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Mendonça F, Mostafa SS, Morgado-Dias F, Ravelo-García AG, Rosenzweig I. Towards automatic EEG cyclic alternating pattern analysis: a systematic review. Biomed Eng Lett 2023; 13:273-291. [PMID: 37519874 PMCID: PMC10382419 DOI: 10.1007/s13534-023-00303-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
This study conducted a systematic review to determine the feasibility of automatic Cyclic Alternating Pattern (CAP) analysis. Specifically, this review followed the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to address the formulated research question: is automatic CAP analysis viable for clinical application? From the identified 1,280 articles, the review included 35 studies that proposed various methods for examining CAP, including the classification of A phase, their subtypes, or the CAP cycles. Three main trends were observed over time regarding A phase classification, starting with mathematical models or features classified with a tuned threshold, followed by using conventional machine learning models and, recently, deep learning models. Regarding the CAP cycle detection, it was observed that most studies employed a finite state machine to implement the CAP scoring rules, which depended on an initial A phase classifier, stressing the importance of developing suitable A phase detection models. The assessment of A-phase subtypes has proven challenging due to various approaches used in the state-of-the-art for their detection, ranging from multiclass models to creating a model for each subtype. The review provided a positive answer to the main research question, concluding that automatic CAP analysis can be reliably performed. The main recommended research agenda involves validating the proposed methodologies on larger datasets, including more subjects with sleep-related disorders, and providing the source code for independent confirmation.
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Affiliation(s)
- Fábio Mendonça
- University of Madeira, Funchal, Portugal
- Interactive Technologies Institute (ITI/ARDITI/LARSyS), Funchal, Portugal
| | | | - Fernando Morgado-Dias
- University of Madeira, Funchal, Portugal
- Interactive Technologies Institute (ITI/ARDITI/LARSyS), Funchal, Portugal
| | - Antonio G. Ravelo-García
- Interactive Technologies Institute (ITI/ARDITI/LARSyS), Funchal, Portugal
- Institute for Technological Development and Innovation in Communications, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Ivana Rosenzweig
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
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Mendonça F, Mostafa SS, Gupta A, Arnardottir ES, Leppänen T, Morgado-Dias F, Ravelo-García AG. A-phase index: an alternative view for sleep stability analysis based on automatic detection of the A-phases from the cyclic alternating pattern. Sleep 2023; 46:6696631. [PMID: 36098558 DOI: 10.1093/sleep/zsac217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 09/01/2022] [Indexed: 01/13/2023] Open
Abstract
STUDY OBJECTIVES Sleep stability can be studied by evaluating the cyclic alternating pattern (CAP) in electroencephalogram (EEG) signals. The present study presents a novel approach for assessing sleep stability, developing an index based on the CAP A-phase characteristics to display a sleep stability profile for a whole night's sleep. METHODS Two ensemble classifiers were developed to automatically score the signals, one for "A-phase" and the other for "non-rapid eye movement" estimation. Both were based on three one-dimension convolutional neural networks. Six different inputs were produced from the EEG signal to feed the ensembles' classifiers. A proposed heuristic-oriented search algorithm individually tuned the classifiers' structures. The outputs of the two ensembles were combined to estimate the A-phase index (API). The models can also assess the A-phase subtypes, their API, and the CAP cycles and rate. RESULTS Four dataset variations were considered, examining healthy and sleep-disordered subjects. The A-phase average estimation's accuracy, sensitivity, and specificity range was 82%-87%, 72%-80%, and 82%-88%, respectively. A similar performance was attained for the A-phase subtype's assessments, with an accuracy range of 82%-88%. Furthermore, in the examined dataset's variations, the API metric's average error varied from 0.15 to 0.25 (with a median range of 0.11-0.24). These results were attained without manually removing wake or rapid eye movement periods, leading to a methodology suitable to produce a fully automatic CAP scoring algorithm. CONCLUSIONS Metrics based on API can be understood as a new view for CAP analysis, where the goal is to produce and examine a sleep stability profile.
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Affiliation(s)
- Fábio Mendonça
- University of Madeira, Funchal, Portugal.,Interactive Technologies Institute (ITI/LARSyS) and M-ITI, Funchal, Portugal
| | | | - Ankit Gupta
- University of Madeira, Funchal, Portugal.,Interactive Technologies Institute (ITI/LARSyS) and M-ITI, Funchal, Portugal
| | - Erna Sif Arnardottir
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland.,Internal Medicine Services, Landspitali-National University Hospital of Iceland, Reykjavik, Iceland
| | - Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | - Fernando Morgado-Dias
- University of Madeira, Funchal, Portugal.,Interactive Technologies Institute (ITI/LARSyS) and M-ITI, Funchal, Portugal
| | - Antonio G Ravelo-García
- Interactive Technologies Institute (ITI/LARSyS) and M-ITI, Funchal, Portugal.,Institute for Technological Development and Innovation in Communications, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Mendonça F, Mostafa SS, Freitas D, Morgado-Dias F, Ravelo-García AG. Multiple Time Series Fusion Based on LSTM: An Application to CAP A Phase Classification Using EEG. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710892. [PMID: 36078611 PMCID: PMC9518445 DOI: 10.3390/ijerph191710892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 05/23/2023]
Abstract
The Cyclic Alternating Pattern (CAP) is a periodic activity detected in the electroencephalogram (EEG) signals. This pattern was identified as a marker of unstable sleep with several possible clinical applications; however, there is a need to develop automatic methodologies to facilitate real-world applications based on CAP assessment. Therefore, a deep learning-based EEG channels' feature level fusion was proposed in this work and employed for the CAP A phase classification. Two optimization algorithms optimized the channel selection, fusion, and classification procedures. The developed methodologies were evaluated by fusing the information from multiple EEG channels for patients with nocturnal frontal lobe epilepsy and patients without neurological disorders. Results showed that both optimization algorithms selected a comparable structure with similar feature level fusion, consisting of three electroencephalogram channels (Fp2-F4, C4-A1, F4-C4), which is in line with the CAP protocol to ensure multiple channels' arousals for CAP detection. Moreover, the two optimized models reached an area under the receiver operating characteristic curve of 0.82, with average accuracy ranging from 77% to 79%, a result in the upper range of the specialist agreement and best state-of-the-art works, despite a challenging dataset. The proposed methodology also has the advantage of providing a fully automatic analysis without requiring any manual procedure. Ultimately, the models were revealed to be noise-resistant and resilient to multiple channel loss, being thus suitable for real-world application.
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Affiliation(s)
- Fábio Mendonça
- Interactive Technologies Institute (ITI/LARSyS and ARDITI), 9020-105 Funchal, Portugal
- Higher School of Technologies and Management, University of Madeira, 9000-082 Funchal, Portugal
| | | | - Diogo Freitas
- Interactive Technologies Institute (ITI/LARSyS and ARDITI), 9020-105 Funchal, Portugal
- Faculty of Exact Sciences and Engineering, University of Madeira, 9000-082 Funchal, Portugal
- NOVA Laboratory for Computer Science and Informatics, 2829-516 Caparica, Portugal
| | - Fernando Morgado-Dias
- Interactive Technologies Institute (ITI/LARSyS and ARDITI), 9020-105 Funchal, Portugal
- Faculty of Exact Sciences and Engineering, University of Madeira, 9000-082 Funchal, Portugal
| | - Antonio G. Ravelo-García
- Interactive Technologies Institute (ITI/LARSyS and ARDITI), 9020-105 Funchal, Portugal
- Institute for Technological Development and Innovation in Communications, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain
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Heuristic Optimization of Deep and Shallow Classifiers: An Application for Electroencephalogram Cyclic Alternating Pattern Detection. ENTROPY 2022; 24:e24050688. [PMID: 35626571 PMCID: PMC9140662 DOI: 10.3390/e24050688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/23/2022] [Accepted: 05/11/2022] [Indexed: 12/04/2022]
Abstract
Methodologies for automatic non-rapid eye movement and cyclic alternating pattern analysis were proposed to examine the signal from one electroencephalogram monopolar derivation for the A phase, cyclic alternating pattern cycles, and cyclic alternating pattern rate assessments. A population composed of subjects free of neurological disorders and subjects diagnosed with sleep-disordered breathing was studied. Parallel classifications were performed for non-rapid eye movement and A phase estimations, examining a one-dimension convolutional neural network (fed with the electroencephalogram signal), a long short-term memory (fed with the electroencephalogram signal or with proposed features), and a feed-forward neural network (fed with proposed features), along with a finite state machine for the cyclic alternating pattern cycle scoring. Two hyper-parameter tuning algorithms were developed to optimize the classifiers. The model with long short-term memory fed with proposed features was found to be the best, with accuracy and area under the receiver operating characteristic curve of 83% and 0.88, respectively, for the A phase classification, while for the non-rapid eye movement estimation, the results were 88% and 0.95, respectively. The cyclic alternating pattern cycle classification accuracy was 79% for the same model, while the cyclic alternating pattern rate percentage error was 22%.
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Automatic Cyclic Alternating Pattern (CAP) analysis: Local and multi-trace approaches. PLoS One 2021; 16:e0260984. [PMID: 34855925 PMCID: PMC8638906 DOI: 10.1371/journal.pone.0260984] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/19/2021] [Indexed: 11/19/2022] Open
Abstract
The Cyclic Alternating Pattern (CAP) is composed of cycles of two different electroencephalographic features: an activation A-phase followed by a B-phase representing the background activity. CAP is considered a physiological marker of sleep instability. Despite its informative nature, the clinical applications remain limited as CAP analysis is a time-consuming activity. In order to overcome this limit, several automatic detection methods were recently developed. In this paper, two new dimensions were investigated in the attempt to optimize novel, efficient and automatic detection algorithms: 1) many electroencephalographic leads were compared to identify the best local performance, and 2) the global contribution of the concurrent detection across several derivations to CAP identification. The developed algorithms were tested on 41 polysomnographic recordings from normal (n = 8) and pathological (n = 33) subjects. In comparison with the visual CAP analysis as the gold standard, the performance of each algorithm was evaluated. Locally, the detection on the F4-C4 derivation showed the best performance in comparison with all other leads, providing practical suggestions of electrode montage when a lean and minimally invasive approach is preferable. A further improvement in the detection was achieved by a multi-trace method, the Global Analysis—Common Events, to be applied when several recording derivations are available. Moreover, CAP time and CAP rate obtained with these algorithms positively correlated with the ones identified by the scorer. These preliminary findings support efficient automated ways for the evaluation of the sleep instability, generalizable to both normal and pathological subjects affected by different sleep disorders.
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Mendonça F, Mostafa SS, Morgado-Dias F, Ravelo-García AG. On the use of patterns obtained from LSTM and feature-based methods for time series analysis: application in automatic classification of the CAP A phase subtypes. J Neural Eng 2020; 18. [PMID: 33271524 DOI: 10.1088/1741-2552/abd047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/03/2020] [Indexed: 11/12/2022]
Abstract
The cyclic alternating pattern is a marker of sleep instability identified in the electroencephalogram signals whose sequence of transient variations compose the A phases. These phases are divided into three subtypes (A1, A2, and A3) according to the presented patterns. The traditional approach of manually scoring the cyclic alternating pattern events for the full night is unpractical, with a high probability of miss classification, due to the large quantity of information that is produced during a full night recording. To address this concern, automatic methodologies were proposed using a long short-term memory to perform the classification of one electroencephalogram monopolar derivation signal. The proposed model is composed of three classifiers, one for each subtype, performing binary classification in a one versus all procedure. Two methodologies were tested: feed the pre-processed electroencephalogram signal to the classifiers; create features from the pre-processed electroencephalogram signal which were fed to the classifiers (feature-based methods). It was verified that the A1 subtype classification performance was similar for both methods and the A2 subtype classification was higher for the feature-based methods. However, the A3 subtype classification was found to be the most challenging to be performed, and for this classification, the feature-based methods were superior. A characterization analysis was also performed using a recurrence quantification analysis to further examine the subtypes characteristics. The average accuracy and area under the receiver operating characteristic curve for the A1, A2, and A3 subtypes of the feature-based methods were respectively: 82% and 0.92; 80% and 0.88; 85% and 0.86.
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Affiliation(s)
- Fábio Mendonça
- Universidade de Lisboa Instituto Superior Tecnico, Lisboa, PORTUGAL
| | | | | | - Antonio G Ravelo-García
- Señales y Comunicaciones, Universidad de Las Palmas de Gran Canaria - Campus de Tafira, Campus de Tafira, Las Palmas de Gran Canaria, 35017, SPAIN
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Mendonça F, Mostafa SS, Morgado-Dias F, Ravelo-García AG. Cyclic alternating pattern estimation based on a probabilistic model over an EEG signal. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.102063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Mendonça F, Mostafa SS, Morgado-Dias F, Ravelo-García AG. Matrix of Lags: A tool for analysis of multiple dependent time series applied for CAP scoring. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 189:105314. [PMID: 31978807 DOI: 10.1016/j.cmpb.2020.105314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/19/2019] [Accepted: 01/04/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Multiple methods have been developed to assess what happens between and within time series. In a particular type of these series, the previous values of the currently observed series are contingent on the lagged values of another series. These cases can commonly be addressed by regression. However, a model selection criteria should be employed to evaluate the compromise between the amount of information provided and the model complexity. This is the basis for the development of the Matrix of Lags (MoL), a tool to study dependent time series. METHODS For each input, multiple regressions were applied to produce a model for each lag and a model selection criterion identifies the lags that will populate an auxiliary matrix. Afterwards, the energy of the lags (that are in the auxiliary matrix) was used to define a row of the MoL. Therefore, each input corresponds to a row of the MoL. To test the proposed tool, the heart rate variability and the electrocardiogram derived respiration were employed to perform the indirect estimation of the electroencephalography cyclic alternating pattern (CAP) cycles. Therefore, a support vector machine was fed with the MoL to perform the CAP cycle classification for each input signal. Multiple tests were carried out to further examine the proposed tool, including the effect of balancing the datasets, application of other regression methods and employment of two feature section models. The first was based on sequential backward selection while the second examined characteristics of a return map. RESULTS The best performance of the subject independent model was attained by feeding the lags, selected by sequential backward selection, to a support vector machine, achieving an average accuracy, sensitivity, specificity and area under the receiver operating characteristic curve of, respectively, 77%, 71%, 82% and 0.77. CONCLUSIONS The developed model allows to perform a measurement of a characteristic marker of sleep instability (the CAP cycle) and the results are in the upper bound of the specialist agreement range with visual analysis. Thus, the developed method could possibly be used for clinical diagnosis.
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Affiliation(s)
- Fábio Mendonça
- Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Lisbon, Portugal; Madeira Interactive Technologies Institute (ITI/Larsys/M-ITI), 9020-105 Funchal, Madeira, Portugal.
| | - Sheikh Shanawaz Mostafa
- Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Lisbon, Portugal; Madeira Interactive Technologies Institute (ITI/Larsys/M-ITI), 9020-105 Funchal, Madeira, Portugal
| | - Fernando Morgado-Dias
- Madeira Interactive Technologies Institute (ITI/Larsys/M-ITI), 9020-105 Funchal, Madeira, Portugal; Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, 9000-082 Funchal, Madeira, Portugal
| | - Antonio G Ravelo-García
- Institute for Technological Development and Innovation in Communications, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Canary Islands, Spain
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Mendonça F, Mostafa SS, Morgado-Dias F, Ravelo-García AG. A Portable Wireless Device for Cyclic Alternating Pattern Estimation from an EEG Monopolar Derivation. ENTROPY 2019. [PMCID: PMC7514548 DOI: 10.3390/e21121203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Quality of sleep can be assessed by analyzing the cyclic alternating pattern, a long-lasting periodic activity that is composed of two alternate electroencephalogram patterns, which is considered to be a marker of sleep instability. Experts usually score this pattern through a visual examination of each one-second epoch of an electroencephalogram signal, a repetitive and time-consuming task that is prone to errors. To address these issues, a home monitoring device was developed for automatic scoring of the cyclic alternating pattern by analyzing the signal from one electroencephalogram derivation. Three classifiers, specifically, two recurrent networks (long short-term memory and gated recurrent unit) and one one-dimension convolutional neural network, were developed and tested to determine which was more suitable for the cyclic alternating pattern phase’s classification. It was verified that the network based on the long short-term memory attained the best results with an average accuracy, sensitivity, specificity and area under the receiver operating characteristic curve of, respectively, 76%, 75%, 77% and 0.752. The classified epochs were then fed to a finite state machine to determine the cyclic alternating pattern cycles and the performance metrics were 76%, 71%, 84% and 0.778, respectively. The performance achieved is in the higher bound of the experts’ expected agreement range and considerably higher than the inter-scorer agreement of multiple experts, implying the usability of the device developed for clinical analysis.
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Affiliation(s)
- Fábio Mendonça
- Instituto Superior Técnico, University of Lisbon, 1049-001 Lisbon, Portugal;
- Madeira Interactive Technologies Institute (ITI/Larsys/M-ITI), 9020-105 Funchal, Portugal;
- Correspondence: ; Tel.: +351-291-721-006
| | - Sheikh Shanawaz Mostafa
- Instituto Superior Técnico, University of Lisbon, 1049-001 Lisbon, Portugal;
- Madeira Interactive Technologies Institute (ITI/Larsys/M-ITI), 9020-105 Funchal, Portugal;
| | - Fernando Morgado-Dias
- Madeira Interactive Technologies Institute (ITI/Larsys/M-ITI), 9020-105 Funchal, Portugal;
- Faculty of Exact Sciences and Engineering, University of Madeira, 9000-082 Funchal, Portugal
| | - Antonio G. Ravelo-García
- Institute for Technological Development and Innovation in Communications, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain;
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Mendonça F, Mostafa SS, Morgado-Dias F, Ravelo-García AG, Penzel T. Sleep quality of subjects with and without sleep-disordered breathing based on the cyclic alternating pattern rate estimation from single-lead ECG. Physiol Meas 2019; 40:105009. [DOI: 10.1088/1361-6579/ab4f08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Largo R, Lopes M, Spruyt K, Guilleminault C, Wang Y, Rosa A. Visual and automatic classification of the cyclic alternating pattern in electroencephalography during sleep. Braz J Med Biol Res 2019; 52:e8059. [PMID: 30810623 PMCID: PMC6393849 DOI: 10.1590/1414-431x20188059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/07/2018] [Indexed: 11/30/2022] Open
Abstract
Cyclic alternating pattern (CAP) is a neurophysiological pattern that can be visually scored by international criteria. The aim of this study was to verify the feasibility of visual CAP scoring using only one channel of sleep electroencephalogram (EEG) to evaluate the inter-scorer agreement in a variety of recordings, and to compare agreement between visual scoring and automatic scoring systems. Sixteen hours of single-channel European data format recordings from four different sleep laboratories with either C4-A1 or C3-A2 channels and with different sampling frequencies were used in this study. Seven independent scorers applied visual scoring according to international criteria. Two automatic blind scorings were also evaluated. Event-based inter-scorer agreement analysis was performed. The pairwise inter-scorer agreement (PWISA) was between 55.5 and 84.3%. The average PWISA was above 60% for all scorers and the global average was 69.9%. Automatic scoring systems showed similar results to those of visual scoring. The study showed that CAP could be scored using only one EEG channel. Therefore, CAP scoring might also be integrated in sleep scoring features and automatic scoring systems having similar performances to visual sleep scoring systems.
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Affiliation(s)
- R. Largo
- LaSEEB - Evolutionary Systems and Biomedical Engineering Laboratory, Institute for Systems and Robotics (ISR-Lisboa), Instituto Superior Técnico (IST), University of Lisbon, Lisbon, Portugal
- Escola Superior de Tecnologia de Setúbal, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - M.C. Lopes
- LaSEEB - Evolutionary Systems and Biomedical Engineering Laboratory, Institute for Systems and Robotics (ISR-Lisboa), Instituto Superior Técnico (IST), University of Lisbon, Lisbon, Portugal
- Instituto de Psiquiatria (PRATA), Hospital das Cl�nicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - K. Spruyt
- Lyon Neuroscience Research Center, INSERM U1028-CNRS UMR 5292 Waking Team, School of Medicine, University Claude Bernard, Lyon, France
| | - C. Guilleminault
- Sleep Disorders Clinic, Stanford University Medical Center, Stanford, CA, USA
| | - Y.P. Wang
- Instituto de Psiquiatria (LIM-23), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A.C. Rosa
- LaSEEB - Evolutionary Systems and Biomedical Engineering Laboratory, Institute for Systems and Robotics (ISR-Lisboa), Instituto Superior Técnico (IST), University of Lisbon, Lisbon, Portugal
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Cyclic alternating pattern in infants with congenital hypothyroidism. Brain Dev 2019; 41:66-71. [PMID: 30037585 DOI: 10.1016/j.braindev.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022]
Abstract
Congenital hypothyroidism is defined as thyroid hormone deficiency present at birth which is crucial for brain development. Recently, the cyclic alternating pattern, a rhythm present in electroencephalography recordings in non-Rapid eye movement sleep, has been related to brain development and cognition in different pediatric conditions. Therefore, we evaluated the cyclic alternating pattern rate in infants with congenital hypothyroidism, thyroxine supplementation, and healthy controls. The parameters of the cyclic alternating pattern were evaluated in 19 healthy infants (10 female, mean age 25.5 ± 15.5 months) and 21 infants diagnosed with congenital hypothyroidism (19 female, mean age 24.3 ± 19.0 months). We considered the transient electro-cortical activations (phase A of the cycle) in non-Rapid eye movement sleep and the subdivisions of the A phase in: A1, A2 and A3, based on their frequency content. All subjects were subjected to polysomnography recording in a standard laboratory setting. Sleep data were stored computer following the International 10-20 System. Data showed that congenital hypothyroidism infants exhibited higher frequency of central apnea, hypopnea, and arousals in comparison to controls. Particularly, central apnea index decreased with age in the control group but not in congenital hypothyroidism group. Regarding to cyclic alternating pattern measurements, congenital hypothyroidism infants exhibit a higher frequency in the percentage of A3 subtype (electroencephalographic desynchrony) and conversely a lower percentage of A1 subtype (electroencephalographic synchrony), than healthy infants. An important finding of this study is the positive correlation between A1 mean duration and age, which is bigger in control group than in congenital hypothyroidism group (time duration in control group (0.52 s/month) versus congenital hypothyroidism group (0.1 s/month). Infants with congenital hypothyroidism showed an increase of A3 subtype, of central apnea, and of arousals. The reduction of percentage and mean duration of A1 subtype could be a valuable indicator of sleep development in patients with congenital hypothyroidism and healthy infants.
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Li Q, Li Q, Liu C, Shashikumar SP, Nemati S, Clifford GD. Deep learning in the cross-time frequency domain for sleep staging from a single-lead electrocardiogram. Physiol Meas 2018; 39:124005. [PMID: 30524025 PMCID: PMC8325056 DOI: 10.1088/1361-6579/aaf339] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study classifies sleep stages from a single lead electrocardiogram (ECG) using beat detection, cardiorespiratory coupling in the time-frequency domain and a deep convolutional neural network (CNN). APPROACH An ECG-derived respiration (EDR) signal and synchronous beat-to-beat heart rate variability (HRV) time series were derived from the ECG using previously described robust algorithms. A measure of cardiorespiratory coupling (CRC) was extracted by calculating the coherence and cross-spectrogram of the EDR and HRV signal in 5 min windows. A CNN was then trained to classify the sleep stages (wake, rapid-eye-movement (REM) sleep, non-REM (NREM) light sleep and NREM deep sleep) from the corresponding CRC spectrograms. A support vector machine was then used to combine the output of CNN with the other features derived from the ECG, including phase-rectified signal averaging (PRSA), sample entropy, as well as standard spectral and temporal HRV measures. The MIT-BIH Polysomnographic Database (SLPDB), the PhysioNet/Computing in Cardiology Challenge 2018 database (CinC2018) and the Sleep Heart Health Study (SHHS) database, all expert-annotated for sleep stages, were used to train and validate the algorithm. MAIN RESULTS Ten-fold cross validation results showed that the proposed algorithm achieved an accuracy (Acc) of 75.4% and a Cohen's kappa coefficient of [Formula: see text] = 0.54 on the out of sample validation data in the classification of Wake, REM, NREM light and deep sleep in SLPDB. This rose to Acc = 81.6% and [Formula: see text] = 0.63 for the classification of Wake, REM sleep and NREM sleep and Acc = 85.1% and [Formula: see text] = 0.68 for the classification of NREM sleep versus REM/wakefulness in SLPDB. SIGNIFICANCE The proposed ECG-based sleep stage classification approach that represents the highest reported results on non-electroencephalographic data and uses datasets over ten times larger than those in previous studies. By using a state-of-the-art QRS detector and deep learning model, the system does not require human annotation and can therefore be scaled for mass analysis.
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Affiliation(s)
- Qiao Li
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States of America
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Mendonca F, Mostafa SS, Morgado-Dias F, Ravelo-Garcia AG. Sleep Quality Estimation by Cardiopulmonary Coupling Analysis. IEEE Trans Neural Syst Rehabil Eng 2018; 26:2233-2239. [DOI: 10.1109/tnsre.2018.2881361] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Moldofsky H, Rothman L, Kleinman R, Rhind SG, Richardson JD. Disturbed EEG sleep, paranoid cognition and somatic symptoms identify veterans with post-traumatic stress disorder. BJPsych Open 2016; 2:359-365. [PMID: 29018561 PMCID: PMC5609777 DOI: 10.1192/bjpo.bp.116.003483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/16/2016] [Accepted: 10/20/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic post-traumatic stress disorder (PTSD) behavioural symptoms and medically unexplainable somatic symptoms are reported to occur following the stressful experience of military combatants in war zones. AIMS To determine the contribution of disordered EEG sleep physiology in those military combatants who have unexplainable physical symptoms and PTSD behavioural difficulties following war-zone exposure. METHOD This case-controlled study compared 59 veterans with chronic sleep disturbance with 39 veterans with DSM-IV and clinician-administered PTSD Scale diagnosed PTSD who were unresponsive to pharmacological and psychological treatments. All had standardised EEG polysomnography, computerised sleep EEG cyclical alternating pattern (CAP) as a measure of sleep stability, self-ratings of combat exposure, paranoid cognition and hostility subscales of Symptom Checklist-90, Beck Depression Inventory and the Wahler Physical Symptom Inventory. Statistical group comparisons employed linear models, logistic regression and chi-square automatic interaction detection (CHAID)-like decision trees. RESULTS Veterans with PTSD were more likely than those without PTSD to show disturbances in non-rapid eye movement (REM) and REM sleep including delayed sleep onset, less efficient EEG sleep, less stage 4 (deep) non-REM sleep, reduced REM and delayed onset to REM. There were no group differences in the prevalence of obstructive sleep apnoeas/hypopnoeas and periodic leg movements, but sleep-disturbed, non-PTSD military had more EEG CAP sleep instability. Rank order determinants for the diagnosis of PTSD comprise paranoid thinking, onset to REM sleep, combat history and somatic symptoms. Decision-tree analysis showed that a specific military event (combat), delayed onset to REM sleep, paranoid thinking and medically unexplainable somatic pain and fatigue characterise chronic PTSD. More PTSD veterans reported domestic and social misbehaviour. CONCLUSIONS Military combat, disturbed REM/non-REM EEG sleep, paranoid ideation and medically unexplained chronic musculoskeletal pain and fatigue are key factors in determining PTSD disability following war-zone exposure. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Harvey Moldofsky
- Harvey Moldofsky, MD, Dip. Psych., FRCPC, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lorne Rothman
- Lorne Rothman, PhD, SAS (Canada) Institute, Inc., Toronto, Ontario, Canada
| | - Robert Kleinman
- Robert Kleinman, MD, Department of Ophthalmology, Stanford University, Palo Alto, California, USA
| | - Shawn G. Rhind
- Shawn G. Rhind, PhD, Individual Behaviour and Performance Section, Toronto Research Centre, Defence Research and Development Canada, Toronto, Ontario, Canada
| | - J. Donald Richardson
- J. Donald Richardson, MD, FRCPC, Operational Stress Injury Clinic, Parkwood Hospital, London, Ontario, Canada; Department of Psychiatry, Western University, London, Ontario, Canada; Department of Psychiatry & Behavioral Neuroscience, McMaster University, Hamilton, Ontario, Canada
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Roebuck A, Monasterio V, Gederi E, Osipov M, Behar J, Malhotra A, Penzel T, Clifford GD. A review of signals used in sleep analysis. Physiol Meas 2014; 35:R1-57. [PMID: 24346125 PMCID: PMC4024062 DOI: 10.1088/0967-3334/35/1/r1] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This article presents a review of signals used for measuring physiology and activity during sleep and techniques for extracting information from these signals. We examine both clinical needs and biomedical signal processing approaches across a range of sensor types. Issues with recording and analysing the signals are discussed, together with their applicability to various clinical disorders. Both univariate and data fusion (exploiting the diverse characteristics of the primary recorded signals) approaches are discussed, together with a comparison of automated methods for analysing sleep.
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Affiliation(s)
- A Roebuck
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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Mariani S, Grassi A, Mendez MO, Milioli G, Parrino L, Terzano MG, Bianchi AM. EEG segmentation for improving automatic CAP detection. Clin Neurophysiol 2013; 124:1815-23. [PMID: 23643311 DOI: 10.1016/j.clinph.2013.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/06/2013] [Accepted: 04/04/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study is to provide an improved method for the automatic classification of the Cyclic Alternating Pattern (CAP) sleep by applying a segmentation technique to the computation of descriptors from the EEG. METHODS A dataset of 16 polysomnographic recordings from healthy subjects was employed, and the EEG traces underwent first an automatic isolation of NREM sleep portions by means of an Artificial Neural Network and then a segmentation process based on the Spectral Error Measure. The information content of the descriptors was evaluated by means of ROC curves and compared with that of descriptors obtained without the use of segmentation. Finally, the descriptors were used to train a discriminant function for the automatic classification of CAP phases A. RESULTS A significant improvement with respect to previous scoring methods in terms of both information content carried by the descriptors and accuracy of the classification was obtained. CONCLUSIONS EEG segmentation proves to be a useful step in the computation of descriptors for CAP scoring. SIGNIFICANCE This study provides a complete method for CAP analysis, which is entirely automatic and allows the recognition of A phases with a high accuracy thanks to EEG segmentation.
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Affiliation(s)
- Sara Mariani
- Politecnico di Milano, Department of Electronics, Information and Bioengineering, P.zza Leonardo da Vinci 32, 20133 Milan, Italy.
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FERRI RAFFAELE, RUNDO FRANCESCO, NOVELLI LUANA, TERZANO MARIOG, PARRINO LIBORIO, BRUNI OLIVIERO. A new quantitative automatic method for the measurement of non-rapid eye movement sleep electroencephalographic amplitude variability. J Sleep Res 2011; 21:212-20. [DOI: 10.1111/j.1365-2869.2011.00981.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moldofsky H, Harris HW, Archambault WT, Kwong T, Lederman S. Effects of bedtime very low dose cyclobenzaprine on symptoms and sleep physiology in patients with fibromyalgia syndrome: a double-blind randomized placebo-controlled study. J Rheumatol 2011; 38:2653-63. [PMID: 21885490 DOI: 10.3899/jrheum.110194] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the effects of bedtime very low dose (VLD) cyclobenzaprine (CBP) on symptoms and sleep physiology of patients with fibromyalgia (FM), unrefreshing sleep, and the α-nonREM sleep electroencephalographic (EEG) anomaly at screening. METHODS Of 37 patients with FM in the screened population, 36 were randomized and treated in this 8-week, double-blind, placebo-controlled, dose-escalating study of VLD CBP 1-4 mg at bedtime. We evaluated changes in subjective symptoms including pain, tenderness, fatigue, mood [Hospital Anxiety and Depression Scale (HAD)], and objective EEG sleep physiology (at screening, baseline, and Weeks 2, 4, and 8). RESULTS In the VLD CBP-treated group (n = 18) over 8 weeks, musculoskeletal pain and fatigue decreased, tenderness improved; total HAD score and the HAD depression subscore decreased; patient-rated and clinician-rated fatigue improved. In the placebo-treated group (n = 18), none of these outcome measures changed significantly. Compared to placebo at 8 weeks, VLD CBP significantly improved pain, tenderness, and the HAD Depression subscore. Analysis of cyclic alternating pattern (CAP) sleep EEG revealed that significantly more subjects in the VLD CBP group than the placebo group had increased nights of restorative sleep in which CAP(A2+A3)/CAP(A1+A2+A3) = CAP(A2+A3(Norm)) ≤ 33%. For VLD CBP-treated subjects, the increase in nights with CAP(A2+A3(Norm)) ≤ 33% was correlated to improvements in fatigue, total HAD score, and HAD depression score. CONCLUSION Bedtime VLD CBP treatment improved core FM symptoms. Nights with CAP(A2+A3(Norm)) ≤ 33% may provide a biomarker for assessing treatment effects on nonrestorative sleep and associated fatigue and mood symptoms in persons with FM.
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Affiliation(s)
- Harvey Moldofsky
- Sleep Disorders Clinics, Centre for Sleep and Chronobiology, University of Toronto, Toronto, Ontario, Canada.
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Moldofsky H, Patcai J. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC Neurol 2011; 11:37. [PMID: 21435231 PMCID: PMC3071317 DOI: 10.1186/1471-2377-11-37] [Citation(s) in RCA: 383] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 03/24/2011] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The long term adverse effects of Severe Acute Respiratory Syndrome (SARS), a viral disease, are poorly understood. METHODS Sleep physiology, somatic and mood symptoms of 22 Toronto subjects, 21 of whom were healthcare workers, (19 females, 3 males, mean age 46.29 yrs.+/- 11.02) who remained unable to return to their former occupation (mean 19.8 months, range: 13 to 36 months following SARS) were compared to 7 healthy female subjects. Because of their clinical similarities to patients with fibromyalgia syndrome (FMS) these post-SARS subjects were similarly compared to 21 drug free female patients, (mean age 42.4 +/- 11.8 yrs.) who fulfilled criteria for fibromyalgia. RESULTS Chronic post-SARS is characterized by persistent fatigue, diffuse myalgia, weakness, depression, and nonrestorative sleep with associated REM-related apneas/hypopneas, an elevated sleep EEG cyclical alternating pattern, and alpha EEG sleep anomaly. Post- SARS patients had symptoms of pre and post-sleep fatigue and post sleep sleepiness that were similar to the symptoms of patients with FMS, and similar to symptoms of patients with chronic fatigue syndrome. Both post-SARS and FMS groups had sleep instability as indicated by the high sleep EEG cyclical alternating pattern rate. The post-SARS group had a lower rating of the alpha EEG sleep anomaly as compared to the FMS patients. The post-SARS group also reported less pre-sleep and post-sleep musculoskeletal pain symptoms. CONCLUSIONS The clinical and sleep features of chronic post-SARS form a syndrome of chronic fatigue, pain, weakness, depression and sleep disturbance, which overlaps with the clinical and sleep features of FMS and chronic fatigue syndrome.
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Affiliation(s)
- Harvey Moldofsky
- Sleep Disorders Clinic of the Centre for Sleep and Chronobiology, 340 College St., Suite 580, Toronto, ON M5T 3A9, Canada
| | - John Patcai
- St. John's Rehab Hospital, 285 Cummer Ave, Toronto, ON M2M 2G1, Canada
- Department of Medicine, University of Toronto, #3S805 - 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
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Mariani S, Bianchi AM, Manfredini E, Rosso V, Mendez MO, Parrino L, Matteucci M, Grassi A, Cerutti S, Terzano MG. Automatic detection of a phases of the cyclic alternating pattern during sleep. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2010:5085-8. [PMID: 21096032 DOI: 10.1109/iembs.2010.5626211] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study aimed to develop an automatic algorithm to detect the activation phases (A phases) of the Cyclic Alternating Pattern. The sleep EEG microstructure of 4 adult, healthy subjects was scored by a sleep medicine expert. Features were calculated from each of the six EEG bands (low delta, high delta, theta, alpha, sigma and beta), and three additional characteristics were computed: the Hjorth activity in the low delta and high delta bands, and the differential variance of the raw EEG signal. The correlation between couples of features was analyzed to find redundancies for the automatic analysis. The features were used to train an Artificial Neural Network to automatically find the A phases of CAP. The data were divided into training, validation and testing set, and the visual scoring provided by the clinician was used as the desired output. The statistics on the second by second classification show an average sensitivity equal to 76%, specificity equal to 83% and accuracy equal to 82%. The results obtained are encouraging, since an automatic classification of the A phases could benefit the practice in clinics, preventing the physician from the time-consuming activity of visually scoring the sleep microstructure over the whole eight-hour sleep recordings. Moreover, it would provide an objective criterion capable of overcoming the problems of inter-scorer variability.
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Affiliation(s)
- Sara Mariani
- Politecnico di Milano, Dept. of Biomedical Engineering, P.zza Leonardo da Vinci 32, 20133, Milan, Italy.
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Mariani S, Grassi A, Mendez MO, Parrino L, Terzano MG, Bianchi AM. Automatic detection of CAP on central and fronto-central EEG leads via Support Vector Machines. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2011:1491-1494. [PMID: 22254602 DOI: 10.1109/iembs.2011.6090364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim of this study is to implement a high-accuracy automatic detector of the Cyclic Alternating Pattern (CAP) during sleep. EEG data from four healthy subjects were used. Both the C4-A1 and the F4-C4 leads were analyzed for this study. Seven features were extracted from each of the two leads and two separate studies were performed for each set of descriptors. For both sets, a Support Vector Machine was trained and tested on the data with the Leave One Out cross-validation method. The two final classifications obtained on the two sets were merged, by considering a CAP A phase scored only if it had been recognized both on the central and on the frontal lead. The length of the A phase was then determined by the result on the fronto-central lead. This method leads to encouraging results, with a classification sensitivity on the whole dataset equal to 73.82%, specificity equal to 85.93%, accuracy equal to 84,05% and Cohen's kappa equal to 0.50.
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Affiliation(s)
- Sara Mariani
- Politecnico di Milano, Dept of Biomedical Engineering, P.zza Leonardo da Vinci 32, 20133 Milan, Italy.
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Moldofsky H, Inhaber NH, Guinta DR, Alvarez-Horine SB. Effects of sodium oxybate on sleep physiology and sleep/wake-related symptoms in patients with fibromyalgia syndrome: a double-blind, randomized, placebo-controlled study. J Rheumatol 2010; 37:2156-66. [PMID: 20682669 DOI: 10.3899/jrheum.091041] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the effects of sodium oxybate (SXB) on sleep physiology and sleep/wake-related symptoms in patients with fibromyalgia syndrome (FM). METHODS Of 304 patients with FM (American College of Rheumatology tender point criteria) in the screened study population, 209 underwent polysomnography, 195 were randomized, and 151 completed this 8-week, double-blind, placebo-controlled study of SXB 4.5 g and 6 g/night. We evaluated changes in objective sleep measures and subjective symptoms, including daytime sleepiness [Epworth Sleepiness Scale (ESS)], fatigue visual analog scale (FVAS), sleep [Jenkins Scale for Sleep (JSS)], and daytime functioning [Functional Outcome of Sleep Questionnaire (FOSQ), SF-36 Vitality domain, and Fibromyalgia Impact Questionnaire (FIQ) general and morning tiredness]. RESULTS Pretreatment screening revealed an elevated incidence of maximum alpha EEG-intrusion > 24 min/hour of sleep (66%), periodic limb movements of sleep (20.1% ≥ 5/hour), and moderate to severe obstructive sleep apnea disorder (15.3% apnea-hypopnea index ≥ 15/hour). Compared with placebo, both doses of SXB achieved statistically significant improvements in ESS, morning FVAS, JSS, FOSQ, SF-36 Vitality, and FIQ general and morning tiredness; both doses also demonstrated decreased rapid eye movement (REM) sleep (all p ≤ 0.040). SXB 6 g/night improved afternoon, evening and overall FVAS, reduced wakefulness after sleep onset, and increased Stage 2, slow-wave, and total non-REM sleep (all p ≤ 0.032) versus placebo. Moderate correlations (≥ 0.40) were noted between changes in subjective sleep and pain measures. Adverse events occurring significantly more frequently with SXB than placebo were nausea, pain in extremity, nervous system disorders, dizziness, restlessness, and renal/urinary disorders (including urinary incontinence). CONCLUSION This large cohort of patients with FM demonstrated that SXB treatment improved EEG sleep physiology and sleep-related FM symptoms.
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Affiliation(s)
- Harvey Moldofsky
- Centre for Sleep and Chronobiology and Toronto Psychiatric Research Foundation, Toronto, Ontario, Canada.
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Martinez D, Breitenbach TC, Lenz MDCS. Light sleep and sleep time misperception - relationship to alpha-delta sleep. Clin Neurophysiol 2010; 121:704-11. [PMID: 20153688 DOI: 10.1016/j.clinph.2010.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Revised: 12/29/2009] [Accepted: 01/06/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We investigated the association of alpha-delta sleep (A-DS) with: (1) perception of light sleep and (2) discrepancy between subjective and objective sleep duration. METHODS We analyzed data from 5764 individuals who underwent polysomnography (PSG) and replied questions about quantity and quality of sleep, including sleep depth. The difference between objectively recorded sleep time and subjectively estimated sleep time was calculated. Alpha-delta sleep (A-DS) was visually scored in a scale from 1 to 4, based on the density and overnight duration of alpha activity and confirmed using spectral array of the electroencephalographic activity. RESULTS A-DS scores 1-4 occurred in, respectively, 37.9%; 31.3%; 20.5%; and 6.2% of the cases. ANOVA showed significant difference of light sleep sensation (p<0.001) and sleep time underestimation (p<0.001) among the four A-DS categories. Regression to explain both light sleep and sleep time underestimation, controlling for confounders, confirmed A-DS as a significant regressor. CONCLUSIONS This study of a large prospective sample provides evidence for the association of alpha-delta sleep with subjective sensation of light sleep and with sleep time underestimation. SIGNIFICANCE Alpha-delta sleep may be a marker of the physiological disorder underlying light sleep and sleep state misperception.
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Affiliation(s)
- Denis Martinez
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul-UFRGS, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil.
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Saccomandi F, Priano L, Mauro A, Nerino R, Guiot C. Automatic detection of transient EEG events during sleep can be improved using a multi-channel approach. Clin Neurophysiol 2008; 119:959-67. [DOI: 10.1016/j.clinph.2007.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2007] [Revised: 12/09/2007] [Accepted: 12/22/2007] [Indexed: 10/22/2022]
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