Design of a multimodal database for research on automatic detection of severe apnoea cases

The aim of this paper is to present the design of a multimodal database suitable for research on new possibilities for automatic diagnosis of patients with severe obstructive sleep apnoea (OSA). Early detection of severe apnoea cases can be very useful to give priority to their early treatment optimizing the expensive and time-consuming tests of current diagnosis methods based on full overnight sleep in a hospital. This work is part of an on-going collaborative project between medical and signal processing groups towards the design of a multimodal database as an innovative resource to promote new research efforts on automatic OSA diagnosis through speech and image processing technologies. In this contribution we present the multimodal design criteria derived from the analysis of specific voice properties related to OSA physiological effects as well as from the morphological facial characteristics in apnoea patients. Details on the database structure and data collection methodology are also given as it is intended to be an open resource to promote further research in this field. Finally, preliminary experimental results on automatic OSA voice assessment are presented for the collected speech data in our OSA multimodal database. Standard GMM speaker recognition techniques obtain an overall correct classification rate of 82%. This represents an initial promising result underlining the interest of this research framework and opening further perspectives for improvement using more specific speech and image recognition technologies

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

Sensor Fusion using Backward Shortcut Connections for Sleep Apnea Detection in Multi-Modal Data

Sleep apnea is a common respiratory disorder characterized by breathing pauses during the night. Consequences of untreated sleep apnea can be severe. Still, many people remain undiagnosed due to shortages of hospital beds and trained sleep technicians. To assist in the diagnosis process, automated detection methods are being developed. Recent works have demonstrated that deep learning models can extract useful information from raw respiratory data and that such models can be used as a robust sleep apnea detector. However, trained sleep technicians take into account multiple sensor signals when annotating sleep recordings instead of relying on a single respiratory estimate. To improve the predictive performance and reliability of the models, early and late sensor fusion methods are explored in this work. In addition, a novel late sensor fusion method is proposed which uses backward shortcut connections to improve the learning of the first stages of the models. The performance of these fusion methods is analyzed using CNN as well as LSTM deep learning base-models. The results demonstrate a significant and consistent improvement in predictive performance over the single sensor methods and over the other explored sensor fusion methods, by using the proposed sensor fusion method with backward shortcut connections.Comment: Paper presented at ML4H (Machine Learning for Health) workshop at NeurIPS 2019. https://ml4health.github.io/2019

Influence of photoplethysmogram signal quality on pulse arrival time during polysomnography

Intervals of low-quality photoplethysmogram (PPG) signals might lead to significant inaccuracies in estimation of pulse arrival time (PAT) during polysomnography (PSG) studies. While PSG is considered to be a “gold standard” test for diagnosing obstructive sleep apnea (OSA), it also enables tracking apnea-related nocturnal blood pressure fluctuations correlated with PAT. Since the electrocardiogram (ECG) is recorded synchronously with the PPG during PSG, it makes sense to use the ECG signal for PPG signal-quality assessment. (1) Objective: to develop a PPG signal-quality assessment algorithm for robust PAT estimation, and investigate the influence of signal quality on PAT during various sleep stages and events such as OSA. (2) Approach: the proposed algorithm uses R and T waves from the ECG to determine approximate locations of PPG pulse onsets. The MESA database of 2055 PSG recordings was used for this study. (3) Results: the proportions of high-quality PPG were significantly lower in apnea-related oxygen desaturation (matched-pairs rc = 0.88 and rc = 0.97, compared to OSA and hypopnea, respectively, when p < 0.001) and arousal (rc = 0.93 and rc = 0.98, when p < 0.001) than in apnea events. The significantly large effect size of interquartile ranges of PAT distributions was between low- and high-quality PPG (p < 0.001, rc = 0.98), and regular and irregular pulse waves (p < 0.001, rc = 0.74), whereas a lower quality of the PPG signal was found to be associated with a higher interquartile range of PAT across all subjects. Suggested PPG signal quality-based PAT evaluation reduced deviations (e.g., rc = 0.97, rc = 0.97, rc = 0.99 in hypopnea, oxygen desaturation, and arousal stages, respectively, when p < 0.001) and allowed obtaining statistically larger differences between different sleep stages and events. (4) Significance: the implemented algorithm has the potential to increase the robustness of PAT estimation in PSG studies related to nocturnal blood pressure monitoring

GMM-based classifiers for the automatic detection of obstructive sleep apnea

The aim of automatic pathological voice detection systems is to serve as tools, to medical specialists, for a more objective, less invasive and improved diagnosis of diseases. In this respect, the gold standard for those system include the usage of a optimized representation of the spectral envelope, either based on cepstral coefficients from the mel-scaled Fourier spectral envelope (Mel-Frequency Cepstral Coefficients) or from an all-pole estimation (Linear Prediction Coding Cepstral Coefficients) forcharacterization, and Gaussian Mixture Models for posterior classification. However, the study of recently proposed GMM-based classifiers as well as Nuisance mitigation techniques, such as those employed in speaker recognition, has not been widely considered inpathology detection labours. The present work aims at testing whether or not the employment of such speaker recognition tools might contribute to improve system performance in pathology detection systems, specifically in the automatic detection of Obstructive Sleep Apnea. The testing procedure employs an Obstructive Sleep Apnea database, in conjunction with GMM-based classifiers looking for a better performance. The results show that an improved performance might be obtained by using such approach