in HF band, LF/HF, Poincare plot parameters, exponents from Detrended fluctuation analysis, and sampEn of the half of the signals. The hyperplane was used to classify the other half of the data. The results show an accuracy of 76.25% with Cohen's kappa as 0.52 for a two-class model of five minute signal. The results dropped to 72.8% accuracy and k=0.48 for the two class model of one minute signal. The minimal set offers a reasonable trade-off for possible in-home monitoring, at least for some conditions that require only REM-NREM distinction. The method after extensive trials and standardisation, can alleviate the load of special purpose PSG labs and enable the tests to be done on general purpose computers.

Seizure detection using dynamic warping for patients with intellectual disability

Electroencephalography (EEG) is paramount for both retrospective analysis and real-time monitoring of epileptic seizures. Studies have shown that EEG-based seizure detection is very difficult for a specific epileptic population with intellectual disability due to the cerebral development disorders. In this work, a seizure detection method based on dynamic warping (DW) is proposed for patients with intellectual disability. It uses an EEG template of an individual subject's dominant seizure type, to extract the morphological features from EEG signals. A linear discriminant analysis (LDA) classifier is used to perform the seizure detection. Results show that the DW-based feature in the frequency domain is superior than that in the time domain, and the features extracted using wavelet transform method.

Cardiorespiratory Sleep Stage Detection Using Conditional Random Fields

This paper explores the probabilistic properties of sleep stage sequences and transitions to improve the performance of sleep stage detection using cardiorespiratory features. A new classifier, based on conditional random fields, is used in different sleep stage detection tasks (N3, NREM, REM, and wake) in night-time recordings of electrocardiogram and respiratory inductance plethysmography of healthy subjects. Using a dataset of 342 polysomnographic recordings of healthy subjects, among which 135 with regular sleep architecture, it outperforms hidden Markov models and Bayesian linear discriminants in all tasks, achieving an average accuracy of 87.38% and kappa of 0.41 (87.27% and 0.49 for regular subjects) for N3 detection, 78.71% and 0.55 (80.34% and 0.56 for regular subjects) for NREM detection, 88.49% and 0.51 (87.35% and 0.57 for regular subjects) for REM, and 85.69% and 0.51 (90.42% and 0.52 for regular subjects) for wake. In comparison with the state of the art, and having been tested on a much larger dataset, the classifier was found to outperform most of the work reported in the literature for some of the tasks, in particular for subjects with regular sleep architecture. It achieves a comparable accuracy for N3, higher accuracy and kappa for REM, and higher accuracy and comparable kappa for NREM than the best performing classifiers described in the literature.

Improving sleep/wake detection via boundary adaptation for respiratory spectral features

In previous work, respiratory spectral features have been successfully used for sleep/wake detection. They are usually extracted from several frequency bands. However, these traditional bands with fixed frequency boundaries might not be the most appropriate to optimize the sleep and wake separation. This is caused by the between-subject variability in physiology, or more specifically, in respiration during sleep. Since the optimal boundaries may relate to mean respiratory frequency over the entire night. Therefore, we propose to adapt these boundaries for each subject in terms of his/her mean respiratory frequency. The adaptive boundaries were considered as those being able to maximize the separation between sleep and wake states by means of their mean power spectral density (PSD) curves overnight. Linear regression models were used to address the association between the adaptive boundaries and mean respiratory frequency based on training data. This was then in turn used to estimate the adaptive boundaries of each test subject. Experiments were conducted on the data from 15 healthy subjects using a linear discriminant classifier with a leave-one-subject-out cross-validation. We reveal that the spectral boundary adaptation can help improve the performance of sleep/wake detection when actigraphy is absent.

Detection of Nocturnal Slow Wave Sleep Based on Cardiorespiratory Activity in Healthy Adults

Human slow wave sleep (SWS) during bedtime is paramount for energy conservation and memory consolidation. This study aims at automatically detecting SWS from nocturnal sleep using cardiorespiratory signals that can be acquired with unobtrusive sensors in a home-based scenario. From the signals, time-dependent features are extracted for continuous 30-s epochs. To reduce the measuring noise, body motion artifacts, and/or within-subject variability in physiology conveyed by the features, and thus, enhance the detection performance, we propose to smooth the features over each night using a spline fitting method. In addition, it was found that the changes in cardiorespiratory activity precede the transitions between SWS and the other sleep stages (non-SWS). To this matter, a novel scheme is proposed that performs the SWS detection for each epoch using the feature values prior to that epoch. Experiments were conducted with a large dataset of 325 overnight polysomnography (PSG) recordings using a linear discriminant classifier and tenfold cross validation. Features were selected with a correlation-based method. Results show that the performance in classifying SWS and non-SWS can be significantly improved when smoothing the features and using the preceding feature values of 5-min earlier. We achieved a Cohen's Kappa coefficient of 0.57 (at an accuracy of 88.8%) using only six selected features for 257 recordings with a minimum of 30-min overnight SWS that were considered representative of their habitual sleeping pattern at home. These features included the standard deviation, low-frequency spectral power, and detrended fluctuation of heartbeat intervals as well as the variations of respiratory frequency and upper and lower respiratory envelopes. A marked drop in Kappa to 0.21 was observed for the other nights with SWS time of less than 30 min, which were found to more likely occur in elderly. This will be the future challenge in cardiorespiratory-based SWS detection.

Automatic detection of overnight deep sleep based on heart rate variability: a preliminary study

This preliminary study investigated the use of cardiac information or more specifically, heart rate variability (HRV), for automatic deep sleep detection throughout the night. The HRV data can be derived from cardiac signals, which were obtained from polysomnography (PSG) recordings. In total 42 features were extracted from the HRV data of 15 single-night PSG recordings (from 15 healthy subjects) for each 30-s epoch, used to perform epoch-by-epoch classification of deep sleep and non-deep sleep (including wake state and all the other sleep stages except deep sleep). To reduce variation of cardiac physiology between subjects, we normalized each feature per subject using a simple Z-score normalization method by subtracting the mean and dividing by the standard deviation of the feature values. A correlation-based feature selection (CFS) method was employed to select informative features as well as removing feature redundancy and a linear discriminant (LD) classifier was applied for deep and non-deep sleep classification. Results show that the use of Z-score normalization can significantly improve the classification performance. A Cohen's Kappa coefficient of 0.42 and an overall accuracy of 81.3% based on a leave-one-subject-out cross-validation were achieved.