Multimodal Signal Processing for Diagnosis of Cardiorespiratory Disorders

This thesis addresses the use of multimodal signal processing to develop algorithms for the automated processing of two cardiorespiratory disorders. The aim of the first application of this thesis was to reduce false alarm rate in an intensive care unit. The goal was to detect five critical arrhythmias using processing of multimodal signals including photoplethysmography, arterial blood pressure, Lead II and augmented right arm electrocardiogram (ECG). A hierarchical approach was used to process the signals as well as a custom signal processing technique for each arrhythmia type. Sleep disorders are a prevalent health issue, currently costly and inconvenient to diagnose, as they normally require an overnight hospital stay by the patient. In the second application of this project, we designed automated signal processing algorithms for the diagnosis of sleep apnoea with a main focus on the ECG signal processing. We estimated the ECG-derived respiratory (EDR) signal using different methods: QRS-complex area, principal component analysis (PCA) and kernel PCA. We proposed two algorithms (segmented PCA and approximated PCA) for EDR estimation to enable applying the PCA method to overnight recordings and rectify the computational issues and memory requirement. We compared the EDR information against the chest respiratory effort signals. The performance was evaluated using three automated machine learning algorithms of linear discriminant analysis (LDA), extreme learning machine (ELM) and support vector machine (SVM) on two databases: the MIT PhysioNet database and the St. Vincent’s database. The results showed that the QRS area method for EDR estimation combined with the LDA classifier was the highest performing method and the EDR signals contain respiratory information useful for discriminating sleep apnoea. As a final step, heart rate variability (HRV) and cardiopulmonary coupling (CPC) features were extracted and combined with the EDR features and temporal optimisation techniques were applied. The cross-validation results of the minute-by-minute apnoea classification achieved an accuracy of 89%, a sensitivity of 90%, a specificity of 88%, and an AUC of 0.95 which is comparable to the best results reported in the literature

A review of automated sleep disorder detection

Automated sleep disorder detection is challenging because physiological symptoms can vary widely. These variations make it difficult to create effective sleep disorder detection models which support hu-man experts during diagnosis and treatment monitoring. From 2010 to 2021, authors of 95 scientific papers have taken up the challenge of automating sleep disorder detection. This paper provides an expert review of this work. We investigated whether digital technology and Artificial Intelligence (AI) can provide automated diagnosis support for sleep disorders. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines during the content discovery phase. We compared the performance of proposed sleep disorder detection methods, involving differ-ent datasets or signals. During the review, we found eight sleep disorders, of which sleep apnea and insomnia were the most studied. These disorders can be diagnosed using several kinds of biomedical signals, such as Electrocardiogram (ECG), Polysomnography (PSG), Electroencephalogram (EEG), Electromyogram (EMG), and snore sound. Subsequently, we established areas of commonality and distinctiveness. Common to all reviewed papers was that AI models were trained and tested with labelled physiological signals. Looking deeper, we discovered that 24 distinct algorithms were used for the detection task. The nature of these algorithms evolved, before 2017 only traditional Machine Learning (ML) was used. From 2018 onward, both ML and Deep Learning (DL) methods were used for sleep disorder detection. The strong emergence of DL algorithms has considerable implications for future detection systems because these algorithms demand significantly more data for training and testing when compared with ML. Based on our review results, we suggest that both type and amount of labelled data is crucial for the design of future sleep disorder detection systems because this will steer the choice of AI algorithm which establishes the desired decision support. As a guiding principle, more labelled data will help to represent the variations in symptoms. DL algorithms can extract information from these larger data quantities more effectively, therefore; we predict that the role of these algorithms will continue to expand

Documenting and predicting topic changes in Computers in Biology and Medicine: A bibliometric keyword analysis from 1990 to 2017

The Computers in Biology and Medicine (CBM) journal promotes the use of com-puting machinery in the fields of bioscience and medicine. Since the first volume in 1970, the importance of computers in these fields has grown dramatically, this is evident in the diversification of topics and an increase in the publication rate. In this study, we quantify both change and diversification of topics covered in CBM. This is done by analysing the author supplied keywords, since they were electronically captured in 1990. The analysis starts by selecting 40 keywords, related to Medical (M) (7), Data (D)(10), Feature (F) (17) and Artificial Intelligence (AI) (6) methods. Automated keyword clustering shows the statistical connection between the selected keywords. We found that the three most popular topics in CBM are: Support Vector Machine (SVM), Elec-troencephalography (EEG) and IMAGE PROCESSING. In a separate analysis step, we bagged the selected keywords into sequential one year time slices and calculated the normalized appearance. The results were visualised with graphs that indicate the CBM topic changes. These graphs show that there was a transition from Artificial Neural Network (ANN) to SVM. In 2006 SVM replaced ANN as the most important AI algo-rithm. Our investigation helps the editorial board to manage and embrace topic change. Furthermore, our analysis is interesting for the general reader, as the results can help them to adjust their research directions

Machine learning approaches for predicting sleep arousal response based on heart rate variability, oxygen saturation, and body profiles.

OBJECTIVE: Obstructive sleep apnea is a global health concern, and several tools have been developed to screen its severity. However, most tools focus on respiratory events instead of sleep arousal, which can also affect sleep efficiency. This study employed easy-to-measure parameters-namely heart rate variability, oxygen saturation, and body profiles-to predict arousal occurrence. METHODS: Body profiles and polysomnography recordings were collected from 659 patients. Continuous heart rate variability and oximetry measurements were performed and then labeled based on the presence of sleep arousal. The dataset, comprising five body profiles, mean heart rate, six heart rate variability, and five oximetry variables, was then split into 80% training/validation and 20% testing datasets. Eight machine learning approaches were employed. The model with the highest accuracy, area under the receiver operating characteristic curve, and area under the precision recall curve values in the training/validation dataset was applied to the testing dataset and to determine feature importance. RESULTS: InceptionTime, which exhibited superior performance in predicting sleep arousal in the training dataset, was used to classify the testing dataset and explore feature importance. In the testing dataset, InceptionTime achieved an accuracy of 76.21%, an area under the receiver operating characteristic curve of 84.33%, and an area under the precision recall curve of 86.28%. The standard deviations of time intervals between successive normal heartbeats and the square roots of the means of the squares of successive differences between normal heartbeats were predominant predictors of arousal occurrence. CONCLUSIONS: The established models can be considered for screening sleep arousal occurrence or integrated in wearable devices for home-based sleep examination

Intelligent Biosignal Analysis Methods

This book describes recent efforts in improving intelligent systems for automatic biosignal analysis. It focuses on machine learning and deep learning methods used for classification of different organism states and disorders based on biomedical signals such as EEG, ECG, HRV, and others

Optimal Feature Search for Vigilance Estimation Using Deep Reinforcement Learning

A low level of vigilance is one of the main reasons for traffic and industrial accidents. We conducted experiments to evoke the low level of vigilance and record physiological data through single-channel electroencephalogram (EEG) and electrocardiogram (ECG) measurements. In this study, a deep Q-network (DQN) algorithm was designed, using conventional feature engineering and deep convolutional neural network (CNN) methods, to extract the optimal features. The DQN yielded the optimal features: two CNN features from ECG and two conventional features from EEG. The ECG features were more significant for tracking the transitions within the alertness continuum with the DQN. The classification was performed with a small number of features, and the results were similar to those from using all of the features. This suggests that the DQN could be applied to investigating biomarkers for physiological responses and optimizing the classification system to reduce the input resources

On the Generalization of Sleep Apnea Detection Methods Based on Heart Rate Variability and Machine Learning

[EN] Obstructive sleep apnea (OSA) is a respiratory disorder highly correlated with severe cardiovascular diseases that has unleashed the interest of hundreds of experts aiming to overcome the elevated requirements of polysomnography, the gold standard for its detection. In this regard, a variety of algorithms based on heart rate variability (HRV) features and machine learning (ML) classifiers have been recently proposed for epoch-wise OSA detection from the surface electrocardiogram signal. Many researchers have employed freely available databases to assess their methods in a reproducible way, but most were purely tested with cross-validation approaches and even some using solely a single database for training and testing procedures. Hence, although promising values of diagnostic accuracy have been reported by some of these methods, they are suspected to be overestimated and the present work aims to analyze the actual generalization ability of several epoch-wise OSA detectors obtained through a common ML pipeline and typical HRV features. Precisely, the performance of the generated OSA detectors has been compared on two validation approaches, i.e., the widely used epoch-wise, k-fold cross-validation and the highly recommended external validation, both considering different combinations of well-known public databases. Regardless of the used ML classifiers and the selected HRV-based features, the external validation results have been 20 to 40% lower than those obtained with cross-validation in terms of accuracy, sensitivity, and specificity. Consequently, these results suggest that ML-based OSA detectors trained with public databases are still not sufficiently general to be employed in clinical practice, as well as that larger, more representative public datasets and the use of external validation are mandatory to improve the generalization ability and to obtain reliable assessment of the true predictive power of these algorithms, respectively.This research has received financial support from public grants PID2021-00X128525-IV0 and PID2021-123804OB-I00 of the Spanish Government 10.13039/501100011033 jointly with the European Regional Development Fund, SBPLY/17/180501/000411 and SBPLY/21/180501/000186 from Junta de Comunidades de Castilla-La Mancha, and AICO/2021/286 from Generalitat Valenciana. Moreover, Daniele Padovano holds a predoctoral scholarship 2022-PRED-20642, which is cofinanced by the operating program of European Social Fund (ESF) 2014-2020 of Castilla-La Mancha.Padovano, D.; Martínez-Rodrigo, A.; Pastor, JM.; Rieta, JJ.; Alcaraz, R. (2022). On the Generalization of Sleep Apnea Detection Methods Based on Heart Rate Variability and Machine Learning. IEEE Access. 10:92710-92725. https://doi.org/10.1109/ACCESS.2022.320191192710927251

ECG based Prediction Model for Cardiac-Related Diseases using Machine Learning Techniques

This dissertation presents research on the construction of predictive models for health conditions through the application of Artificial Intelligence methods. The work is thus focused on the prediction, in the short and long term, of Atrial Fibrillation conditions through the analysis of Electrocardiography exams, with the use of several techniques to reduce noise and interference, as well as their representation through spectrograms and their application in Artificial Intelligence models, specifically Deep Learning. The training and testing processes of the models made use of a publicly available database. In its two approaches, predictive algorithms were obtained with an accuracy of 96.73% for a short horizon prediction and 96.52% for long Atrial Fibrillation prediction horizon. The main objectives of this dissertation are thus the study of works already carried out in the area during the last decade, to present a new methodology of prediction of the presented condition, as well as to present and discuss its results, including suggestions for improvement for future development.Esta dissertação descreve a construção de modelos preditivos de condições de saúde através de aplicação de métodos de Inteligência Artificial. O trabalho é assim focado na predição, a curto e longo prazo, de condições de Fibrilhação Auricular através da análise de exames de Eletrocardiografia, com a utilização de diversas técnicas de redução de ruído e de interferência, bem como a sua representação através de espectrogramas e sua aplicação em modelos de Inteligência Artificial, concretamente de Aprendizagem Profunda (Deep Learning na língua inglesa). Os processos de treino e teste dos modelos obtidos recorreram a uma base de dados publicamente disponível. Nas suas duas abordagens, foram obtidos algoritmos preditivos com uma precisão de 96.73% para uma predição de curto horizonte e 96.52% para longo horizonte de predição de Fibrilhação Auricular. Os objetivos principais da presente dissertação são assim o estudo de trabalhos já realizados na área durante a última década, apresentar uma nova metodologia de predição da condição apresentada, bem como apresentar e discutir os seus resultados, incluindo sugestões de melhoria para futuro desenvolvimento

Sleep detection with photoplethysmography for wearable-based health monitoring

Remote health monitoring has gained increasing attention in the recent years. Detecting sleep patterns provides users with insights on their personal health issues, and can help in the diagnosis of various sleep disorders. Conventional methods are focused on the acceleration data, or are not suitable for continuous monitoring, like the polysomnography. Wearable devices enable a way to continuously measure photoplethysmography signal. Photoplethysmography signal contains information on multiple physiological systems, and can be used to detect sleep patterns. Sleep detection using wearable-based photoplethysmography signal offers a convenient and easy way to monitor health. In this thesis, a photoplethysmography-based sleep detection method for wearable-based health monitoring is described. This technique aims to separate wakefulness and asleep states with adequate accuracy. To examine the importance of good quality data in sleep detection, the quality of the signal is assessed. The proposed method uses statistical and heart rate based features extracted from the photoplethysmography signal. Using the most relevant features, various supervised learning algorithms are trained, compared and evaluated. These algorithms are logistic regression, decision tree, random forest, support vector machine, k-nearest neighbors, and Naive Bayes. The best performance is obtained by the random forest classifier. The method received an overall accuracy of 81 percent. It was able to detect the sleep periods with 86 percent accuracy and the awake periods with 74 percent accuracy. Motion artifacts occurring during the awake time caused distortion to the signal. Features related to the shape of the signal improved the accuracy of sleep detection, since signal distortion was associated with the awake time. It is concluded that photoplethysmography signal provides a good alternative for wearable-based sleep detection. Future studies with more comprehensive sleep level analysis could be conducted to provide valuable information on the quality of sleep.Viime vuosina etänä tapahtuva terveyden seuranta on saanut yhä enemmän huomiota. Unen tunnistaminen antaa käyttäjille tietoa heidän henkilökohtaisista terveysongelmistaan ja voi auttaa erilaisten unihäiriöiden diagnosoinnissa. Tavanomaiset menetelmät käyttävät kiihtyvyyteen perustuvaa dataa, tai eivät ole soveltuvia jatkuvaan seurantaan, kuten polysomnografia. Puettavan teknologian avulla fotopletysmografiasignaalin jatkuva mittaus on mahdollista. Fotopletysmografiasignaali sisältää tietoa useista fysiologisista järjestelmistä ja sitä voidaan käyttää unen tunnistamiseen. Puettavan teknologian avulla mitatun fotopletysmografiasignaalin käyttö unen tunnistuksessa tarjoaa kätevän ja helpon tavan seurata terveyttä. Tässä diplomityössä kuvataan fotopletysmografiaan perustuva unenhavaitsemismenetelmä, joka soveltuu puettavaa teknologiaa hyödyntävään terveyden seurantaan. Tekniikalla pyritään erottamaan hereillä olo ja uni riittävän tarkasti. Signaalin laatu arvioidaan, jotta voidaan tutkia datan laadun tärkeys unen tunnistuksessa. Kehitetty menetelmä käyttää tilastollisia ja sykkeeseen perustuvia ominaisuuksia, jotka on erotettu fotopletysmografiasignaalista. Tärkeimpiä ominaisuuksia käyttämällä erilaisia valvottuja oppimisalgoritmeja koulutetaan, vertaillaan ja arvioidaan. Käytetyt algoritmit ovat logistinen regressio, päätöspuu, satunnainen metsä, tukivektorikone, k-lähimmät naapurit ja Naive Bayes. Paras tulos saadaan käyttämällä satunnainen metsä -algoritmia. Menetelmällä saavutetaan 81 prosentin kokonaistarkkuus. Uni pystytään tunnistamaan 86 prosentin tarkkuudella ja hereillä olo 74 prosentin tarkkuudella. Hereillä ollessa liikkeestä johtuvat häiriöt aiheuttavat vääristymää signaaliin. Signaalin muotoon liittyvät ominaisuudet paransivat unentunnistuksen tarkkuutta, koska signaalin vääristyminen yhdistettiin hereilläoloaikaan. Tutkimuksen tuloksista voidaan tehdä johtopäätös, että fotopletysmografiasignaali tarjoaa hyvän vaihtoehdon puettavaa teknologiaa hyödyntävään unen tunnistamiseen. Tulevaisuudessa unen eri vaiheita voitaisiin tutkia kattavammin, jolloin saataisiin arvokasta tietoa unen laadusta