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Cordoza ML, Anderson BJ, Cevasco M, Diamond JM, Younes M, Gerardy B, Iroegbu C, Riegel B. Feasibility and Acceptability of Using Wireless Limited Polysomnography to Capture Sleep Before, During, and After Hospitalization for Patients With Planned Cardiothoracic Surgery. J Cardiovasc Nurs 2024:00005082-990000000-00180. [PMID: 38509035 DOI: 10.1097/jcn.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Sleep disruption, a common symptom among patients requiring cardiovascular surgery, is a potential risk factor for the development of postoperative delirium. Postoperative delirium is a disorder of acute disturbances in cognition associated with prolonged hospitalization, cognitive decline, and mortality. OBJECTIVE The aim of this study was to evaluate the feasibility and acceptability of using polysomnography (PSG) to capture sleep in patients with scheduled cardiothoracic surgery. METHODS Wireless limited PSG assessed sleep at baseline (presurgery at home), postoperatively in the intensive care unit, and at home post hospital discharge. Primary outcomes were quality and completeness of PSG signals, and acceptability by participants and nursing staff. RESULTS Among 15 patients, PSG data were of high quality, and mean percentage of unscorable data was 5.5% ± 11.1%, 3.7% ± 5.4%, and 3.7% ± 8.4% for baseline, intensive care unit, and posthospitalization measurements, respectively. Nurses and patients found the PSG monitor acceptable. CONCLUSIONS Wireless, limited PSG to capture sleep across the surgical continuum was feasible, and data were of high quality. Authors of future studies will evaluate associations of sleep indices and development of postoperative delirium in this high-risk population.
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Hilditch CJ, Pradhan S, Costedoat G, Bathurst NG, Glaros Z, Gregory KB, Shattuck NL, Flynn-Evans EE. An at-home evaluation of a light intervention to mitigate sleep inertia symptoms. Sleep Health 2024; 10:S121-S129. [PMID: 37679265 DOI: 10.1016/j.sleh.2023.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Under laboratory settings, light exposure upon waking at night improves sleep inertia symptoms. We investigated whether a field-deployable light source would mitigate sleep inertia in a real-world setting. METHODS Thirty-six participants (18 female; 26.6 years ± 6.1) completed an at-home, within-subject, randomized crossover study. Participants were awoken 45 minutes after bedtime and wore light-emitting glasses with the light either on (light condition) or off (control). A visual 5-minute psychomotor vigilance task, Karolinska sleepiness scale, alertness and mood scales, and a 3-minute auditory/verbal descending subtraction task were performed at 2, 12, 22, and 32 minutes after awakening. Participants then went back to sleep and were awoken after 45 minutes for the opposite condition. A series of mixed-effect models were performed with fixed effects of test bout, condition, test bout × condition, a random effect of the participant, and relevant covariates. RESULTS Participants rated themselves as more alert (p = .01) and energetic (p = .001) in the light condition compared to the control condition. There was no effect of condition for descending subtraction task outcomes when including all participants, but there was a significant improvement in descending subtraction task total responses in the light condition in the subset of participants waking from N3 (p = .03). There was a significant effect of condition for psychomotor vigilance task outcomes, with faster responses (p < .001) and fewer lapses (p < .001) in the control condition. CONCLUSIONS Our findings suggest that light modestly improves self-rated alertness and energy after waking at home regardless of sleep stage, with lower aggression and improvements to working memory only after waking from N3. Contrary to laboratory studies, we did not observe improved performance on the psychomotor vigilance task. Future studies should include measures of visual acuity and comfort to assess the feasibility of interventions in real-world settings.
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Affiliation(s)
- Cassie J Hilditch
- Fatigue Countermeasures Laboratory, San José State University, San José, California, USA.
| | - Sean Pradhan
- Fatigue Countermeasures Laboratory, San José State University, San José, California, USA; School of Business, Menlo College, Atherton, California, USA
| | - Gregory Costedoat
- Fatigue Countermeasures Laboratory, San José State University, San José, California, USA
| | - Nicholas G Bathurst
- Fatigue Countermeasures Laboratory, NASA Ames Research Center, Moffett Field, California, USA
| | - Zachary Glaros
- Fatigue Countermeasures Laboratory, NASA Ames Research Center, Moffett Field, California, USA
| | - Kevin B Gregory
- Fatigue Countermeasures Laboratory, NASA Ames Research Center, Moffett Field, California, USA
| | - Nita L Shattuck
- Operations Research Department, Naval Postgraduate School, Monterey, California, USA
| | - Erin E Flynn-Evans
- Fatigue Countermeasures Laboratory, NASA Ames Research Center, Moffett Field, California, USA
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Korkalainen H, Kainulainen S, Islind AS, Óskarsdóttir M, Strassberger C, Nikkonen S, Töyräs J, Kulkas A, Grote L, Hedner J, Sund R, Hrubos-Strom H, Saavedra JM, Ólafsdóttir KA, Ágústsson JS, Terrill PI, McNicholas WT, Arnardóttir ES, Leppänen T. Review and perspective on sleep-disordered breathing research and translation to clinics. Sleep Med Rev 2024; 73:101874. [PMID: 38091850 DOI: 10.1016/j.smrv.2023.101874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/18/2023] [Accepted: 11/09/2023] [Indexed: 01/23/2024]
Abstract
Sleep-disordered breathing, ranging from habitual snoring to severe obstructive sleep apnea, is a prevalent public health issue. Despite rising interest in sleep and awareness of sleep disorders, sleep research and diagnostic practices still rely on outdated metrics and laborious methods reducing the diagnostic capacity and preventing timely diagnosis and treatment. Consequently, a significant portion of individuals affected by sleep-disordered breathing remain undiagnosed or are misdiagnosed. Taking advantage of state-of-the-art scientific, technological, and computational advances could be an effective way to optimize the diagnostic and treatment pathways. We discuss state-of-the-art multidisciplinary research, review the shortcomings in the current practices of SDB diagnosis and management in adult populations, and provide possible future directions. We critically review the opportunities for modern data analysis methods and machine learning to combine multimodal information, provide a perspective on the pitfalls of big data analysis, and discuss approaches for developing analysis strategies that overcome current limitations. We argue that large-scale and multidisciplinary collaborative efforts based on clinical, scientific, and technical knowledge and rigorous clinical validation and implementation of the outcomes in practice are needed to move the research of sleep-disordered breathing forward, thus increasing the quality of diagnostics and treatment.
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Affiliation(s)
- Henri Korkalainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Anna Sigridur Islind
- Department of Computer Science, Reykjavik University, Reykjavik, Iceland; Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland
| | - María Óskarsdóttir
- Department of Computer Science, Reykjavik University, Reykjavik, Iceland
| | - Christian Strassberger
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Sami Nikkonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia; Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Kulkas
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Ludger Grote
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Sleep Disorders Centre, Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Hedner
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Sleep Disorders Centre, Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Reijo Sund
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Harald Hrubos-Strom
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Ear, Nose and Throat Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Jose M Saavedra
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland; Physical Activity, Physical Education, Sport and Health (PAPESH) Research Group, Department of Sports Science, Reykjavik University, Reykjavik, Iceland
| | | | | | - Philip I Terrill
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
| | - Walter T McNicholas
- School of Medicine, University College Dublin, and Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin Ireland
| | - Erna Sif Arnardóttir
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland; Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
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Wu FM, Gorelik D, Brenner MJ, Takashima M, Goyal A, Kita AE, Rose AS, Hong RS, Abuzeid WM, Maria PS, Al-Sayed AA, Dunham ME, Kadkade P, Schaffer SR, Johnson AW, Eshraghi AA, Samargandy S, Morrison RJ, Weissbrod PA, Mitchell MB, Rabbani CC, Futran N, Ahmed OG. New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review of 2022. OTO Open 2024; 8:e105. [PMID: 38259521 PMCID: PMC10802084 DOI: 10.1002/oto2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/14/2023] [Indexed: 01/24/2024] Open
Abstract
Objective To review new drugs and devices relevant to otolaryngology approved by the Food and Drug Administration (FDA) in 2022. Data Sources Publicly available FDA data on drugs and devices approved in 2022. Review Methods A preliminary screen was conducted to identify drugs and devices relevant to otolaryngology. A secondary screen by members of the American Academy of Otolaryngology-Head and Neck Surgery's (AAO-HNS) Medical Devices and Drugs Committee differentiated between minor updates and new approvals. The final list of drugs and devices was sent to members of each subspecialty for review and analysis. Conclusion A total of 1251 devices and 37 drugs were identified on preliminary screening. Of these, 329 devices and 5 drugs were sent to subspecialists for further review, from which 37 devices and 2 novel drugs were selected for further analysis. The newly approved devices spanned all subspecialties within otolaryngology. Many of the newly approved devices aimed to enhance patient experience, including over-the-counter hearing aids, sleep monitoring devices, and refined CPAP devices. Other advances aimed to improve surgical access, convenience, or comfort in the operating room and clinic. Implications for Practice Many new devices and drugs are approved each year to improve patient care and care delivery. By staying up to date with these advances, otolaryngologists can leverage new innovations to improve the safety and quality of care. Given the recent approval of these devices, further studies are needed to assess long-term impact within the field of otolaryngology.
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Affiliation(s)
- Franklin M Wu
- Department of Otolaryngology-Head and Neck Surgery Houston Methodist Hospital Houston USA
| | - Daniel Gorelik
- Department of Otolaryngology-Head and Neck Surgery Houston Methodist Hospital Houston USA
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery University of Michigan Medical School Ann Arbor USA
| | - Masayoshi Takashima
- Department of Otolaryngology-Head and Neck Surgery Houston Methodist Hospital Houston USA
| | - Amit Goyal
- Department of Otorhinolaryngology All India Institute of Medical Sciences Jodhpur Jodhpur USA
| | - Ashley E Kita
- Department of Head and Neck Surgery David Geffen School of Medicine at UCLA Los Angeles USA
| | - Austin S Rose
- University of North Carolina School of Medicine Department of Otolaryngology-Head and Neck Surgery
| | - Robert S Hong
- Michigan Ear Institute Farmington Hills USA
- Department of Otolaryngology-Head and Neck Surgery Wayne State University Detroit USA
| | - Waleed M Abuzeid
- University of Washington Department of Otolaryngology-Head and Neck Surgery
| | - Peter S Maria
- Stanford University Department of Otolaryngology-Head and Neck Surgery
| | - Ahmed A Al-Sayed
- King Saud University Department of Otolaryngology-Head & Neck Surgery
| | - Michael E Dunham
- Louisiana State University Health Sciences Center School of Medicine Department of Otolaryngology-Head and Neck Surgery
| | - Prajoy Kadkade
- Columbia University-Harlem Hospital Department of Surgery
- Department of Surgery NYU Long Island School of Medicine New York City USA
| | - Scott R Schaffer
- Department of Otorhinolaryngology-Head and Neck Surgery Hospital University of Pennsylvania Philadelphia USA
| | - Alan W Johnson
- Department of Otolaryngology-Head & Neck Surgery Park Nicollet Specialty Care Bloomington USA
| | - Adrien A Eshraghi
- Department of Otolaryngology and Neurosurgery University of Miami Miller School of Medicine Miami USA
| | - Shireen Samargandy
- Department of Otolaryngology-Head and Neck Surgery University of Arizona Tucson USA
- Department of Otolaryngology-Head and Neck Surgery King Abdulaziz University Jeddah Saudi Arabia
| | - Robert J Morrison
- Department of Otolaryngology-Head & Neck Surgery University of Michigan Medical School Ann Arbor USA
| | - Philip A Weissbrod
- Division of Otolaryngology-Head and Neck Surgery University of California San Diego La Jolla USA
| | - Margaret B Mitchell
- Department of Otolaryngology-Head & Neck Surgery Harvard Medical School/Mass Eye and Ear Boston USA
| | - Cyrus C Rabbani
- Department of Otolaryngology-Head and Neck Surgery Case Western Reserve University and University Hospitals Cleveland USA
| | - Neil Futran
- University of Washington Department of Otolaryngology-Head and Neck Surgery
| | - Omar G Ahmed
- Department of Otolaryngology-Head and Neck Surgery Houston Methodist Hospital Houston USA
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Younes M. New insights and potential clinical implications of the odds ratio product. Front Neurol 2023; 14:1273623. [PMID: 37885480 PMCID: PMC10598615 DOI: 10.3389/fneur.2023.1273623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
The odds ratio product (ORP) is a continuous metric of sleep depth that ranges from 0 (very deep sleep) to 2. 5 (full wakefulness). Its advantage over the conventional method recommended by AASM is that it discloses different levels of stage wake (sleep propensity) and different sleep depths within the same sleep stage. As such, it can be used to identify differences in sleep depth between subjects, and in the same subjects under different circumstances, when differences are not discernible by conventional staging. It also identifies different sleep depths within stage rapid-eye-movement sleep, with possible implications to disorders during this stage. Epoch-by-epoch ORP can be displayed graphically across the night or as average values in conventional sleep stages. In addition, ORP can be reported as % of recording time in specific ORP ranges (e.g., deciles of the total ORP range) where it produces distinct distribution patterns (ORP-architecture) that have been associated with different clinical disorders and outcomes. These patterns offer unique research opportunities to identify different mechanisms and potential therapy for various sleep complaints and disorders. In this review I will discuss how ORP is measured, its validation, differences from delta power, and the various phenotypes, and their postulated mechanisms, identified by ORP architecture and the opportunities for research to advance management of sleep-disordered breathing, insomnia and idiopathic hypersomnia.
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Affiliation(s)
- Magdy Younes
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Tabar YR, Mikkelsen KB, Shenton N, Kappel SL, Bertelsen AR, Nikbakht R, Toft HO, Henriksen CH, Hemmsen MC, Rank ML, Otto M, Kidmose P. At-home sleep monitoring using generic ear-EEG. Front Neurosci 2023; 17:987578. [PMID: 36816118 PMCID: PMC9928964 DOI: 10.3389/fnins.2023.987578] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023] Open
Abstract
Introduction A device comprising two generic earpieces with embedded dry electrodes for ear-centered electroencephalography (ear-EEG) was developed. The objective was to provide ear-EEG based sleep monitoring to a wide range of the population without tailoring the device to the individual. Methods To validate the device ten healthy subjects were recruited for a 12-night sleep study. The study was divided into two parts; part A comprised two nights with both ear-EEG and polysomnography (PSG), and part B comprised 10 nights using only ear-EEG. In addition to the electrophysiological measurements, subjects filled out a questionnaire after each night of sleep. Results The subjects reported that the ear-EEG system was easy to use, and that the comfort was better in part B. The performance of the system was validated by comparing automatic sleep scoring based on ear-EEG with PSG-based sleep scoring performed by a professional trained sleep scorer. Cohen's kappa was used to assess the agreement between the manual and automatic sleep scorings, and the study showed an average kappa value of 0.71. The majority of the 20 recordings from part A yielded a kappa value above 0.7. The study was compared to a companioned study conducted with individualized earpieces. To compare the sleep across the two studies and two parts, 7 different sleeps metrics were calculated based on the automatic sleep scorings. The ear-EEG nights were validated through linear mixed model analysis in which the effects of equipment (individualized vs. generic earpieces), part (PSG and ear-EEG vs. only ear-EEG) and subject were investigated. We found that the subject effect was significant for all computed sleep metrics. Furthermore, the equipment did not show any statistical significant effect on any of the sleep metrics. Discussion These results corroborate that generic ear-EEG is a promising alternative to the gold standard PSG for sleep stage monitoring. This will allow sleep stage monitoring to be performed in a less obtrusive way and over longer periods of time, thereby enabling diagnosis and treatment of diseases with associated sleep disorders.
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Affiliation(s)
- Yousef R. Tabar
- Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark
| | - Kaare B. Mikkelsen
- Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark
| | | | - Simon L. Kappel
- Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark
| | | | | | | | | | | | | | - Marit Otto
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Preben Kidmose
- Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark,*Correspondence: Preben Kidmose,
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Kjaer TW, Rank ML, Hemmsen MC, Kidmose P, Mikkelsen K. Repeated automatic sleep scoring based on ear-EEG is a valuable alternative to manually scored polysomnography. PLOS DIGITAL HEALTH 2022; 1:e0000134. [PMID: 36812563 PMCID: PMC9931275 DOI: 10.1371/journal.pdig.0000134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/25/2022] [Indexed: 11/07/2022]
Abstract
While polysomnography (PSG) is the gold standard to quantify sleep, modern technology allows for new alternatives. PSG is obtrusive, affects the sleep it is set out to measure and requires technical assistance for mounting. A number of less obtrusive solutions based on alternative methods have been introduced, but few have been clinically validated. Here we validate one of these solutions, the ear-EEG method, against concurrently recorded PSG in twenty healthy subjects each measured for four nights. Two trained technicians scored the 80 nights of PSG independently, while an automatic algorithm scored the ear-EEG. The sleep stages and eight sleep metrics (Total Sleep Time (TST), Sleep Onset Latency, Sleep Efficiency, Wake After Sleep Onset, REM latency, REM fraction of TST, N2 fraction of TST, and N3 fraction of TST) were used in the further analysis. We found the sleep metrics: Total Sleep Time, Sleep Onset Latency, Sleep Efficiency, Wake After Sleep Onset were estimated with high accuracy and precision between automatic sleep scoring and manual sleep scoring. However, the REM latency and REM fraction of sleep showed high accuracy but low precision. Further, the automatic sleep scoring systematically overestimated the N2 fraction of sleep and slightly underestimated the N3 fraction of sleep. We demonstrate that sleep metrics estimated from automatic sleep scoring based on repeated ear-EEG in some cases are more reliably estimated with repeated nights of automatically scored ear-EEG than with a single night of manually scored PSG. Thus, given the obtrusiveness and cost of PSG, ear-EEG seems to be a useful alternative for sleep staging for the single night recording and an advantageous choice for several nights of sleep monitoring.
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Affiliation(s)
| | | | | | - Preben Kidmose
- Department of Electrical and Computer Engineering, University of Aarhus, Denmark
| | - Kaare Mikkelsen
- Department of Electrical and Computer Engineering, University of Aarhus, Denmark,* E-mail:
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Younes M, Gerardy B, Pack AI, Kuna ST, Castro-Diehl C, Redline S. Sleep architecture based on sleep depth and propensity: patterns in different demographics and sleep disorders and association with health outcomes. Sleep 2022; 45:6546700. [PMID: 35272350 PMCID: PMC9195236 DOI: 10.1093/sleep/zsac059] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/10/2022] [Indexed: 12/30/2022] Open
Abstract
Study Objectives Conventional metrics of sleep quantity/depth have serious shortcomings. Odds-Ratio-Product (ORP) is a continuous metric of sleep depth ranging from 0 (very deep sleep) to 2.5 (full-wakefulness). We describe an ORP-based approach that provides information on sleep disorders not apparent from traditional metrics. Methods We analyzed records from the Sleep-Heart-Health-Study and a study of performance deficit following sleep deprivation. ORP of all 30-second epochs in each PSG and percent of epochs in each decile of ORPs range were calculated. Percentage of epochs in deep sleep (ORP < 0.50) and in full-wakefulness (ORP > 2.25) were each assigned a rank, 1–3, representing first and second digits, respectively, of nine distinct types (“1,1”, “1,2” … ”3,3”). Prevalence of each type in clinical groups and their associations with demographics, sleepiness (Epworth-Sleepiness-Scale, ESS) and quality of life (QOL; Short-Form-Health-Survey-36) were determined. Results Three types (“1,1”, “1,2”, “1,3”) were prevalent in OSA and were associated with reduced QOL. Two (“1,3” and “2,3”) were prevalent in insomnia with short-sleep-duration (insomnia-SSD), but only “1,3” was associated with poor sleep depth and reduced QOL, suggesting two phenotypes in insomnia-SSD. ESS was high in types “1,1” and “1,2”, and low in “1,3” and “2,3”. Prevalence of some types increased with age while in others it decreased. Other types were either rare (“1,1” and “3,3”) or high (“2,2”) at all ages. Conclusions The proposed ORP histogram offers specific and unique information on the underlying neurophysiological characteristics of sleep disorders not captured by routine metrics, with potential of advancing diagnosis and management of these disorders.
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Affiliation(s)
- Magdy Younes
- Sleep Disorders Centre, University of Manitoba , Winnipeg, Manitoba , Canada
- YRT Ltd. , Winnipeg, Manitoba , Canada
| | | | - Allan I Pack
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, Perelman School of Medicine , Philadelphia, PA , USA
| | - Samuel T Kuna
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, Perelman School of Medicine , Philadelphia, PA , USA
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia, PA , USA
| | - Cecilia Castro-Diehl
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School , Boston, MA , USA
| | - Susan Redline
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School , Boston, MA , USA
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10
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Smith MG, Younes M, Aeschbach D, Elmenhorst EM, Müller U, Basner M. Traffic noise-induced changes in wake-propensity measured with the Odds-Ratio Product (ORP). THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 805:150191. [PMID: 34818802 DOI: 10.1016/j.scitotenv.2021.150191] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
Nocturnal traffic noise can disrupt sleep and impair physical and mental restoration, but classical sleep scoring techniques may not fully capture subtle yet clinically relevant alterations of sleep induced by noise. We used a validated continuous measure of sleep depth and quality based on automatic analysis of physiologic sleep data, termed Wake Propensity (WP), to investigate temporal changes of sleep in response to nocturnal noise events in 3-s epochs. Seventy-two healthy participants (mean age 40.3 years, range 18-71 years, 40 females, 32 males) slept for 11 nights in a laboratory, during which we measured sleep with polysomnography. In 8 nights, participants were exposed to 40, 80 or 120 road, rail and/or aircraft noise events with maximum noise levels of 45-65 dB LAS,max during 8-h sleep opportunities. We analyzed sleep macrostructure and event-related change of WP during noise exposure with linear mixed models. Nocturnal traffic noise led to event-related shifts towards wakefulness and less deep, more unstable sleep (increase in WP relative to pre-noise baseline ranging from +29.5% at 45 dB to +38.3% at 65 dB; type III effect p < 0.0001). Sleep depth decreased dynamically with increasing noise level, peaking when LAS,max was highest. This change in WP was stronger and occurred more quickly for events where the noise onset was more rapid (road and rail) compared to more gradually time-varying noise (aircraft). Sleep depth did not immediately recover to pre-noise WP, leading to decreased sleep stability across the night compared to quiet nights, which was greater with an increasing number of noise events (standardized β = 0.053, p = 0.003). Further, WP was more sensitive to noise than classical arousals. Results demonstrate the usefulness of WP as a measure of the effects of external stimuli on sleep, and show WP is a more sensitive measure of noise-induced sleep disruption than traditional methods of sleep analysis.
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Affiliation(s)
- Michael G Smith
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Magdy Younes
- Sleep Disorders Center, University of Manitoba, Winnipeg, MB, Canada
| | - Daniel Aeschbach
- Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany; Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Eva-Maria Elmenhorst
- Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany; Institute for Occupational and Social Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Uwe Müller
- Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Mathias Basner
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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da Silva Souto CF, Pätzold W, Wolf KI, Paul M, Matthiesen I, Bleichner MG, Debener S. Flex-Printed Ear-EEG Sensors for Adequate Sleep Staging at Home. Front Digit Health 2021; 3:688122. [PMID: 34713159 PMCID: PMC8522006 DOI: 10.3389/fdgth.2021.688122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/01/2021] [Indexed: 12/03/2022] Open
Abstract
A comfortable, discrete and robust recording of the sleep EEG signal at home is a desirable goal but has been difficult to achieve. We investigate how well flex-printed electrodes are suitable for sleep monitoring tasks in a smartphone-based home environment. The cEEGrid ear-EEG sensor has already been tested in the laboratory for measuring night sleep. Here, 10 participants slept at home and were equipped with a cEEGrid and a portable amplifier (mBrainTrain, Serbia). In addition, the EEG of Fpz, EOG_L and EOG_R was recorded. All signals were recorded wirelessly with a smartphone. On average, each participant provided data for M = 7.48 h. An expert sleep scorer created hypnograms and annotated grapho-elements according to AASM based on the EEG of Fpz, EOG_L and EOG_R twice, which served as the baseline agreement for further comparisons. The expert scorer also created hypnograms using bipolar channels based on combinations of cEEGrid channels only, and bipolar cEEGrid channels complemented by EOG channels. A comparison of the hypnograms based on frontal electrodes with the ones based on cEEGrid electrodes (κ = 0.67) and the ones based on cEEGrid complemented by EOG channels (κ = 0.75) both showed a substantial agreement, with the combination including EOG channels showing a significantly better outcome than the one without (p = 0.006). Moreover, signal excerpts of the conventional channels containing grapho-elements were correlated with those of the cEEGrid in order to determine the cEEGrid channel combination that optimally represents the annotated grapho-elements. The results show that the grapho-elements were well-represented by the front-facing electrode combinations. The correlation analysis of the grapho-elements resulted in an average correlation coefficient of 0.65 for the most suitable electrode configuration of the cEEGrid. The results confirm that sleep stages can be identified with electrodes placement around the ear. This opens up opportunities for miniaturized ear-EEG systems that may be self-applied by users.
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Affiliation(s)
- Carlos F da Silva Souto
- Branch for Hearing, Speech and Audio Technology HSA, Fraunhofer Institute for Digital Media Technology IDMT, Oldenburg, Germany
| | - Wiebke Pätzold
- Branch for Hearing, Speech and Audio Technology HSA, Fraunhofer Institute for Digital Media Technology IDMT, Oldenburg, Germany
| | - Karen Insa Wolf
- Branch for Hearing, Speech and Audio Technology HSA, Fraunhofer Institute for Digital Media Technology IDMT, Oldenburg, Germany
| | | | - Ida Matthiesen
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - Martin G Bleichner
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany.,Neurophysiology of Everyday Life Group, Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - Stefan Debener
- Branch for Hearing, Speech and Audio Technology HSA, Fraunhofer Institute for Digital Media Technology IDMT, Oldenburg, Germany.,Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany
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12
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Korkalainen H, Nikkonen S, Kainulainen S, Dwivedi AK, Myllymaa S, Leppänen T, Töyräs J. Self-Applied Home Sleep Recordings: The Future of Sleep Medicine. Sleep Med Clin 2021; 16:545-556. [PMID: 34711380 DOI: 10.1016/j.jsmc.2021.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sleep disorders form a massive global health burden and there is an increasing need for simple and cost-efficient sleep recording devices. Recent machine learning-based approaches have already achieved scoring accuracy of sleep recordings on par with manual scoring, even with reduced recording montages. Simple and inexpensive monitoring over multiple consecutive nights with automatic analysis could be the answer to overcome the substantial economic burden caused by poor sleep and enable more efficient initial diagnosis, treatment planning, and follow-up monitoring for individuals suffering from sleep disorders.
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Affiliation(s)
- Henri Korkalainen
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, Kuopio 70211, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - Sami Nikkonen
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, Kuopio 70211, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Samu Kainulainen
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, Kuopio 70211, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Amit Krishna Dwivedi
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, Kuopio 70211, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Sami Myllymaa
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, Kuopio 70211, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, Kuopio 70211, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, Kuopio 70211, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia; Science Service Center, Kuopio University Hospital, Kuopio, Finland
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13
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Kang DY, DeYoung PN, Tantiongloc J, Coleman TP, Owens RL. Statistical uncertainty quantification to augment clinical decision support: a first implementation in sleep medicine. NPJ Digit Med 2021; 4:142. [PMID: 34593972 PMCID: PMC8484290 DOI: 10.1038/s41746-021-00515-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/13/2021] [Indexed: 11/09/2022] Open
Abstract
Machine learning has the potential to change the practice of medicine, particularly in areas that require pattern recognition (e.g. radiology). Although automated classification is unlikely to be perfect, few modern machine learning tools have the ability to assess their own classification confidence to recognize uncertainty that might need human review. Using automated single-channel sleep staging as a first implementation, we demonstrated that uncertainty information (as quantified using Shannon entropy) can be utilized in a "human in the loop" methodology to promote targeted review of uncertain sleep stage classifications on an epoch-by-epoch basis. Across 20 sleep studies, this feedback methodology proved capable of improving scoring agreement with the gold standard over automated scoring alone (average improvement in Cohen's Kappa of 0.28), in a fraction of the scoring time compared to full manual review (60% reduction). In summary, our uncertainty-based clinician-in-the-loop framework promotes the improvement of medical classification accuracy/confidence in a cost-effective and economically resourceful manner.
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Affiliation(s)
- Dae Y Kang
- Department of Medicine, Division of Pulmonary, Critical Care, & Sleep Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Pamela N DeYoung
- Department of Medicine, Division of Pulmonary, Critical Care, & Sleep Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Justin Tantiongloc
- Department of Computer Science & Engineering, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Todd P Coleman
- Department of Bioengineering, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Robert L Owens
- Department of Medicine, Division of Pulmonary, Critical Care, & Sleep Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
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14
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Effects of Sedatives on Sleep Architecture Measured With Odds Ratio Product in Critically Ill Patients. Crit Care Explor 2021; 3:e0503. [PMID: 34396142 PMCID: PMC8357257 DOI: 10.1097/cce.0000000000000503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. OBJECTIVES: Evaluation of sleep quality in critically ill patients is difficult using conventional scoring criteria. The aim of this study was to examine sleep in critically ill patients with and without light sedation using the odds ratio product, a validated continuous metric of sleep depth (0 = deep sleep; 2.5 = full wakefulness) that does not rely on the features needed for conventional staging. DESIGN: Retrospective study. SETTINGS: A 16-bed medical-surgical ICU. PATIENTS: Twenty-three mechanically ventilated patients who had previously undergone two nocturnal sleep studies, one without and one with sedation (propofol, n = 12; dexmedetomidine, n = 11). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sleep architecture was evaluated with odds ratio product analysis by the distribution of 30-second epochs with different odds ratio product values. Electroencephalogram spectral patterns and frequency of wake intrusions (3-s odds ratio product > 1.75) were measured at different odds ratio product levels. Thirty-seven normal sleepers were used as controls. Compared with normal sleepers, unsedated critically ill patients spent little time in stable sleep (percent odds ratio product < 1.0: 31% vs 63%; p < 0.001), whereas most of the time were either in stage wake (odds ratio product > 1.75) or in a transitional state (odds ratio product 1.0–1.75), characterized by frequent wake intrusions. Propofol and dexmedetomidine had comparable effects on sleep. Sedation resulted in significant shift in odds ratio product distribution toward normal; percent odds ratio product less than 1.0 increased by 54% (p = 0.006), and percent odds ratio product greater than 1.75 decreased by 48% (p = 0.013). In six patients (26%), sedation failed to improve sleep. CONCLUSIONS: In stable critically ill unsedated patients, sleep quality is poor with frequent wake intrusions and little stable sleep. Light sedation with propofol or dexmedetomidine resulted in a shift in sleep architecture toward normal in most, but not all, patients.
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15
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Comparing sleep studies in terms of the apnea-hypopnea index using the dedicated Shiny web application. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tabar YR, Mikkelsen KB, Rank ML, Hemmsen MC, Kidmose P. Investigation of low dimensional feature spaces for automatic sleep staging. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 205:106091. [PMID: 33882415 DOI: 10.1016/j.cmpb.2021.106091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/03/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND Automatic sleep stage classification depends crucially on the selection of a good set of descriptive features. However, the selection of a feature set with an appropriate low computational cost without compromising classification performance is still a challenge. This study attempts to represent sleep EEG patterns using a minimum number of features, without significant performance loss. METHODS Three feature selection algorithms were applied to a high dimensional feature space comprising 84 features. These methods were based on a bootstrapping approach guided by Gini ranking and mutual information between the features. The algorithms were tested on three scalp electroencephalography (EEG) and one ear-EEG datasets. The relationship between the information carried by different features was investigated using mutual information and illustrated by a graphical clustering tool. RESULTS The minimum number of features that can represent the whole feature set without performance loss was found to range between 5 and 11 for different datasets. In ear-EEG, 7 features based on Continuous Wavelet Transform (CWT) resulted in similar performance as the whole set whereas in two scalp EEG datasets, the difference between minimal CWT set and the whole set was statistically significant (0.008 and 0.017 difference in average kappa). Features were divided into groups according to the type of information they carry. The group containing relative power features was identified as the most informative feature group in sleep stage classification, whereas the group containing non-linear features was found to be the least informative. CONCLUSIONS This study showed that EEG sleep staging can be performed based on a low dimensional feature space without significant decrease in sleep staging performance. This is especially important in the case of wearable devices like ear-EEG where low computational complexity is needed. The division of the feature space into groups of features, and the analysis of the distribution of feature groups for different feature set sizes, is helpful in the selection of an appropriate feature set.
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Affiliation(s)
- Yousef Rezaei Tabar
- Department of Engineering, Aarhus University, Tabar, Finlandsgade 22, Building 5125, 8200 Aarhus N, Denmark.
| | - Kaare B Mikkelsen
- Department of Engineering, Aarhus University, Tabar, Finlandsgade 22, Building 5125, 8200 Aarhus N, Denmark
| | | | | | - Preben Kidmose
- Department of Engineering, Aarhus University, Tabar, Finlandsgade 22, Building 5125, 8200 Aarhus N, Denmark
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Leone MJ, Sun H, Boutros CL, Liu L, Ye E, Sullivan L, Thomas RJ, Robbins GK, Mukerji SS, Westover MB. HIV Increases Sleep-based Brain Age Despite Antiretroviral Therapy. Sleep 2021; 44:6204183. [PMID: 33783511 DOI: 10.1093/sleep/zsab058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/06/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Age-related comorbidities and immune activation raise concern for advanced brain aging in people living with HIV (PLWH). The brain age index (BAI) is a machine learning model that quantifies deviations in brain activity during sleep relative to healthy individuals of the same age. High BAI was previously found to be associated with neurological, psychiatric, cardiometabolic diseases, and reduced life expectancy among people without HIV. Here, we estimated the effect of HIV infection on BAI by comparing PLWH and HIV-controls. METHODS Clinical data and sleep EEGs from 43 PLWH on antiretroviral therapy (HIV+) and 3,155 controls (HIV-) were collected from Massachusetts General Hospital. The effect of HIV infection on BAI, and on individual EEG features, was estimated using causal inference. RESULTS The average effect of HIV on BAI was estimated to be +3.35 years (p < 0.01, 95% CI = [0.67, 5.92]) using doubly robust estimation. Compared to HIV- controls, HIV+ participants exhibited a reduction in delta band power during deep sleep and rapid eye movement sleep. CONCLUSION We provide causal evidence that HIV contributes to advanced brain aging reflected in sleep EEG. A better understanding is greatly needed of potential therapeutic targets to mitigate the effect of HIV on brain health, potentially including sleep disorders and cardiovascular disease.
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Affiliation(s)
| | - Haoqi Sun
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Lin Liu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Elissa Ye
- Massachusetts General Hospital, Boston, MA, USA
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Mikkelsen KB, Tabar YR, Christensen CB, Kidmose P. EEGs Vary Less Between Lab and Home Locations Than They Do Between People. Front Comput Neurosci 2021; 15:565244. [PMID: 33679356 PMCID: PMC7928278 DOI: 10.3389/fncom.2021.565244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 01/13/2021] [Indexed: 11/24/2022] Open
Abstract
Given the rapid development of light weight EEG devices which we have witnessed the past decade, it is reasonable to ask to which extent neuroscience could now be taken outside the lab. In this study, we have designed an EEG paradigm well suited for deployment “in the wild.” The paradigm is tested in repeated recordings on 20 subjects, on eight different occasions (4 in the laboratory, 4 in the subject's own home). By calculating the inter subject, intra subject and inter location variance, we find that the inter location variation for this paradigm is considerably less than the inter subject variation. We believe the paradigm is representative of a large group of other relevant paradigms. This means that given the positive results in this study, we find that if a research paradigm would benefit from being performed in less controlled environments, we expect limited problems in doing so.
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Affiliation(s)
- Kaare B Mikkelsen
- Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark
| | - Yousef R Tabar
- Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark
| | | | - Preben Kidmose
- Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark
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19
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Miyata S, Iwamoto K, Banno M, Eguchi J, Kaneko S, Noda A, Ozaki N. Performance of an ambulatory electroencephalogram sleep monitor in patients with psychiatric disorders. J Sleep Res 2020; 30:e13273. [PMID: 33372341 DOI: 10.1111/jsr.13273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/01/2022]
Abstract
Key clinical symptoms observed among individuals with psychiatric disorders include difficulty falling asleep or maintaining sleep, poor sleep quality and nightmares. Those suffering from sleep disorders often present with symptoms of discontent with regard to sleep quality, timing and quantity, and these symptoms have an adverse impact on function and quality of life. A minimally invasive technique would be preferable in patients with psychiatric disorders, who tend to be sensitive to environmental change. Accordingly, we evaluated the performance of Zmachine Insight Plus, an ambulatory electroencephalography sleep monitor, in patients with psychiatric disorders. One hundred and three patients undergoing polysomnography were enrolled in this study. Zmachine Insight Plus was performed simultaneously with polysomnography. Total sleep time, sleep efficiency, wake after sleep onset, rapid eye movement (REM) sleep, light sleep (stages N1 and N2) and deep sleep (stage N3) were assessed. Total sleep time, sleep efficiency, wake after sleep onset, REM sleep duration and non-REM sleep duration of Zmachine Insight Plus showed a significant correlation with those of polysomnography. Lower sleep efficiency and increased frequency of waking after sleep onset, the arousal index and the apnea-hypopnea index on polysomnography were significantly associated with the difference in sleep parameters between the two methods. Among patients with psychiatric disorders who are sensitive to environmental change, Zmachine Insight Plus would be a useful technique to objectively evaluate sleep quality.
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Affiliation(s)
- Seiko Miyata
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kunihiro Iwamoto
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Banno
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Akiko Noda
- Department of Biomedical Sciences, Chubu University Graduate School of Life and Health Sciences, Kasugai, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
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20
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Tabar YR, Mikkelsen KB, Rank ML, Hemmsen MC, Otto M, Kidmose P. Ear-EEG for sleep assessment: a comparison with actigraphy and PSG. Sleep Breath 2020; 25:1693-1705. [PMID: 33219908 DOI: 10.1007/s11325-020-02248-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/20/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess automatic sleep staging of three ear-EEG setups with different electrode configurations and compare performance with concurrent polysomnography and wrist-worn actigraphy recordings. METHODS Automatic sleep staging was performed for single-ear, single-ear with ipsilateral mastoid, and cross-ear electrode configurations, and for actigraphy data. The polysomnography data were manually scored and used as the gold standard. The automatic sleep staging was tested on 80 full-night recordings from 20 healthy subjects. The scoring performance and sleep metrics were determined for all ear-EEG setups and the actigraphy device. RESULTS The single-ear, the single-ear with ipsilateral mastoid setup, and the cross-ear setup performed five class sleep staging with kappa values 0.36, 0.63, and 0.72, respectively. For the single-ear with mastoid electrode and the cross-ear setup, the performance of the sleep metrics, in terms of mean absolute error, was better than the sleep metrics estimated from the actigraphy device in the current study, and also better than current state-of-the-art actigraphy studies. CONCLUSION A statistically significant improvement in both accuracy and kappa was observed from single-ear to single-ear with ipsilateral mastoid, and from single-ear with ipsilateral mastoid to cross-ear configurations for both two and five-sleep stage classification. In terms of sleep metrics, the results were more heterogeneous, but in general, actigraphy and single-ear with ipsilateral mastoid configuration were better than the single-ear configuration; and the cross-ear configuration was consistently better than both the actigraphy device and the single-ear configuration.
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Affiliation(s)
- Yousef Rezaei Tabar
- Department of Electrical and Computer Engineering, Aarhus University, Finlandsgade 22, Building 5125, 8200, Aarhus, Denmark.
| | - Kaare B Mikkelsen
- Department of Electrical and Computer Engineering, Aarhus University, Finlandsgade 22, Building 5125, 8200, Aarhus, Denmark
| | | | | | - Marit Otto
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Preben Kidmose
- Department of Electrical and Computer Engineering, Aarhus University, Finlandsgade 22, Building 5125, 8200, Aarhus, Denmark
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21
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Mikkelsen KB, Tabar YR, Kidmose P. Predicting Sleep Classification Performance without Labels. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:645-648. [PMID: 33018070 DOI: 10.1109/embc44109.2020.9175743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
When generating automatic sleep reports with mobile sleep monitoring devices, it is crucial to have a good grasp of the reliability of the result. In this paper, we feed features derived from the output of a sleep scoring algorithm to a 'regression ensemble' to estimate the quality of the automatic sleep scoring. We compare this estimate to the actual quality, calculated using a manual scoring of a concurrent polysomnography recording. We find that it is generally possible to estimate the quality of a sleep scoring, but with some uncertainty ('root mean squared error' between estimated and true Cohen's kappa is 0.078). We expect that this method could be useful in situations with many scored nights from the same subject, where an overall picture of scoring quality is needed, but where uncertainty on single nights is less of an issue.
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Penner CG, Gerardy B, Ryan R, Williams M. The Odds Ratio Product (An Objective Sleep Depth Measure): Normal Values, Repeatability, and Change With CPAP in Patients With OSA. J Clin Sleep Med 2020; 15:1155-1163. [PMID: 31482838 DOI: 10.5664/jcsm.7812] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The Odds Ratio Product (ORP) is an objective measure of sleep depth using the relationships of the powers of different electroencephalogram (EEG) frequencies in a single index. The range of the ORP is 0 (deeply asleep) to 2.5 (fully awake). This investigation seeks to elucidate normal values of non-rapid eye movement ORP (ORPNR) in healthy individuals, repeatability of the measure, and the change in ORPNR following continuous positive airway pressure (CPAP) treatment. METHODS Healthy individuals underwent a home sleep apnea test (HSAT) with EEG followed 1 week later by EEG alone. Another cohort with OSA underwent baseline HSAT with EEG followed by a second EEG study approximately 4 weeks into treatment with CPAP. RESULTS Thirty-eight healthy individuals completed the protocol (mean age of 34.9 ± 7.4 years, Epworth Sleepiness Scale score 3.6 ± 2.4, Insomnia Severity Index score 2.0 ± 1.6 and Functional Outcomes of Sleep Questionnaire - shorter version score 19 ± 1.2). The mean ORPNR for all nights was 0.52 ± 0.13. The difference between the first night and the second night was 0.024 ± 0.17 (not significant). The intraclass correlation coefficient was 0.525, suggesting only moderate agreement between the first and second nights. The normal value for ORPNR in healthy individuals is ≤ 0.78 units using two standard deviations as the cutoff. Forty participants completed the OSA protocol (mean age 49 ± 11 years, body mass index 35 ± 6 kg/m², apnea-hypopnea index 33.5 ± 28.4 events/h). The mean pre-CPAP ORPNR was 0.69 ± 0.24 and the mean post-CPAP ORPNR was 0.57 ± 0.22 (P = .02). CONCLUSIONS The ORPNR proves to have significant variability from night to night in healthy individuals. ORPNR objectively improves following CPAP treatment, providing further evidence that it measures sleep depth. CITATION Penner CG, Gerardy B, Ryan R, Williams M. The odds ratio product (an objective sleep depth measure): normal values, repeatability, and change with CPAP in patients with OSA. J Clin Sleep Med. 2019;15(8):1155-1163.
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Affiliation(s)
- Charles Gerhard Penner
- University of Manitoba, Winnipeg, Canada; Cerebra Health Inc., Winnipeg, Canada; RANA Respiratory Care Group, Brandon, Manitoba
| | | | - Rob Ryan
- RANA Respiratory Care Group, Brandon, Manitoba
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Pan Q, Brulin D, Campo E. Current Status and Future Challenges of Sleep Monitoring Systems: Systematic Review. JMIR BIOMEDICAL ENGINEERING 2020. [DOI: 10.2196/20921] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background
Sleep is essential for human health. Considerable effort has been put into academic and industrial research and in the development of wireless body area networks for sleep monitoring in terms of nonintrusiveness, portability, and autonomy. With the help of rapid advances in smart sensing and communication technologies, various sleep monitoring systems (hereafter, sleep monitoring systems) have been developed with advantages such as being low cost, accessible, discreet, contactless, unmanned, and suitable for long-term monitoring.
Objective
This paper aims to review current research in sleep monitoring to serve as a reference for researchers and to provide insights for future work. Specific selection criteria were chosen to include articles in which sleep monitoring systems or devices are covered.
Methods
This review investigates the use of various common sensors in the hardware implementation of current sleep monitoring systems as well as the types of parameters collected, their position in the body, the possible description of sleep phases, and the advantages and drawbacks. In addition, the data processing algorithms and software used in different studies on sleep monitoring systems and their results are presented. This review was not only limited to the study of laboratory research but also investigated the various popular commercial products available for sleep monitoring, presenting their characteristics, advantages, and disadvantages. In particular, we categorized existing research on sleep monitoring systems based on how the sensor is used, including the number and type of sensors, and the preferred position in the body. In addition to focusing on a specific system, issues concerning sleep monitoring systems such as privacy, economic, and social impact are also included. Finally, we presented an original sleep monitoring system solution developed in our laboratory.
Results
By retrieving a large number of articles and abstracts, we found that hotspot techniques such as big data, machine learning, artificial intelligence, and data mining have not been widely applied to the sleep monitoring research area. Accelerometers are the most commonly used sensor in sleep monitoring systems. Most commercial sleep monitoring products cannot provide performance evaluation based on gold standard polysomnography.
Conclusions
Combining hotspot techniques such as big data, machine learning, artificial intelligence, and data mining with sleep monitoring may be a promising research approach and will attract more researchers in the future. Balancing user acceptance and monitoring performance is the biggest challenge in sleep monitoring system research.
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Younes M, Schweitzer PK, Griffin KS, Balshaw R, Walsh JK. Comparing two measures of sleep depth/intensity. Sleep 2020; 43:5867896. [DOI: 10.1093/sleep/zsaa127] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/20/2020] [Indexed: 01/05/2023] Open
Abstract
Abstract
Study Objectives
To compare delta spectral power (delta) and odds ratio product (ORP) as measures of sleep depth during sleep restriction with placebo or a drug that increases delta.
Methods
This is a secondary analysis of data from a study of 41 healthy participants randomized to receive placebo or gaboxadol 15 mg during sleep restriction. Participants underwent in-laboratory sleep studies on two baseline, four sleep restriction (5-h), and two recovery nights. Relation between delta or ORP and sleep depth was operationally defined as the degree of association of each metric to the probability of arousal or awakening occurring during the next 30 s (arousability).
Results
ORP values in wake, N1, N2, N3, and REM were significantly different. Delta differed between both N2 and N3 and other sleep stages but not between wake and N1 or N1 and REM. Epoch-by-epoch and individual correlations between ORP and delta power were modest or insignificant. The relation between ORP and arousability was linear across the entire ORP range. Delta also changed with arousability but only when delta values were less than 300 μV2. Receiver-operating-characteristic analysis found the ability to predict imminent arousal to be significantly greater with ORP than with log delta power for all experimental conditions. Changes in ORP, but not log delta, across the night correlated with next-day physiologic sleep tendency.
Conclusions
Compared to delta power, ORP is more discriminating among sleep stages, more sensitive to sleep restriction, and more closely associated with arousability. This evidence supports ORP as a measure of sleep depth/intensity.
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Affiliation(s)
- Magdy Younes
- Sleep Disorders Centre, Misericordia Health Centre, University of Manitoba, Winnipeg, Canada
| | | | - Kara S Griffin
- Sleep Medicine & Research Center, St. Luke’s Hospital, Chesterfield, MO
| | - Robert Balshaw
- Centre for Healthcare Innovation, Rady Faculty of Health Science, University of Manitoba, Winnipeg, Canada
| | - James K Walsh
- Sleep Medicine & Research Center, St. Luke’s Hospital, Chesterfield, MO
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Zhang L, Fabbri D, Upender R, Kent D. Automated sleep stage scoring of the Sleep Heart Health Study using deep neural networks. Sleep 2020; 42:5530377. [PMID: 31289828 DOI: 10.1093/sleep/zsz159] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 05/19/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Polysomnography (PSG) scoring is labor intensive and suffers from variability in inter- and intra-rater reliability. Automated PSG scoring has the potential to reduce the human labor costs and the variability inherent to this task. Deep learning is a form of machine learning that uses neural networks to recognize data patterns by inspecting many examples rather than by following explicit programming. METHODS A sleep staging classifier trained using deep learning methods scored PSG data from the Sleep Heart Health Study (SHHS). The training set was composed of 42 560 hours of PSG data from 5213 patients. To capture higher-order data, spectrograms were generated from electroencephalography, electrooculography, and electromyography data and then passed to the neural network. A holdout set of 580 PSGs not included in the training set was used to assess model accuracy and discrimination via weighted F1-score, per-stage accuracy, and Cohen's kappa (K). RESULTS The optimal neural network model was composed of spectrograms in the input layer feeding into convolutional neural network layers and a long short-term memory layer to achieve a weighted F1-score of 0.87 and K = 0.82. CONCLUSIONS The deep learning sleep stage classifier demonstrates excellent accuracy and agreement with expert sleep stage scoring, outperforming human agreement on sleep staging. It achieves comparable or better F1-scores, accuracy, and Cohen's kappa compared to literature for automated sleep stage scoring of PSG epochs. Accurate automated scoring of other PSG events may eventually allow for fully automated PSG scoring.
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Affiliation(s)
- Linda Zhang
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel Fabbri
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Raghu Upender
- Department of Neurology, Sleep Disorders Division, Vanderbilt University School of Medicine, Nashville, TN
| | - David Kent
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
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Mikkelsen KB, Kappel SL, Hemmsen MC, Rank ML, Kidmose P. Discrimination of Sleep Spindles in Ear-EEG. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:6697-6700. [PMID: 31947378 DOI: 10.1109/embc.2019.8857114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Sleep spindles are brief oscillatory events observed in EEG measurements during sleep, related to both sleep staging and basic neuroscience. The objective of this study was to investigate to which extent sleep spindles are observable from ear-EEG. The analysis was based on single-night recordings from 12 subjects, wearing both a polysomnography setup and two light-weight mobile EEG devices (ear-EEG). By introducing a sleep spindle index capable of discriminating between epochs with distinct spindles and distinctly spindle-free epochs, we describe to which extent the most clear cut sleep spindles (as labeled using scalp EEG) can be detected using ear-EEG. We find that ear-EEG can be used to detect sleep spindles, at a performance level similar to scalp derivations. We speculate that part of the observed discrepancy between ear-EEG and the gold standard (scalp EEG) could be caused by the visibility of different spindles in the ear-EEG.
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27
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Younes M, Giannouli E. Mechanism of excessive wake time when associated with obstructive sleep apnea or periodic limb movements. J Clin Sleep Med 2020; 16:389-399. [PMID: 31992415 DOI: 10.5664/jcsm.8214] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES It is uncertain whether obstructive apnea (OSA) or periodic limb movements (PLMs) contribute to excessive wake time (EWT) when EWT and these disorders coexist. We hypothesized that such EWT is an independent disorder related to central regulation of sleep depth. Accordingly, we compared sleep depth in patients with EWT and OSA/PLMs (EWT+P) with patients with EWT and no OSA/PLMs (EWT-NP) and patients with a normal wake time. METHODS A total of 267 participants were divided into five groups: (1) EWT+P: n = 100 (wake time > 20% total recording time; TRT) with OSA (apnea-hypopnea index 5-110 events/h) and/or PLMs (PLM index 10-151 events/h); (2) EWT-NP: n = 49 (wake time > 20%TRT), no associated pathology; (3) normal wake time (NWT)+P: n = 54 (wake time < 20%TRT, with OSA/PLMs); (4) NWT-NP: n = 26; (5) Healthy participants: n = 38 (no sleep complaints, NWT and no OSA/PLMs). Sleep depth was evaluated by the odds ratio product (ORP; 0 = deep sleep, 2.5 = fully alert). We also measured ORP in the 9 seconds immediately following arousals (ORP-9) to distinguish between peripheral and central mechanisms of light sleep. RESULTS ORP during sleep was higher (lighter sleep) in both EWT groups than in the three NWT groups (P < 1E-11) with no difference between those with and those without OSA/PLMs. ORP-9 was also significantly higher in the EWT groups than in the NWT groups (P < 1E-19), also with no difference between those with and without OSA/PLMs, indicating that the lighter sleep was of central origin. There were highly significant correlations between wake time and ORP-9 across all groups (P < 1E-35). CONCLUSIONS EWT associated with OSA/PLMs is independent of OSA/PLMs and related to abnormal central regulation of sleep depth.
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Affiliation(s)
- Magdy Younes
- Sleep Disorders Centre, Misericordia Health Centre, University of Manitoba, Winnipeg, Canada
| | - Eleni Giannouli
- Sleep Disorders Centre, Misericordia Health Centre, University of Manitoba, Winnipeg, Canada
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28
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Biswal S, Sun H, Goparaju B, Westover MB, Sun J, Bianchi MT. Expert-level sleep scoring with deep neural networks. J Am Med Inform Assoc 2019; 25:1643-1650. [PMID: 30445569 PMCID: PMC6289549 DOI: 10.1093/jamia/ocy131] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/21/2018] [Indexed: 12/15/2022] Open
Abstract
Objectives Scoring laboratory polysomnography (PSG) data remains a manual task of visually annotating 3 primary categories: sleep stages, sleep disordered breathing, and limb movements. Attempts to automate this process have been hampered by the complexity of PSG signals and physiological heterogeneity between patients. Deep neural networks, which have recently achieved expert-level performance for other complex medical tasks, are ideally suited to PSG scoring, given sufficient training data. Methods We used a combination of deep recurrent and convolutional neural networks (RCNN) for supervised learning of clinical labels designating sleep stages, sleep apnea events, and limb movements. The data for testing and training were derived from 10 000 clinical PSGs and 5804 research PSGs. Results When trained on the clinical dataset, the RCNN reproduces PSG diagnostic scoring for sleep staging, sleep apnea, and limb movements with accuracies of 87.6%, 88.2% and 84.7% on held-out test data, a level of performance comparable to human experts. The RCNN model performs equally well when tested on the independent research PSG database. Only small reductions in accuracy were noted when training on limited channels to mimic at-home monitoring devices: frontal leads only for sleep staging, and thoracic belt signals only for the apnea-hypopnea index. Conclusions By creating accurate deep learning models for sleep scoring, our work opens the path toward broader and more timely access to sleep diagnostics. Accurate scoring automation can improve the utility and efficiency of in-lab and at-home approaches to sleep diagnostics, potentially extending the reach of sleep expertise beyond specialty clinics.
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Affiliation(s)
- Siddharth Biswal
- School of Computational Science and Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Haoqi Sun
- Neurology Department, Massachusetts General Hospital, Wang 720, Boston, MA, USA
| | - Balaji Goparaju
- Neurology Department, Massachusetts General Hospital, Wang 720, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - M Brandon Westover
- Neurology Department, Massachusetts General Hospital, Wang 720, Boston, MA, USA
| | - Jimeng Sun
- School of Computational Science and Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Matt T Bianchi
- Neurology Department, Massachusetts General Hospital, Wang 720, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
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29
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Fatt SJ, Beilharz JE, Joubert M, Wilson C, Lloyd AR, Vollmer-Conna U, Cvejic E. Parasympathetic activity is reduced during slow-wave sleep, but not resting wakefulness, in patients with chronic fatigue syndrome. J Clin Sleep Med 2019; 16:19-28. [PMID: 31957647 DOI: 10.5664/jcsm.8114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Physiological dearousal characterized by an increase in parasympathetic nervous system activity is important for good-quality sleep. Previous research shows that nocturnal parasympathetic activity (reflected by heart rate variability [HRV]) is diminished in individuals with chronic fatigue syndrome (CFS), suggesting hypervigilant sleep. This study investigated differences in nocturnal autonomic activity across sleep stages and explored the association of parasympathetic activity with sleep quality and self-reported physical and psychological wellbeing in individuals with CFS. METHODS Twenty-four patients with medically diagnosed CFS, and 24 matched healthy control individuals participated. Electroencephalography and HRV were recorded during sleep in participants' homes using a minimally invasive ambulatory device. Questionnaires were used to measure self-reported wellbeing and sleep quality. RESULTS Sleep architecture in patients with CFS differed from that of control participants in slower sleep onset, more awakenings, and a larger proportion of time spent in slow-wave sleep (SWS). Linear mixed-model analyses controlling for age revealed that HRV reflecting parasympathetic activity (normalized high frequency power) was reduced in patients with CFS compared to control participants, particularly during deeper stages of sleep. Poorer self-reported wellbeing and sleep quality was associated with reduced parasympathetic signaling during deeper sleep, but not during wake before sleep, rapid eye movement sleep, or with the proportion of time spent in SWS. CONCLUSIONS Autonomic hypervigilance during the deeper, recuperative stages of sleep is associated with poor quality sleep and self-reported wellbeing. Causal links need to be confirmed but provide potential intervention opportunities for the core symptom of unrefreshing sleep in CFS.
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Affiliation(s)
- Scott J Fatt
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Jessica E Beilharz
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Michael Joubert
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Chloe Wilson
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Andrew R Lloyd
- Viral Immunology Systems Program, The Kirby Institute, University of New South Wales Sydney, New South Wales, Australia
| | - Uté Vollmer-Conna
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Erin Cvejic
- School of Psychiatry, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia.,The University of Sydney, School of Public Health, Faculty of Medicine and Health, New South Wales, Australia
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30
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Jørgensen SD, Zibrandtsen IC, Kjaer TW. Ear-EEG-based sleep scoring in epilepsy: A comparison with scalp-EEG. J Sleep Res 2019; 29:e12921. [PMID: 31621976 DOI: 10.1111/jsr.12921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/21/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022]
Abstract
Ear-EEG is a wearable electroencephalogram-recording device. It relies on recording electrodes that are nested within a custom-fitted earpiece in the external ear canal. The concept has previously been tested for seizure detection in epileptic patients and for sleep recordings in a healthy population. This study is the first to examine the use of ear-EEG recordings for sleep staging in patients with epilepsy, comparing it with standard recordings from scalp-EEG. We use individuals with epilepsy because of their multiple sleep disturbances, and their complex relationship between seizures and sleep, which make this group very likely to benefit from wearable electroencephalogram devices for sleep if it were introduced in the clinic. The accuracy of the ear-EEG against that of the scalp-EEG is compared for sleep staging, and we evaluate features of sleep architecture in individuals with epilepsy. A mean kappa value of 0.74 is found for the agreement between hypnograms derived from ear-EEG and scalp-EEG. Furthermore, it was discovered that sleep stage transition frequency could be contributing to the kappa variation. These findings are related to other ear-recording systems in the literature, and the potentials and future obstacles of the device are discussed.
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Affiliation(s)
- Sofie D Jørgensen
- Neurological Department, Zealand University Hospital, Roskilde, Denmark
| | | | - Troels W Kjaer
- Neurological Department, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
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31
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Banfi T, Coletto E, d'Ascanio P, Dario P, Menciassi A, Faraguna U, Ciuti G. Effects of Sleep Deprivation on Surgeons Dexterity. Front Neurol 2019; 10:595. [PMID: 31244758 PMCID: PMC6579828 DOI: 10.3389/fneur.2019.00595] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/20/2019] [Indexed: 12/14/2022] Open
Abstract
Sleep deprivation is an ordinary aspect in the global society and its prevalence is increasing. Chronic and acute sleep deprivation have been linked to diabetes and heart diseases as well as depression and enhanced impulsive behaviors. Surgeons are often exposed to long hour on call and few hours of sleep in the previous days. Nevertheless, few studies have focused their attention on the effects of sleep deprivation on surgeons and more specifically on the effects of sleep deprivation on surgical dexterity, often relying on virtual surgical simulators. A better understanding of the consequences of sleep loss on the key surgical skill of dexterity can shed light on the possible risks associated to a sleepy surgeon. In this paper, the authors aim to provide a comprehensive review of the relationship between sleep deprivation and surgical dexterity.
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Affiliation(s)
- Tommaso Banfi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Erika Coletto
- Norwich Research Park Innovation Centre, Quadram Institute of Bioscience, Norwich, United Kingdom
| | - Paola d'Ascanio
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Ugo Faraguna
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Gastone Ciuti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
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32
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Mikkelsen KB, Ebajemito JK, Bonmati‐Carrion MA, Santhi N, Revell VL, Atzori G, della Monica C, Debener S, Dijk D, Sterr A, de Vos M. Machine-learning-derived sleep-wake staging from around-the-ear electroencephalogram outperforms manual scoring and actigraphy. J Sleep Res 2019; 28:e12786. [PMID: 30421469 PMCID: PMC6446944 DOI: 10.1111/jsr.12786] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 09/23/2018] [Accepted: 10/05/2018] [Indexed: 12/22/2022]
Abstract
Quantification of sleep is important for the diagnosis of sleep disorders and sleep research. However, the only widely accepted method to obtain sleep staging is by visual analysis of polysomnography (PSG), which is expensive and time consuming. Here, we investigate automated sleep scoring based on a low-cost, mobile electroencephalogram (EEG) platform consisting of a lightweight EEG amplifier combined with flex-printed cEEGrid electrodes placed around the ear, which can be implemented as a fully self-applicable sleep system. However, cEEGrid signals have different amplitude characteristics to normal scalp PSG signals, which might be challenging for visual scoring. Therefore, this study evaluates the potential of automatic scoring of cEEGrid signals using a machine learning classifier ("random forests") and compares its performance with manual scoring of standard PSG. In addition, the automatic scoring of cEEGrid signals is compared with manual annotation of the cEEGrid recording and with simultaneous actigraphy. Acceptable recordings were obtained in 15 healthy volunteers (aged 35 ± 14.3 years) during an extended nocturnal sleep opportunity, which induced disrupted sleep with a large inter-individual variation in sleep parameters. The results demonstrate that machine-learning-based scoring of around-the-ear EEG outperforms actigraphy with respect to sleep onset and total sleep time assessments. The automated scoring outperforms human scoring of cEEGrid by standard criteria. The accuracy of machine-learning-based automated scoring of cEEGrid sleep recordings compared with manual scoring of standard PSG was satisfactory. The findings show that cEEGrid recordings combined with machine-learning-based scoring holds promise for large-scale sleep studies.
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Affiliation(s)
- Kaare B. Mikkelsen
- Institute of Biomedical EngineeringUniversity of OxfordOxfordUK
- Department of EngineeringAarhus UniversityAarhusDenmark
| | | | | | | | | | | | | | - Stefan Debener
- Cluster of Excellence Hearing4AllOldenburgGermany
- Department of PsychologyUniversity of OldenburgOldenburgGermany
| | - Derk‐Jan Dijk
- Surrey Sleep Research CentreUniversity of SurreySurreyUK
- Surrey Clinical Research CentreUniversity of SurreySurreyUK
| | | | - Maarten de Vos
- Institute of Biomedical EngineeringUniversity of OxfordOxfordUK
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33
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Sterr A, Ebajemito JK, Mikkelsen KB, Bonmati-Carrion MA, Santhi N, Della Monica C, Grainger L, Atzori G, Revell V, Debener S, Dijk DJ, DeVos M. Sleep EEG Derived From Behind-the-Ear Electrodes (cEEGrid) Compared to Standard Polysomnography: A Proof of Concept Study. Front Hum Neurosci 2018; 12:452. [PMID: 30534063 PMCID: PMC6276915 DOI: 10.3389/fnhum.2018.00452] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/24/2018] [Indexed: 11/20/2022] Open
Abstract
Electroencephalography (EEG) recordings represent a vital component of the assessment of sleep physiology, but the methodology presently used is costly, intrusive to participants, and laborious in application. There is a recognized need to develop more easily applicable yet reliable EEG systems that allow unobtrusive long-term recording of sleep-wake EEG ideally away from the laboratory setting. cEEGrid is a recently developed flex-printed around-the-ear electrode array, which holds great potential for sleep-wake monitoring research. It is comfortable to wear, simple to apply, and minimally intrusive during sleep. Moreover, it can be combined with a smartphone-controlled miniaturized amplifier and is fully portable. Evaluation of cEEGrid as a motion-tolerant device is ongoing, but initial findings clearly indicate that it is very well suited for cognitive research. The present study aimed to explore the suitability of cEEGrid for sleep research, by testing whether cEEGrid data affords the signal quality and characteristics necessary for sleep stage scoring. In an accredited sleep laboratory, sleep data from cEEGrid and a standard PSG system were acquired simultaneously. Twenty participants were recorded for one extended nocturnal sleep opportunity. Fifteen data sets were scored manually. Sleep parameters relating to sleep maintenance and sleep architecture were then extracted and statistically assessed for signal quality and concordance. The findings suggest that the cEEGrid system is a viable and robust recording tool to capture sleep and wake EEG. Further research is needed to fully determine the suitability of cEEGrid for basic and applied research as well as sleep medicine.
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Affiliation(s)
- Annette Sterr
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guilford, United Kingdom
| | - James K Ebajemito
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guilford, United Kingdom
| | - Kaare B Mikkelsen
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | | | - Nayantara Santhi
- Surrey Sleep Research Centre, University of Surrey, Guildford, United Kingdom
| | - Ciro Della Monica
- Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Lucinda Grainger
- Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Giuseppe Atzori
- Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Victoria Revell
- Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Stefan Debener
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany.,Cluster of Excellence Hearing, University of Oldenburg, Oldenburg, Germany
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford, United Kingdom.,Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Maarten DeVos
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
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Randerath W, Bassetti CL, Bonsignore MR, Farre R, Ferini-Strambi L, Grote L, Hedner J, Kohler M, Martinez-Garcia MA, Mihaicuta S, Montserrat J, Pepin JL, Pevernagie D, Pizza F, Polo O, Riha R, Ryan S, Verbraecken J, McNicholas WT. Challenges and perspectives in obstructive sleep apnoea. Eur Respir J 2018; 52:13993003.02616-2017. [DOI: 10.1183/13993003.02616-2017] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/25/2018] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems throughout the world. The high prevalence and the impact on daily life of OSA oblige clinicians to offer effective and acceptable treatment options. However, recent evidence has raised questions about the benefits of positive airway pressure therapy in ameliorating comorbidities.An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field, and proposed topics for future research on epidemiology, phenotyping, underlying mechanisms, prognostic implications and optimal treatment of patients with OSA.The group concluded that a revision to the diagnostic criteria for OSA is required to include factors that reflect different clinical and pathophysiological phenotypes and relevant comorbidities (e.g.nondipping nocturnal blood pressure). Furthermore, current severity thresholds require revision to reflect factors such as the disparity in the apnoea–hypopnoea index (AHI) between polysomnography and sleep studies that do not include sleep stage measurements, in addition to the poor correlation between AHI and daytime symptoms such as sleepiness. Management decisions should be linked to the underlying phenotype and consider outcomes beyond AHI.
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35
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Younes M, Kuna ST, Pack AI, Walsh JK, Kushida CA, Staley B, Pien GW. Reliability of the American Academy of Sleep Medicine Rules for Assessing Sleep Depth in Clinical Practice. J Clin Sleep Med 2018; 14:205-213. [PMID: 29351821 PMCID: PMC5786839 DOI: 10.5664/jcsm.6934] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/08/2017] [Accepted: 10/18/2017] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVES The American Academy of Sleep Medicine has published manuals for scoring polysomnograms that recommend time spent in non-rapid eye movement sleep stages (stage N1, N2, and N3 sleep) be reported. Given the well-established large interrater variability in scoring stage N1 and N3 sleep, we determined the range of time in stage N1 and N3 sleep scored by a large number of technologists when compared to reasonably estimated true values. METHODS Polysomnograms of 70 females were scored by 10 highly trained sleep technologists, two each from five different academic sleep laboratories. Range and confidence interval (CI = difference between the 5th and 95th percentiles) of the 10 times spent in stage N1 and N3 sleep assigned in each polysomnogram were determined. Average values of times spent in stage N1 and N3 sleep generated by the 10 technologists in each polysomnogram were considered representative of the true values for the individual polysomnogram. Accuracy of different technologists in estimating delta wave duration was determined by comparing their scores to digitally determined durations. RESULTS The CI range of the ten N1 scores was 4 to 39 percent of total sleep time (% TST) in different polysomnograms (mean CI ± standard deviation = 11.1 ± 7.1 % TST). Corresponding range for N3 was 1 to 28 % TST (14.4 ± 6.1 % TST). For stage N1 and N3 sleep, very low or very high values were reported for virtually all polysomnograms by different technologists. Technologists varied widely in their assignment of stage N3 sleep, scoring that stage when the digitally determined time of delta waves ranged from 3 to 17 seconds. CONCLUSIONS Manual scoring of non-rapid eye movement sleep stages is highly unreliable among highly trained, experienced technologists. Measures of sleep continuity and depth that are reliable and clinically relevant should be a focus of clinical research.
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Affiliation(s)
- Magdy Younes
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Samuel T. Kuna
- Department of Medicine and Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Allan I. Pack
- Department of Medicine and Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James K. Walsh
- Sleep Medicine and Research Center, St. Luke's Hospital, Chesterfield, Missouri
| | - Clete A. Kushida
- Department of Psychiatry, Stanford University, Palo Alto, California
| | - Bethany Staley
- Department of Medicine and Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Grace W. Pien
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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36
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Assessment of intervention-related changes in non-rapid-eye-movement sleep depth: importance of sleep depth changes within stage 2. Sleep Med 2017; 40:84-93. [DOI: 10.1016/j.sleep.2017.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/16/2017] [Accepted: 09/08/2017] [Indexed: 01/15/2023]
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Sun H, Jia J, Goparaju B, Huang GB, Sourina O, Bianchi MT, Westover MB. Large-Scale Automated Sleep Staging. Sleep 2017; 40:4209286. [PMID: 29029305 PMCID: PMC6251659 DOI: 10.1093/sleep/zsx139] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Study Objectives Automated sleep staging has been previously limited by a combination of clinical and physiological heterogeneity. Both factors are in principle addressable with large data sets that enable robust calibration. However, the impact of sample size remains uncertain. The objectives are to investigate the extent to which machine learning methods can approximate the performance of human scorers when supplied with sufficient training cases and to investigate how staging performance depends on the number of training patients, contextual information, model complexity, and imbalance between sleep stage proportions. Methods A total of 102 features were extracted from six electroencephalography (EEG) channels in routine polysomnography. Two thousand nights were partitioned into equal (n = 1000) training and testing sets for validation. We used epoch-by-epoch Cohen's kappa statistics to measure the agreement between classifier output and human scorer according to American Academy of Sleep Medicine scoring criteria. Results Epoch-by-epoch Cohen's kappa improved with increasing training EEG recordings until saturation occurred (n = ~300). The kappa value was further improved by accounting for contextual (temporal) information, increasing model complexity, and adjusting the model training procedure to account for the imbalance of stage proportions. The final kappa on the testing set was 0.68. Testing on more EEG recordings leads to kappa estimates with lower variance. Conclusion Training with a large data set enables automated sleep staging that compares favorably with human scorers. Because testing was performed on a large and heterogeneous data set, the performance estimate has low variance and is likely to generalize broadly.
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Affiliation(s)
- Haoqi Sun
- Energy Research Institute @ NTU, Interdisciplinary Graduate School, Nanyang Technological University, 639798, Singapore
- Fraunhofer IDM @ NTU, Nanyang Technological University, 639798, Singapore
| | - Jian Jia
- School of Mathematics, Northwest University, Xi’an, Shaanxi, 710127China
| | - Balaji Goparaju
- Massachusetts General Hospital, Neurology Department,Boston, MA
| | - Guang-Bin Huang
- School of Electrical and Electronic Engineering, Nanyang Technological University, 639798,Singapore.
| | - Olga Sourina
- Fraunhofer IDM @ NTU, Nanyang Technological University, 639798, Singapore
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Levendowski DJ, Ferini-Strambi L, Gamaldo C, Cetel M, Rosenberg R, Westbrook PR. The Accuracy, Night-to-Night Variability, and Stability of Frontopolar Sleep Electroencephalography Biomarkers. J Clin Sleep Med 2017; 13:791-803. [PMID: 28454598 PMCID: PMC5443740 DOI: 10.5664/jcsm.6618] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/11/2017] [Accepted: 03/22/2017] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVES To assess the validity of sleep architecture and sleep continuity biomarkers obtained from a portable, multichannel forehead electroencephalography (EEG) recorder. METHODS Forty-seven subjects simultaneously underwent polysomnography (PSG) while wearing a multichannel frontopolar EEG recording device (Sleep Profiler). The PSG recordings independently staged by 5 registered polysomnographic technologists were compared for agreement with the autoscored sleep EEG before and after expert review. To assess the night-to-night variability and first night bias, 2 nights of self-applied, in-home EEG recordings obtained from a clinical cohort of 63 patients were used (41% with a diagnosis of insomnia/depression, 35% with insomnia/obstructive sleep apnea, and 17.5% with all three). The between-night stability of abnormal sleep biomarkers was determined by comparing each night's data to normative reference values. RESULTS The mean overall interscorer agreements between the 5 technologists were 75.9%, and the mean kappa score was 0.70. After visual review, the mean kappa score between the autostaging and five raters was 0.67, and staging agreed with a majority of scorers in at least 80% of the epochs for all stages except stage N1. Sleep spindles, autonomic activation, and stage N3 exhibited the least between-night variability (P < .0001) and strongest between-night stability. Antihypertensive medications were found to have a significant effect on sleep quality biomarkers (P < .02). CONCLUSIONS A strong agreement was observed between the automated sleep staging and human-scored PSG. One night's recording appeared sufficient to characterize abnormal slow wave sleep, sleep spindle activity, and heart rate variability in patients, but a 2-night average improved the assessment of all other sleep biomarkers. COMMENTARY Two commentaries on this article appear in this issue on pages 771 and 773.
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Affiliation(s)
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Sleep Disorders Center, Università Vita-Salute San Raffaele, Milan, Italy
| | - Charlene Gamaldo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mindy Cetel
- Integrative Insomnia and Sleep Health Center, San Diego, California
| | - Robert Rosenberg
- Sleep Disorders Center of Prescott Valley, Prescott Valley, Arizona
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