Algorithmic detection of sleep-disordered breathing using respiratory signals: a systematic review

Background and Objective. Sleep-disordered breathing (SDB) poses health risks linked to hypertension, cardiovascular disease, and diabetes. However, the time-consuming and costly standard diagnostic method, polysomnography (PSG), limits its wide adoption and leads to underdiagnosis. To tackle this, cost-effective algorithms using single-lead signals (like respiratory, blood oxygen, and electrocardiogram) have emerged. Despite respiratory signals being preferred for SDB assessment, a lack of comprehensive reviews addressing their algorithmic scope and performance persists. This paper systematically reviews 2012-2022 literature, covering signal sources, processing, feature extraction, classification, and application, aiming to bridge this gap and provide future research references.Methods. This systematic review followed the registered PROSPERO protocol (CRD42022385130), initially screening 342 papers, with 32 studies meeting data extraction criteria.Results. Respiratory signal sources include nasal airflow (NAF), oronasal airflow (OAF), and respiratory movement-related signals such as thoracic respiratory effort (TRE) and abdominal respiratory effort (ARE). Classification techniques include threshold rule-based methods (8), machine learning models (13), and deep learning models (11). The NAF-based algorithm achieved the highest average accuracy at 94.11%, surpassing 78.19% for other signals. Hypopnea detection sensitivity with single-source respiratory signals remained modest, peaking at 73.34%. The TRE and ARE signals proved to be reliable in identifying different types of SDB because distinct respiratory disorders exhibited different patterns of chest and abdominal motion.Conclusions. Multiple detection algorithms have been widely applied for SDB detection, and their accuracy is closely related to factors such as signal source, signal processing, feature selection, and model selection.

Automated detection of airflow obstructive diseases: A systematic review of the last decade (2013-2022)

BACKGROUND AND OBJECTIVE

Obstructive airway diseases, including asthma and Chronic Obstructive Pulmonary Disease (COPD), are two of the most common chronic respiratory health problems. Both of these conditions require health professional expertise in making a diagnosis. Hence, this process is time intensive for healthcare providers and the diagnostic quality is subject to intra- and inter- operator variability. In this study we investigate the role of automated detection of obstructive airway diseases to reduce cost and improve diagnostic quality.

METHODS

We investigated the existing body of evidence and applied Preferred Reporting Items for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search records in IEEE, Google scholar, and PubMed databases. We identified 65 papers that were published from 2013 to 2022 and these papers cover 67 different studies. The review process was structured according to the medical data that was used for disease detection. We identified six main categories, namely air flow, genetic, imaging, signals, and miscellaneous. For each of these categories, we report both disease detection methods and their performance.

RESULTS

We found that medical imaging was used in 14 of the reviewed studies as data for automated obstructive airway disease detection. Genetics and physiological signals were used in 13 studies. Medical records and air flow were used in 9 and 7 studies, respectively. Most papers were published in 2020 and we found three times more work on Machine Learning (ML) when compared to Deep Learning (DL). Statistical analysis shows that DL techniques achieve higher Accuracy (ACC) when compared to ML. Convolutional Neural Network (CNN) is the most common DL classifier and Support Vector Machine (SVM) is the most widely used ML classifier. During our review, we discovered only two publicly available asthma and COPD datasets. Most studies used private clinical datasets, so data size and data composition are inconsistent.

CONCLUSIONS

Our review results indicate that Artificial Intelligence (AI) can improve both decision quality and efficiency of health professionals during COPD and asthma diagnosis. However, we found several limitations in this review, such as a lack of dataset consistency, a limited dataset and remote monitoring was not sufficiently explored. We appeal to society to accept and trust computer aided airflow obstructive diseases diagnosis and we encourage health professionals to work closely with AI scientists to promote automated detection in clinical practice and hospital settings.

Detection and Prediction of Sleep Disorders by Covert Bed-Integrated RF Sensors

OBJECTIVE

Respiratory disturbances during sleep are a prevalent health condition that affects a large adult population. The gold standard to evaluate sleep disorders including apnea is overnight polysomnography, which requires a trained technician for live monitoring and post-processing scoring. Currently, the disorder events can hardly be predicted using the respiratory waveforms preceding the events. The objective of this paper is to develop an autonomous system to detect and predict respiratory events reliably based on real-time covert sensing.

METHODS

A bed-integrated radio-frequency (RF) sensor by near-field coherent sensing (NCS) was employed to retrieve continuous respiratory waveforms without user's awareness. Overnight recordings were collected from 27 patients in the Weill Cornell Center for Sleep Medicine. We extracted respiratory features to feed into the random-forest machine learning model for disorder detection and prediction. The technician annotation, derived from observation by polysomnography, was used as the ground truth during the supervised learning.

RESULTS

Apneic event detection achieved a sensitivity and specificity up to 88.6% and 89.0% for k-fold validation, and 83.1% and 91.6% for subject-independent validation. Prediction of forthcoming apneic events could be made up to 90 s in advance. Apneic event prediction achieved a sensitivity and specificity up to 81.3% and 82.1% for k-fold validation, and 80.5% and 82.4% for subject-independent validation. The most important features for event detection and prediction can be assessed in the learning model.

CONCLUSION

A bed-integrated RF sensor can covertly and reliably detect and predict apneic events.

SIGNIFICANCE

Predictive warning of the sleep disorders in advance can intervene serious apnea, especially for infants, servicemen, and patients with chronic conditions.

Environmental Benefits of Sleep Apnoea Detection in the Home Environment

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

A spatio-temporal learning-based model for sleep apnea detection using single-lead ECG signals

Sleep apnea (SA) is a common chronic sleep breathing disorder, which would cause stroke, cognitive decline, cardiovascular disease, or even death. The SA symptoms often manifest as frequent breathing interruptions during sleep and most individuals with sleeping disorders are not aware of the SA events. Using a portable device with single-lead ECG signal is an effective way to help an individual to monitor their sleep conditions at home. However, the SA detection performance of ECG-based methods is still difficult to meet the clinical practice requirement. In this study, we propose an end-to-end spatio-temporal learning-based SA detection method, which consists of multiple spatio-temporal blocks. Each block has the identical architecture with a convolutional neural network (CNN) layer, a max-pooling layer, and a bi-gated recurrent unit (BiGRU) layer. This architecture with repeated spatio-temporal blocks can well capture the morphological spatial feature information as well as the temporal feature information from ECG signals. The proposed SA detection model was evaluated on the publicly available datasets of PhysioNet Apnea-ECG dataset (Apnea-ECG) and University College Dublin Sleep Apnea Database (UCDDB). Extensive experimental results show that our proposed SA model on both Apnea-ECG and UCDDB datasets achieves state-of-the-art results, which are obviously superior to existing ECG-based SA detection methods. It means that our proposed method has the potential to be deployed into a healthcare system to provide a sleep monitoring service, which can screen out SA population with high risk and help to take timely interventions to prevent serious consequences.

A Comprehensive Review: Computational Models for Obstructive Sleep Apnea Detection in Biomedical Applications

Obstructive sleep apnea (OSA) is a sleep disorder characterized by periodic episodes of partial or complete upper airway obstruction caused by narrowing or collapse of the pharyngeal airway despite ongoing breathing efforts during sleep. Fall in the blood oxygen saturation and cortical arousals are prompted by this reduction in the airflow which lasts for at least 10 seconds. Impaired labor performance, debilitated quality of life, excessive daytime sleepiness, high snoring, and tiredness even after a whole night's sleep are the primary symptoms of OSA. In due course, the long-standing contributions of OSA culminate in hypertension, arrhythmia, cerebrovascular disease, and heart failure. The traditional diagnostic approach of OSA is the laboratory-based polysomnography (PSG) overnight sleep study, which is a tedious and labor-intensive process that exaggerates the discomfort to the patient. With the advent of computer-aided diagnosis (CAD), automatic detection of OSA has gained increasing interest among researchers in the area of sleep disorders as it influences both diagnostic and therapeutic decisions. The research literature on sleep apnea published during the last decade has been surveyed, focusing on the varied screening approaches accustomed to identifying OSA events and the developmental knowledge offered by multiple contributors from the software perspective. The current study presents an overview of the pathophysiology of OSA, the detection methods, physiological signals related to OSA, the different preprocessing, feature extraction, feature selection, and classification techniques employed for the detection and classification of OSA. Consequently, the research challenges and research gaps in the diagnosis of OSA are identified, critically analyzed, and presented in the best possible light.

Classification of Respiratory States Using Spectrogram with Convolutional Neural Network

This paper proposes an approach to the classification of respiration states based on a neural network model by visualizing respiratory signals using a spectrogram. The analysis and processing of human biosignals are still considered some of the most crucial and fundamental research areas in both signal processing and medical applications. Recently, learning-based algorithms in signal and image processing for medical applications have shown significant improvement from both quantitative and qualitative perspectives. Human respiration is still considered an important factor for diagnosis, and it plays a key role in preventing fatal diseases in practice. This paper chiefly deals with a contactless-based approach for the acquisition of respiration data using an ultra-wideband (UWB) radar sensor because it is simple and easy for use in an experimental setup and shows high accuracy in distance estimation. This paper proposes the classification of respiratory states by using a feature visualization scheme, a spectrogram, and a neural network model. The proposed method shows competitive and promising results in the classification of respiratory states. The experimental results also show that the method provides better accuracy (precision: 0.86 and specificity: 0.90) than conventional methods that use expensive equipment for respiration measurement.

Diagnosis of Obstructive Sleep Apnea from ECG Signals Using Machine Learning and Deep Learning Classifiers

Obstructive sleep apnea (OSA) is a well-known sleep ailment. OSA mostly occurs due to the shortage of oxygen for the human body, which causes several symptoms (i.e., low concentration, daytime sleepiness, and irritability). Discovering the existence of OSA at an early stage can save lives and reduce the cost of treatment. The computer-aided diagnosis (CAD) system can quickly detect OSA by examining the electrocardiogram (ECG) signals. Over-serving ECG using a visual procedure is challenging for physicians, time-consuming, expensive, and subjective. In general, automated detection of the ECG signal’s arrhythmia is a complex task due to the complexity of the data quantity and clinical content. Moreover, ECG signals are usually affected by noise (i.e., patient movement and disturbances generated by electric devices or infrastructure), which reduces the quality of the collected data. Machine learning (ML) and Deep Learning (DL) gain a higher interest in health care systems due to its ability of achieving an excellent performance compared to traditional classifiers. We propose a CAD system to diagnose apnea events based on ECG in an automated way in this work. The proposed system follows the following steps: (1) remove noise from the ECG signal using a Notch filter. (2) extract nine features from the ECG signal (3) use thirteen ML and four types of DL models for the diagnosis of sleep apnea. The experimental results show that our proposed approach offers a good performance of DL classifiers to detect OSA. The proposed model achieves an accuracy of 86.25% in the validation stage.

Capacitively-coupled ECG and respiration for the unobtrusive detection of sleep apnea

OBJECTIVE

The performance of a novel unobtrusive system based on capacitively-coupled electrocardiography (ccECG) combined with different respiratory measurements is evaluated for the detection of sleep apnea.

APPROACH

A sleep apnea detection algorithm is proposed, which can be applied to electrocardiography (ECG) and ccECG, combined with different unobtrusive respiratory measurements, including ECG derived respiration (EDR), respiratory effort measured using the thoracic belt (TB) and capacitively-coupled bioimpedance (ccBioz). Several ECG, respiratory and cardiorespiratory features were defined, of which the most relevant ones were identified using a random forest based backwards wrapper. Using this relevant feature set, a least-squares support vector machine classifier was trained to decide if a one minute segment is apneic or not, based on the annotated polysomnography (PSG) data of 218 patients suspected of having sleep apnea. The obtained classifier was then tested on the PSG and capacitively-coupled data of 28 different patients.

MAIN RESULTS

On the PSG data, an AUC of 76.3% was obtained when the ECG was combined with the EDR. Replacing the EDR with the TB led to an AUC of 80.0%. Using the ccECG and ccBioz or the ccECG and TB resulted in similar performances as on the PSG data, while using the ccECG and ccECG-based EDR resulted in a drop in AUC to 67.4%.

SIGNIFICANCE

This is the first study which tests an apnea detection algorithm on capacitively-coupled ECG and bioimpedance signals and shows promising results on the capacitively-coupled data set. However, it was shown that the EDR could not be accurately estimated from the ccECG signals. Further research into the effect that respiration has on the ccECG is needed to propose alternative EDR estimates.

A Smart Service Platform for Cost Efficient Cardiac Health Monitoring

AIM

In this study we have investigated the problem of cost effective wireless heart health monitoring from a service design perspective.

SUBJECT AND METHODS

There is a great medical and economic need to support the diagnosis of a wide range of debilitating and indeed fatal non-communicable diseases, like Cardiovascular Disease (CVD), Atrial Fibrillation (AF), diabetes, and sleep disorders. To address this need, we put forward the idea that the combination of Heart Rate (HR) measurements, Internet of Things (IoT), and advanced Artificial Intelligence (AI), forms a Heart Health Monitoring Service Platform (HHMSP). This service platform can be used for multi-disease monitoring, where a distinct service meets the needs of patients having a specific disease. The service functionality is realized by combining common and distinct modules. This forms the technological basis which facilitates a hybrid diagnosis process where machines and practitioners work cooperatively to improve outcomes for patients.

RESULTS

Human checks and balances on independent machine decisions maintain safety and reliability of the diagnosis. Cost efficiency comes from efficient signal processing and replacing manual analysis with AI based machine classification. To show the practicality of the proposed service platform, we have implemented an AF monitoring service.

CONCLUSION

Having common modules allows us to harvest the economies of scale. That is an advantage, because the fixed cost for the infrastructure is shared among a large group of customers. Distinct modules define which AI models are used and how the communication with practitioners, caregivers and patients is handled. That makes the proposed HHMSP agile enough to address safety, reliability and functionality needs from healthcare providers.

Automated sleep apnea detection from cardio-pulmonary signal using bivariate fast and adaptive EMD coupled with cross time-frequency analysis

Sleep apnea is a sleep related pathology in which breathing or respiratory activity of an individual is obstructed, resulting in variations in the cardio-pulmonary (CP) activity. The monitoring of both cardiac (heart rate (HR)) and pulmonary (respiration rate (RR)) activities are important for the automated detection of this ailment. In this paper, we propose a novel automated approach for sleep apnea detection using the bivariate CP signal. The bivariate CP signal is formulated using both HR and RR signals extracted from the electrocardiogram (ECG) signal. The approach consists of three stages. First, the bivariate CP signal is decomposed into intrinsic mode functions (IMFs) and residuals for both HR and RR channels using bivariate fast and adaptive empirical mode decomposition (FAEMD). Second, the features are extracted using time-domain analysis, spectral analysis, and time-frequency domain analysis of IMFs from CP signal. The time-frequency domain features are computed from the cross time-frequency matrices of IMFs of CP signal. The cross time-frequency matrix of each IMF is evaluated using the Stockwell (S)-transform. Third, the support vector machine (SVM) and the random forest (RF) classifiers are used for automated detection of sleep apnea with the features from the bivariate CP signal. Our proposed approach has demonstrated an average sensitivity and specificity of 82.27% and 78.67%, respectively for sleep apnea detection using the 10-fold cross-validation method. The approach has yielded an average sensitivity and specificity of 73.19% and 73.13%, respectively for the subject-specific cross-validation. The performance of the approach was compared with other CPC features used for the detection of sleep apnea.

Heart Rate Dynamics in Patients with Obstructive Sleep Apnea: Heart Rate Variability and Entropy

Background: Obstructive sleep apnea (OSA), a highly prevalent sleep disorder, is closely related to cardiovascular disease (CVD). Our previous work demonstrated that Shannon entropy of the degree distribution (E_DD), obtained from the network domain of heart rate variability (HRV), might be a potential indicator for CVD. Method: To investigate the potential association between OSA and E_DD, OSA patients and healthy controls (HCs) were identified from a sleep study database. Then E_DD was calculated from electrocardiogram (ECG) signals during sleep, followed by cross-sectional comparisons between OSA patients and HCs, and longitudinal comparisons from baseline to follow-up visits. Furthermore, for OSA patients, the association between E_DD and OSA severity, measured by apnea-hypopnea index (AHI), was also analyzed. Results: Compared with HCs, OSA patients had significantly increased E_DD during sleep. A positive correlation between E_DD and the severity of OSA was also observed. Although the value of E_DD became larger with aging, it was not OSA-specified. Conclusion: Increased E_DD derived from ECG signals during sleep might be a potential dynamic biomarker to identify OSA patients from HCs, which may be used in screening OSA with high risk before polysomnography is considered.

A RR interval based automated apnea detection approach using residual network

BACKGROUND AND OBJECTIVE

Apnea is one of the most common conditions that causes sleep-disorder breathing. With growing number of patients worldwide, more and more patients suffer from complications of apnea. But most of them stay untreated due to the complex and time-consuming polysomnography (PSG) diagnosis method. Effective and precise diagnosis support system using electrocardiograph (ECG) is required. In this paper, we propose an approach using residual network to detect apnea based on RR intervals (intervals between R-peaks of ECG signal).

METHODS

In our model, we apply residual network to represent information carried by RR intervals. Moreover, we proposed a novel perspective, called dynamic autoregressive representation, to provide interpretation of representing the RR intervals by convolutional layers.

RESULTS

This approach is tested for per-segment apnea detection using publicly available dataset on Physionet. 30 overnight recordings are used for training and 5 for testing. We achieve a good result of 94.4% accuracy, 93.0% sensitivity and 94.9% specificity. This result outperform other prevalent methods based on RR intervals. This model also shows its good adaptivity while using ECG-derived respiration signal (EDR) in experiments. Its extensiveness is evaluated and compared in experiments. The proposed model is also compared with deep neural networks using original ECG signals for apnea detection, and it achieves better result using fewer input samples.

CONCLUSIONS

We develop a deep residual network to detect apnea on low-sample-rate RR intervals. The result suggests a possibility of representing RR intervals by neural network. The model showed strong adaptivity when using EDR input.

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.

HEART-RATE BASED SLEEP APNEA DETECTION USING ARDUINO

The purpose of this study was to investigate the use of a cost-effective heart rate monitor sensor and Arduino Uno configuration to accurately detect simulated sleep apnea, through the use of the inter-beat interval (R-R interval). Three separate 30[Formula: see text]min heart rate recordings were taken, each with six simulated sleep apnea events ranging from 20 to 40[Formula: see text]s. The results were gathered and processed to identify the simulated sleep apnea events. In each of the recordings, the simulated sleep apnea events were visible and the key characteristics, surrounding the events, could be recognized. The heart rate monitor sensor and Arduino Uno configuration successfully detected the simulated sleep apnea events through the analysis and processing of the hearts R-R interval.

Deep learning for healthcare applications based on physiological signals: A review

BACKGROUND AND OBJECTIVE

We have cast the net into the ocean of knowledge to retrieve the latest scientific research on deep learning methods for physiological signals. We found 53 research papers on this topic, published from 01.01.2008 to 31.12.2017.

METHODS

An initial bibliometric analysis shows that the reviewed papers focused on Electromyogram(EMG), Electroencephalogram(EEG), Electrocardiogram(ECG), and Electrooculogram(EOG). These four categories were used to structure the subsequent content review.

RESULTS

During the content review, we understood that deep learning performs better for big and varied datasets than classic analysis and machine classification methods. Deep learning algorithms try to develop the model by using all the available input.

CONCLUSIONS

This review paper depicts the application of various deep learning algorithms used till recently, but in future it will be used for more healthcare areas to improve the quality of diagnosis.

Application of an optimal class of antisymmetric wavelet filter banks for obstructive sleep apnea diagnosis using ECG signals

Obstructive sleep apnea (OSA) is a sleep disorder caused due to interruption of breathing resulting in insufficient oxygen to the human body and brain. If the OSA is detected and treated at an early stage the possibility of severe health impairment can be mitigated. Therefore, an accurate automated OSA detection system is indispensable. Generally, OSA based computer-aided diagnosis (CAD) system employs multi-channel, multi-signal physiological signals. However, there is a great need for single-channel bio-signal based low-power, a portable OSA-CAD system which can be used at home. In this study, we propose single-channel electrocardiogram (ECG) based OSA-CAD system using a new class of optimal biorthogonal antisymmetric wavelet filter bank (BAWFB). In this class of filter bank, all filters are of even length. The filter bank design problem is transformed into a constrained optimization problem wherein the objective is to minimize either frequency-spread for the given time-spread or time-spread for the given frequency-spread. The optimization problem is formulated as a semi-definite programming (SDP) problem. In the SDP problem, the objective function (time-spread or frequency-spread), constraints of perfect reconstruction (PR) and zero moment (ZM) are incorporated in their time domain matrix formulations. The global solution for SDP is obtained using interior point algorithm. The newly designed BAWFB is used for the classification of OSA using ECG signals taken from the physionet's Apnea-ECG database. The ECG segments of 1 min duration are decomposed into six wavelet subbands (WSBs) by employing the proposed BAWFB. Then, the fuzzy entropy (FE) and log-energy (LE) features are computed from all six WSBs. The FE and LE features are classified into normal and OSA groups using least squares support vector machine (LS-SVM) with 35-fold cross-validation strategy. The proposed OSA detection model achieved the average classification accuracy, sensitivity, specificity and F-score of 90.11%, 90.87% 88.88% and 0.92, respectively. The performance of the model is found to be better than the existing works in detecting OSA using the same database. Thus, the proposed automated OSA detection system is accurate, cost-effective and ready to be tested with a huge database.