Utility of AdaBoost to Detect Sleep Apnea-Hypopnea Syndrome From Single-Channel Airflow

Producción CientíficaThe purpose of this study is to evaluate the usefulness of the boosting algorithm AdaBoost (AB) in the context of the sleep apnea-hypopnea syndrome (SAHS) diagnosis. Methods: We characterize SAHS in single-channel airflow (AF) signals from 317 subjects by the extraction of spectral and non-linear features. Relevancy and redundancy analyses are conducted through the fast correlation-based filter (FCBF) to derive the optimum set of features among them. These are used to feed classifiers based on linear discriminant analysis (LDA) and classification and regression trees (CART). LDA and CART models are sequentially obtained through AB, which combines their performances to reach higher diagnostic ability than each of them separately. Results: Our AB-LDA and AB-CART approaches showed high diagnostic performance when determining SAHS and its severity. The assessment of different apnea-hypopnea index cutoffs using an independent test set derived into high accuracy: 86.5% (5 events/h), 86.5% (10 events/h), 81.0% (15 events/h), and 83.3% (30 events/h). These results widely outperformed those from logistic regression and a conventional event-detection algorithm applied to the same database. Conclusion: Our results suggest that AB applied to data from single-channel AF can be useful to determine SAHS and its severity. Significance: SAHS detection might be simplified through the only use of single-channel AF data.Ministerio de Economía y Competitividad (project TEC2011-22987)Junta de Castilla y León (project VA059U13

A Time-Series Approach to Predict Obstructive Sleep Apnea (OSA) Episodes

Abstract -Sleep apnea is a common respiratory disorder during sleep. It is characterized by pauses in breathing or shallow breathing during sleep for longer than 10 seconds. Except the fact that not having a proper sleep and being rested for the next day, in some cases the apnea period (not breathing interval) may last more than 30 seconds and this situation can even be fatal. 14% of men and 5% of women suffer from Obstructive Sleep Apnea (OSA) in United States. Patients may experience apnea for more than 300 times in a single night sleep. Polysomnography (PSG) is a multi-parametric recording of biophysiological changes, containing EEG, ECG, SpO2, Nasal Airflow signals, performed during overnight sleep. In this study, a fully automatic apnea detection algorithm is developed and an early warning system is proposed to predict OSA episodes by extracting time-series features of OSA periods and regular respiration using nasal airflow signal. Extracted features are then reduced to improve the performance of the prediction. Support vector machines (SVM), one of the commonly used classification algorithms in medical applications, is implemented for learning and prediction of the OSA episodes. The results show that OSA episodes are predicted with 87.6% of accuracy and 91.3% of sensitivity, 30 seconds before patient faces apnea. By this approach, apnea related health risks can be minimized by foreknowledge

PVDF 필름 센서를 사용한 수면관련 호흡장애 및 수면 단계의 무구속적 모니터링

학위논문 (박사)-- 서울대학교 대학원 : 협동과정 바이오엔지니어링전공, 2015. 8. 박광석.이 연구에서는 PVDF 필름 센서를 사용하여 무구속적으로 수면관련 호흡장애 및 수면 단계를 모니터링 할 수 있는 기법을 개발하였다. PVDF 센서는 4 x 1 배열로 구성되었으며, 센서 시스템의 총 두께는 약 1.1mm 였다. PVDF 센서는 침대보와 매트리스 사이에 위치시켜 참가자의 몸에 직접적인 접촉이 없도록 하였다. 수면무호흡증 검출 연구에는 26명의 수면무호흡증 환자와 6명의 정상인이 참가하였다. PVDF 신호의 표준편차에 근거하여 수면무호흡증 검출 방법을 개발하였고, 추정된 수면무호흡증 검출 결과를 수면 전문의의 판독 결과와 비교하였다. 추정된 결과와 판독 결과 간의 수면 무호흡-저호흡 지수 상관계수는 0.94 (p < 0.001) 이었다. 코골이 검출 연구에는 총 20명의 수면무호흡증 환자가 참가하였다. PVDF 신호를 단시간 푸리에 변환하여 얻은 파워 비율과 최대 주파수를 주파수 영역 특징으로 추출하였다. 추출된 특징들을 서포트 벡터 머신 분류기에 입력하였고, 분류기의 검출 결과에 따라 코골이 또는 코골이가 아닌 구간으로 나누었다. 제안된 방법에서 추정한 코골이 검출 결과를 정상 성인 3명의 청각 및 시각 기반 코골이 판독 결과와 비교하였다. 코골이 검출에 대한 평균 민감도 및 양성예측도는 각각 94.6% 및 97.5% 이었다. 수면 단계 검출 연구에는 11명의 정상인과 13명의 수면무호흡증 환자가 참가하였다. 렘 (REM) 수면 구간은 호흡의 주기와 그 변동률에 근거하여 추정하였다. 깸 구간은 움직임 신호에 근거하여 추정하였다. 깊은 수면 구간은 분당 호흡수의 변화폭에 기반하여 추정하였다. 각 수면 단계 검출 결과를 통합하여 최종 결과를 수면 전문의의 판독 결과와 비교하였다. 30초 단위로 수면 단계를 검출하였을 때, 평균 정확도는 71.3% 이었으며 평균 카파 값은 0.48 이었다. 연구에서 제안된 PVDF 센서와 알고리즘을 통하여 상용화된 수면 모니터링 장치에 비교할 수 있을 만한 수준의 성능을 확보하였다. 이 연구 결과가 가정환경 기반 수면모니터링 시스템의 활용도와 정확도를 높이는데 기여할 수 있을 것으로 기대한다.In this study, unconstrained sleep-related breathing disorders (SRBD) and sleep stages monitoring methods using a polyvinylidene fluoride (PVDF) film sensor were established and tested. Subjects physiological signals were measured in an unconstrained manner using the PVDF sensor during polysomnography (PSG). The sensor was comprised of a 4×1 array, and the total thickness of the system was approximately 1.1 mm. It was designed to be placed under the subjects back and installed between a bed cover and mattress. In the sleep apnea detection study, twenty six sleep apnea patients and six normal subjects participated. The sleep apnea detection method was based on the standard deviation of the PVDF signals, and the methods performance was assessed by comparing the results with a sleep physicians manual scoring. The correlation coefficient for the apnea-hypopnea index (AHI) values between the methods was 0.94 (p < 0.001). For minute-by-minute sleep apnea detection, the method classified sleep apnea with average sensitivity of 72.9%, specificity of 90.6%, accuracy of 85.5%, and kappa statistic of 0.60. In the snoring detection study, twenty patients with obstructive sleep apnea (OSA) participated. The power ratio and peak frequency from the short-time Fourier transform were used to extract spectral features from the PVDF data. A support vector machine (SVM) was applied to the spectral features to classify the data into either snore or non-snore class. The performance of the method was assessed using manual labelling by three human observers. For event-by-event snoring detection, PVDF data that contained snoring (SN), snoring with movement (SM), and normal breathing (NB) epochs were selected for each subject. The results showed that the overall sensitivity and the positive predictive values were 94.6% and 97.5%, respectively, and there was no significant difference between the SN and SM results. In the sleep stages detection study, eleven normal subjects and thirteen OSA patients participated. Rapid eye movement (REM) sleep was estimated based on the average rate and variability of the respiratory signal. Wakefulness was detected based on the body movement signal. Variability of the respiratory rate was chosen as an indicator for slow wave sleep (SWS) detection. The performance of the method was assessed by comparing the results with manual scoring by a sleep physician. In an epoch-by-epoch analysis, the method classified the sleep stages with average accuracy of 71.3% and kappa statistic of 0.48. The experimental results demonstrated that the performances of the proposed sleep stages and SRBD detection methods were comparable to those of ambulatory devices and the results of constrained sensor based studies. The developed system and methods could be applied to a sleep monitoring system in a residential or ambulatory environment.Chapter 1. Introduction 1 1.1. Background 1 1.2. Sleep Apnea 3 1.3. Snoring 5 1.4. Sleep Stages 8 1.5. Polyvinylidene Fluoride Film Sensor 11 1.6. Purpose 12 Chapter 2. Sleep Apnea Detection 13 2.1. Signal Acquisition System 13 2.2. Methods 16 2.2.1. Participants and PSG Data 16 2.2.2. Apneic Events Detection 18 2.2.3. Statistical Analysis 25 2.3. Results 26 2.3.1. AHI Estimation 26 2.3.2. Diagnosing Sleep Apnea 29 2.3.3. Minute-By-Minute Sleep Apnea Detection 30 2.4. Discussion 34 2.4.1. Agreement between Proposed Method and PSG 34 2.4.2. Comparisons with Previous Studies 34 2.4.3. Validation of PVDF Film Sensors 36 2.4.4. Validation of Sleep Apnea Detection Algorithm 37 Chapter 3. Snoring Detection 40 3.1. Methods 40 3.1.1. Participants and PSG Data 40 3.1.2. Feature Extraction for Snoring Event Detection 42 3.1.3. Data Selection and Reference Snoring Labelling 46 3.1.4. Snoring Event Classification Based on the SVM 48 3.2. Results 52 3.2.1. Event-By-Event Snoring Detection 52 3.2.2. Snoring Event Detection and Sleep Posture 56 3.2.3. Epoch-By-Epoch Snoring Detection 57 3.3. Discussion 59 3.3.1. Agreement between Proposed Method and Reference Snoring 59 3.3.2. Comparisons with Previous Studies 59 3.3.3. Validation of the Snoring Detection Algorithm 61 Chapter 4. Sleep Stages Detection 65 4.1. Methods 65 4.1.1. Participants and PSG Data 65 4.1.2. REM Sleep Detection 68 4.1.3. Wakefulness Detection 74 4.1.4. SWS Detection 80 4.2. Results 86 4.2.1. REM Sleep Detection 86 4.2.2. Wakefulness Detection 89 4.2.3. SWS Detection 92 4.2.4. Sleep Macro- and Microstructure Detection 94 4.3. Discussion 99 4.3.1. Agreement between Proposed Method and PSG 99 4.3.2. Comparisons with Previous Studies 99 4.3.3. Validation of Sleep Stages Detection Algorithm 102 Chapter 5. Conclusion 105 References 107 Abstract in Korean 118Docto

Pattern recognition applied to airflow recordings to help in sleep Apnea-Hypopnea Syndrome diagnosis

El Síndrome de la Apnea Hipopnea del Sueño (SAHS) es un trastorno caracterizado por pausas respiratorias durante el sueño. Se considera un grave problema de salud que afecta muy negativamente a la calidad de vida y está relacionada con las principales causas de mortalidad, como los accidentes cardiovasculares y cerebrovasculares. A pesar de su elevada prevalencia (2–7%) se considera una enfermedad infradiagnosticada. El diagnóstico estándar se realiza mediante polisomnografía (PSG) nocturna, que es un método complejo y de alto coste. Estas limitaciones han originado largas listas de espera. Esta Tesis Doctoral tiene como principal objetivo simplificar la metodología de diagnóstico del SAHS . Para ello, se propone el análisis exhaustivo de la señal de flujo aéreo monocanal. La metodología propuesta se basa en tres fases (i) extracción de características, (ii) selección de características, y (iii) procesado de la señal mediante métodos de reconocimiento de patrones. Los resultados obtenidos muestran un alto rendimiento diagnóstico de la propuesta tanto en la detección como en la determinación del grado de severidad del SAHS. Por ello, la principal conclusión de la Tesis Doctoral es que los métodos de reconocimiento automático de patrones aplicados sobre la señal de flujo aéreo monocanal resultan de utilidad para reducir la complejidad del proceso de diagnóstico del SAHS.Departamento de Teoría de la Señal y Comunicaciones e Ingeniería Telemátic

Automatic analysis of overnight airflow to help in the diagnosis of pediatric obstructive sleep apnea

La apnea obstructiva del sueño (AOS) pediátrica es una enfermedad respiratoria altamente prevalente e infradiagnosticada que puede afectar negativamente a las funciones fisiológicas y cognitivas de los niños, causándoles graves deficiencias neurocognitivas, cardiometabólicas y endocrinas. El método estándar para su diagnóstico es la polisomnografía nocturna, una prueba compleja, de elevado coste, altamente intrusiva y poco accesible, lo que genera largas listas de espera y retrasos en el diagnóstico. Por ello, es necesario desarrollar pruebas diagnósticas más sencillas. Una de estas alternativas es el análisis automático de señales cardiorrespiratorias. Así, esta tesis doctoral presenta un compendio de cuatro publicaciones que proponen el uso de novedosos métodos de procesado de señal (no lineal, espectral, bispectral, gráficos de recurrencia y wavelet) que permiten caracterizar exhaustivamente el comportamiento del flujo aéreo nocturno de los niños y simplificar el diagnóstico de la apnea obstructiva del sueño pediátrica.Departamento de Teoría de la Señal y Comunicaciones e Ingeniería TelemáticaDoctorado en Tecnologías de la Información y las Telecomunicacione

QUANTIFICATION OF PRETERM INFANT FEEDING COORDINATION: AN ALGORITHMIC APPROACH

Oral feeding competency is a primary requirement for preterm infant hospital release. Currently there is no widely accepted method to objectively measure oral feeding. Feeding consists primarily of the integration of three individual feeding events: sucking, breathing, and swallowing, and the objective of feeding coordination is to minimize aspiration. The purpose of this work was to quantify the infant feeding process from signals obtained during bottle feeding and ultimately develop a measure of feeding coordination. Sucking was measured using a pressure transducer embedded within a modified silicone bottle block. Breathing was measured using a thermistor embedded within nasal cannula, and swallowing was measured through the use of several different piezoelectric sensors. In addition to feeding signals, electrocardiogram (ECG) signals were obtained as an indicator of overall infant behavioral state during feeding. Event detection algorithms for the individual feeding signals were developed and validated, then used for the development of a measurement of feeding coordination. The final suck event detection algorithm was the result of an iterative process that depended on the validity of the signal model. As the model adapted to better represent the data, the accuracy and specificity of the algorithm improved. For the breath signal, however, the primary barrier to effective event detection was significant baseline drift. The frequency components of the baseline drift overlapped significantly with the breath event frequency components, so a time domain solution was developed. Several methods were tested, and it was found that the acceleration vector of the signal provided the most robust representation of the underlying breath signal while minimizing baseline drift. Swallow signal event detection was not possible due to a lack of available data resulting from problems with the consistency of the obtained signal. A robust method was developed for the batch processing of heart rate variability analysis. Finally a method of coordination analysis was developed based on the event detection algorithm outputs. Coordination was measured by determining the percentage of feeding time that consisted of overlapping suck and breath activity

Portable detection of apnea and hypopnea events using bio-impedance of the chest and deep learning

Sleep apnea is one of the most common sleep-related breathing disorders. It is diagnosed through an overnight sleep study in a specialized sleep clinic. This setup is expensive and the number of beds and staff are limited, leading to a long waiting time. To enable more patients to be tested, and repeated monitoring for diagnosed patients, portable sleep monitoring devices are being developed. These devices automatically detect sleep apnea events in one or more respiration-related signals. There are multiple methods to measure respiration, with varying levels of signal quality and comfort for the patient. In this study, the potential of using the bio-impedance (bioZ) of the chest as a respiratory surrogate is analyzed. A novel portable device is presented, combined with a two-phase Long Short-Term Memory (LSTM) deep learning algorithm for automated event detection. The setup is benchmarked using simultaneous recordings of the device and the traditional polysomnography in 25 patients. The results demonstrate that using only the bioZ, an area under the precision-recall curve of 46.9% can be achieved, which is on par with automatic scoring using a polysomnography respiration channel. The sensitivity, specificity and accuracy are 58.4%, 76.2% and 72.8% respectively. This confirms the potential of using the bioZ device and deep learning algorithm for automatically detecting sleep respiration events during the night, in a portable and comfortable setup

Protocol of the SOMNIA project : an observational study to create a neurophysiological database for advanced clinical sleep monitoring

Introduction Polysomnography (PSG) is the primary tool for sleep monitoring and the diagnosis of sleep disorders. Recent advances in signal analysis make it possible to reveal more information from this rich data source. Furthermore, many innovative sleep monitoring techniques are being developed that are less obtrusive, easier to use over long time periods and in the home situation. Here, we describe the methods of the Sleep and Obstructive Sleep Apnoea Monitoring with Non-Invasive Applications (SOMNIA) project, yielding a database combining clinical PSG with advanced unobtrusive sleep monitoring modalities in a large cohort of patients with various sleep disorders. The SOMNIA database will facilitate the validation and assessment of the diagnostic value of the new techniques, as well as the development of additional indices and biomarkers derived from new and/or traditional sleep monitoring methods. Methods and analysis We aim to include at least 2100 subjects (both adults and children) with a variety of sleep disorders who undergo a PSG as part of standard clinical care in a dedicated sleep centre. Full-video PSG will be performed according to the standards of the American Academy of Sleep Medicine. Each recording will be supplemented with one or more new monitoring systems, including wrist-worn photoplethysmography and actigraphy, pressure sensing mattresses, multimicrophone recording of respiratory sounds including snoring, suprasternal pressure monitoring and multielectrode electromyography of the diaphragm

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

Positive airway pressure and electrical stimulation methods for obstructive sleep apnea treatment: a patent review (2005-2014)

Producción CientíficaIntroduction. Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a major health problem with significant negative effects on the health and quality of life. Continuous positive airway pressure (CPAP) is currently the primary treatment option and it is considered the most effective therapy for OSAHS. Nevertheless, comfort issues due to improper fit to patient’s changing needs and breathing gas leakage limit the patient’s adherence to treatment. Areas covered. The present patent review describes recent innovations in the treatment of OSAHS related to optimization of the positive pressure delivered to the patient, methods and systems for continuous self-adjusting pressure during inspiration and expiration phases, and techniques for electrical stimulation of nerves and muscles responsible for the airway patency. Expert opinion. In the last years, CPAP-related inventions have mainly focused on obtaining an optimal self-adjusting pressure according to patient’s needs. Despite intensive research carried out, treatment compliance is still a major issue. Hypoglossal electrical nerve stimulation could be an effective secondary treatment option when CPAP primary therapy fails. Several patents have been granted focused on selective stimulation techniques and parameter optimization of the stimulating pulse waveform. Nevertheless, there remain important issues to address, like effectiveness and adverse events due to improper stimulation.Ministerio de Economía y Competitividad (TEC2011-22987)Junta de Castilla y León (VA059U13