Automated sleep classification using the new sleep stage standards

Sleep is fundamental for physical health and good quality of life, and clinicians and researchers have long debated how best to understand it. Manual approaches to sleep classification have been in use for over 40 years, and in 2007, the American Academy of Sleep Medicine (AASM) published a new sleep scoring manual. Over the years, many attempts have been made to introduce and validate machine learning and automated classification techniques in the sleep research field, with the goals of improving consistency and reliability. This thesis explored and assessed the use of automated classification systems with the updated sleep stage definitions and scoring rules using neuro-fuzzy system (NFS) and support vector machine (SVM) methodology. For both the NFS and SVM classification techniques, the overall percent correct was approximately 65%, with sensitivity and specificity rates around 80% and 95%, respectively. The overall Kappa scores, one means for evaluating system reliability, were approximately 0.57 for both the NFS and SVM, indicating moderate agreement that is not accidental. Stage 3 sleep was detected with an 87-89% success rate. The results presented in this thesis show that the use of NFS and SVM methods for classifying sleep stages is possible using the new AASM guidelines. While the current work supports and confirms the use of these classification techniques within the research community, the results did not indicate a significant difference in the accuracy of either approach-nor a difference in one over the other. The results suggest that the important clinical stage 3 (slow wave sleep) can be accurately scored with these classifiers; however, the techniques used here would need more investigation and optimization prior to serious use in clinical applications

A knowledge model for the development of a framework for hypnogram construction

The final publication is available via http://dx.doi.org/10.1016/j.knosys.2016.11.016[Abstract] We describe a proposal of a knowledge model for the development of a framework for hypnogram construction from intelligent analysis of pulmonology and electrophysiological signals. Throughout the twentieth century, after the development of electroencephalography (EEG) by Hans Berger, there have been multiple studies on human sleep and its structure. Polysomnography (PSG), a sleep study from several biophysiological variables, gives us the hypnogram, a graphic representation of the stages of sleep as a function of time. This graph, when analyzed in conjunction with other physiological parameters, such as the heart rate or the amount of oxygen in arterial blood, has become a valuable diagnostic tool for different clinical problems that can occur during sleep and that often cause poor quality sleep. Currently, the gold standard for the detection of sleep events and for the correct classification of sleep stages are the rules published by the American Academy of Sleep Medicine (AASM), version 2.2. Based on the standards available to date, different studies on methods of automatic analysis of sleep and its stages have been developed but because of the different development and validation procedures used in existing methods, a rigorous and useful comparative analysis of results and their ability to correctly classify sleep stages is not possible. In this sense, we propose an approach that ensures that sleep stage classification task is not affected by the method for extracting PSG features and events. This approach is based on the development of a knowledge-intensive base system (KBS) for classifying sleep stages and building the corresponding hypnogram. For this development we used the CommonKADS methodology, that has become a de facto standard for the development of KBSs. As a result, we present a new knowledge model that can be used for the subsequent development of an intelligent system for hypnogram construction that allows us to isolate the process of signal processing to identify sleep stages so that the hypnograms obtained become comparable, independently of the signal analysis techniques.Xunta de Galicia; GRC2014/035Ministerio de Economía y Competitividad; TIN2013-40686-

Classification techniques on computerized systems to predict and/or to detect Apnea: A systematic review

Sleep apnea syndrome (SAS), which can significantly decrease the quality of life is associated with a major risk factor of health implications such as increased cardiovascular disease, sudden death, depression, irritability, hypertension, and learning difficulties. Thus, it is relevant and timely to present a systematic review describing significant applications in the framework of computational intelligence-based SAS, including its performance, beneficial and challenging effects, and modeling for the decision-making on multiple scenarios.info:eu-repo/semantics/publishedVersio

Usefulness of Artificial Neural Networks in the Diagnosis and Treatment of Sleep Apnea-Hypopnea Syndrome

Sleep apnea-hypopnea syndrome (SAHS) is a chronic and highly prevalent disease considered a major health problem in industrialized countries. The gold standard diagnostic methodology is in-laboratory nocturnal polysomnography (PSG), which is complex, costly, and time consuming. In order to overcome these limitations, novel and simplified diagnostic alternatives are demanded. Sleep scientists carried out an exhaustive research during the last decades focused on the design of automated expert systems derived from artificial intelligence able to help sleep specialists in their daily practice. Among automated pattern recognition techniques, artificial neural networks (ANNs) have demonstrated to be efficient and accurate algorithms in order to implement computer-aided diagnosis systems aimed at assisting physicians in the management of SAHS. In this regard, several applications of ANNs have been developed, such as classification of patients suspected of suffering from SAHS, apnea-hypopnea index (AHI) prediction, detection and quantification of respiratory events, apneic events classification, automated sleep staging and arousal detection, alertness monitoring systems, and airflow pressure optimization in positive airway pressure (PAP) devices to fit patients’ needs. In the present research, current applications of ANNs in the framework of SAHS management are thoroughly reviewed

Diagnosis of the sleep apnea-hypopnea syndrome : a comprehensive approach through an intelligent system to support medical decision

[Abstract] This doctoral thesis carries out the development of an intelligent system to support medical decision in the diagnosis of the Sleep Apnea-Hypopnea Syndrome (SAHS). SAHS is the most common disorder within those affecting sleep. The estimates of the disease prevalence range from 3% to 7%. Diagnosis of SAHS requires of a polysomnographic test (PSG) to be done in the Sleep Unit of a medical center. Manual scoring of the resulting recording entails too much effort and time to the medical specialists and as a consequence it implies a high economic cost. In the developed system, automatic analysis of the PSG is accomplished which follows a comprehensive perspective. Firstly an analysis of the neurophysiological signals related to the sleep function is carried out in order to obtain the hypnogram. Then, an analysis is performed over the respiratory signals which have to be subsequently interpreted in the context of the remaining signals included in the PSG. In order to carry out such a task, the developed system is supported by the use of artificial intelligence techniques, specially focusing on the use of reasoning mechanisms capable of handling data imprecision. Ultimately, it is the aim of the proposed system to improve the diagnostic procedure and help physicians in the diagnosis of SAHS.[Resumen] Esta tesis aborda el desarrollo de un sistema inteligente de apoyo a la decisión clínica para el diagnóstico del Síndrome de Apneas-Hipopneas del Sueño (SAHS). El SAHS es el trastorno más común de aquellos que afectan al sueño. Afecta a un rango del 3% al 7% de la población con consecuencias severas sobre la salud. El diagnóstico requiere la realización de un análisis polisomnográfico (PSG) en una Unidad del Sueño de un centro hospitalario. El análisis manual de dicha prueba resulta muy costoso en tiempo y esfuerzo para el médico especialista, y como consecuencia en un elevado coste económico. El sistema desarrollado lleva a cabo el análisis automático del PSG desde una perspectiva integral. A tal efecto, primero se realiza un análisis de las señales neurofisiológicas vinculadas al sueño para obtener el hipnograma, y seguidamente, se lleva a cabo un análisis neumológico de las señales respiratorias interpretándolas en el contexto que marcan las demás señales del PSG. Para lleva a cabo dicha tarea el sistema se apoya en el uso de distintas técnicas de inteligencia artificial, con especial atención al uso mecanismos de razonamiento con soporte a la imprecisión. El principal objetivo del sistema propuesto es la mejora del procedimiento diagnóstico y ayudar a los médicos en diagnóstico del SAHS.[Resumo] Esta tese aborda o desenvolvemento dun sistema intelixente de apoio á decisión clínica para o diagnóstico do Síndrome de Apneas-Hipopneas do Sono (SAHS). O SAHS é o trastorno máis común daqueles que afectan ao sono. Afecta a un rango do 3% ao 7% da poboación con consecuencias severas sobre a saúde. O diagnóstico pasa pola realización dunha análise polisomnográfica (PSG) nunha Unidade do Sono dun centro hospitalario. A análise manual da devandita proba resulta moi custosa en tempo e esforzo para o médico especialista, e como consecuencia nun elevado custo económico. O sistema desenvolvido leva a cabo a análise automática do PSG dende unha perspectiva integral. A tal efecto, primeiro realizase unha análise dos sinais neurofisiolóxicos vinculados ao sono para obter o hipnograma, e seguidamente, lévase a cabo unha análise neumolóxica dos sinais respiratorios interpretándoos no contexto que marcan os demais sinais do PSG. Para leva a cabo esta tarefa o sistema apoiarase no uso de distintas técnicas de intelixencia artificial, con especial atención a mecanismos de razoamento con soporte para a imprecisión. O principal obxectivo do sistema proposto é a mellora do procedemento diagnóstico e axudar aos médicos no diagnóstico do SAHS

EEG-based Brain-Computer Interfaces (BCIs): A Survey of Recent Studies on Signal Sensing Technologies and Computational Intelligence Approaches and Their Applications.

Brain-Computer interfaces (BCIs) enhance the capability of human brain activities to interact with the environment. Recent advancements in technology and machine learning algorithms have increased interest in electroencephalographic (EEG)-based BCI applications. EEG-based intelligent BCI systems can facilitate continuous monitoring of fluctuations in human cognitive states under monotonous tasks, which is both beneficial for people in need of healthcare support and general researchers in different domain areas. In this review, we survey the recent literature on EEG signal sensing technologies and computational intelligence approaches in BCI applications, compensating for the gaps in the systematic summary of the past five years. Specifically, we first review the current status of BCI and signal sensing technologies for collecting reliable EEG signals. Then, we demonstrate state-of-the-art computational intelligence techniques, including fuzzy models and transfer learning in machine learning and deep learning algorithms, to detect, monitor, and maintain human cognitive states and task performance in prevalent applications. Finally, we present a couple of innovative BCI-inspired healthcare applications and discuss future research directions in EEG-based BCI research

Closed-loop control of anesthesia : survey on actual trends, challenges and perspectives

Automation empowers self-sustainable adaptive processes and personalized services in many industries. The implementation of the integrated healthcare paradigm built on Health 4.0 is expected to transform any area in medicine due to the lightning-speed advances in control, robotics, artificial intelligence, sensors etc. The two objectives of this article, as addressed to different entities, are: i) to raise awareness throughout the anesthesiologists about the usefulness of integrating automation and data exchange in their clinical practice for providing increased attention to alarming situations, ii) to provide the actualized insights of drug-delivery research in order to create an opening horizon towards precision medicine with significantly improved human outcomes. This article presents a concise overview on the recent evolution of closed-loop anesthesia delivery control systems by means of control strategies, depth of anesthesia monitors, patient modelling, safety systems, and validation in clinical trials. For decades, anesthesia control has been in the midst of transformative changes, going from simple controllers to integrative strategies of two or more components, but not achieving yet the breakthrough of an integrated system. However, the scientific advances that happen at high speed need a modern review to identify the current technological gaps, societal implications, and implementation barriers. This article provides a good basis for control research in clinical anesthesia to endorse new challenges for intelligent systems towards individualized patient care. At this connection point of clinical and engineering frameworks through (semi-) automation, the following can be granted: patient safety, economical efficiency, and clinicians' efficacy

Sleep Stage Classification: A Deep Learning Approach

Sleep occupies significant part of human life. The diagnoses of sleep related disorders are of great importance. To record specific physical and electrical activities of the brain and body, a multi-parameter test, called polysomnography (PSG), is normally used. The visual process of sleep stage classification is time consuming, subjective and costly. To improve the accuracy and efficiency of the sleep stage classification, automatic classification algorithms were developed. In this research work, we focused on pre-processing (filtering boundaries and de-noising algorithms) and classification steps of automatic sleep stage classification. The main motivation for this work was to develop a pre-processing and classification framework to clean the input EEG signal without manipulating the original data thus enhancing the learning stage of deep learning classifiers. For pre-processing EEG signals, a lossless adaptive artefact removal method was proposed. Rather than other works that used artificial noise, we used real EEG data contaminated with EOG and EMG for evaluating the proposed method. The proposed adaptive algorithm led to a significant enhancement in the overall classification accuracy. In the classification area, we evaluated the performance of the most common sleep stage classifiers using a comprehensive set of features extracted from PSG signals. Considering the challenges and limitations of conventional methods, we proposed two deep learning-based methods for classification of sleep stages based on Stacked Sparse AutoEncoder (SSAE) and Convolutional Neural Network (CNN). The proposed methods performed more efficiently by eliminating the need for conventional feature selection and feature extraction steps respectively. Moreover, although our systems were trained with lower number of samples compared to the similar studies, they were able to achieve state of art accuracy and higher overall sensitivity

Towards Automating Sleep Stage Scoring to Diagnose Sleep Disorders

Overnight polysomnography (PSG) is an important tool used to characterize sleep and the gold standard procedure for diagnosing many sleep disorders. PSG is a non-invasive procedure that collects various physiological data, such as EEG, EMG, EOG and ECG signals. The data is then scored in a subjective, laborious and time-consuming process by sleep specialists who assign a sleep stage to every 30-second window of the data according to predefined scoring rules by the American Academy of Sleep Medicine (AASM). Finally, clinicians make a diagnosis based on this annotated data. Consequently, the current process is heavily dependent upon human factors, which can result in poor agreement between expert scorers, but inter-scorer reliability has been found to be only around 82%. In this study we developed an automatic sleep stage scoring method, using a likelihood ratio decision tree classifier, with the goal of improving the speed, reliability, accuracy and cost efficiency of the current PSG scoring process. The algorithm was developed using the AASM Manual for Scoring Sleep. We extracted features from various physiological recordings of the PSG, based on the predefined rules of the AASM Manual. The features were computed for each 30-second epoch, in either the time or the frequency domain. The most useful features were selected by looking at probability distributions for each metric conditioned on the sleep stage, and identifying the features giving the greatest separation between stages. Examples of meaningful features include the power in different frequency bands of EEG signals, EMG energy per epoch, and number of spindles per epoch, to mention a few. These features were then used as inputs to the classifier which assigned each epoch one of five possible stages:; N3, N2, N1, REM or Wake. The automatic scoring was trained and tested on PSG data from 39 healthy individuals (age range: 24.2±3.1 years) with no sleep disturbances. The overall scoring accuracy was 76.97% on the test set. Some of the stages, such as stage N2, have more distinctive characteristics and thus yielded a higher per-stage scoring accuracy, whereas the other stages, for example stages N1 and REM, got confused more easily, resulting in lower per-stage accuracies. As expected, most misclassifications occurred between adjacent sleep stages. Although this accuracy may at first seem low, it is likely that the stages that the tool classified inaccurately may be sleep stages that contribute to inter-scorer reliability. Therefore, we see this tool as assisting sleep scorers to enhance efficiency with the further goal of eventually improving inter-scorer reliability. Sleep stage scoring provides an important basis for diagnosis of sleep disorders in general. However, the detection of sleep disturbances is very costly and time-consuming, and relies on subjective measures. Automating the scoring process improves the efficiency and consistency of scoring procedures and offers a way to diagnose sleeping disorders in a more robust, quantitative manner

Automation of Sleep Staging

This thesis primarily covers the automation problem for sleep versus awake detection, which is sometimes accomplished by differentiating the various sleep stages prior to clustering. This thesis documents various experimentation into areas where the performance can be improved, including classifer design and feature selection from EEG, EOG and Context. In terms of classifers, it was found that the neural network MLP outperforms the continuous Hidden Markov Model with an accuracy of 91.91%, and additional performance requires better feature sets and more training data. Improved EEG features based on time frequency representation were optimized to differentiate Awake with 93.52% sensitivity and 94.60% specificity, differentiate REM with 96.12% sensitivity and 93.63% specificity, differentiate Stages II and III with 96.81% sensitivity and 89.28% specificity, and differentiate Stages III and IV with 93.60% sensitivity and 90.43% specificity. Due to the limited data set, an example of applying contextual information using a One-Cycle-Duo-Direction model was built and shown to improve EEG features by up to 10%. This level of performance is comparable if not superior to the human scorer accuracy of 88% to 94%. This thesis improved some aspects of sleep staging automation, but due to the limitations on resources, the full potential of these improvements could not be demonstrated. To further develop these improvements, additional data sets customized by sleep staging experts is crucial