Robust, automated sleep scoring by a compact neural network with distributional shift correction.

Studying the biology of sleep requires the accurate assessment of the state of experimental subjects, and manual analysis of relevant data is a major bottleneck. Recently, deep learning applied to electroencephalogram and electromyogram data has shown great promise as a sleep scoring method, approaching the limits of inter-rater reliability. As with any machine learning algorithm, the inputs to a sleep scoring classifier are typically standardized in order to remove distributional shift caused by variability in the signal collection process. However, in scientific data, experimental manipulations introduce variability that should not be removed. For example, in sleep scoring, the fraction of time spent in each arousal state can vary between control and experimental subjects. We introduce a standardization method, mixture z-scoring, that preserves this crucial form of distributional shift. Using both a simulated experiment and mouse in vivo data, we demonstrate that a common standardization method used by state-of-the-art sleep scoring algorithms introduces systematic bias, but that mixture z-scoring does not. We present a free, open-source user interface that uses a compact neural network and mixture z-scoring to allow for rapid sleep scoring with accuracy that compares well to contemporary methods. This work provides a set of computational tools for the robust automation of sleep scoring

U-Sleep's resilience to AASM guidelines

AASM guidelines are the result of decades of efforts aiming at standardizing sleep scoring procedure, with the final goal of sharing a worldwide common methodology. The guidelines cover several aspects from the technical/digital specifications,e.g., recommended EEG derivations, to detailed sleep scoring rules accordingly to age. Automated sleep scoring systems have always largely exploited the standards as fundamental guidelines. In this context, deep learning has demonstrated better performance compared to classical machine learning. Our present work shows that a deep learning based sleep scoring algorithm may not need to fully exploit the clinical knowledge or to strictly adhere to the AASM guidelines. Specifically, we demonstrate that U-Sleep, a state-of-the-art sleep scoring algorithm, can be strong enough to solve the scoring task even using clinically non-recommended or non-conventional derivations, and with no need to exploit information about the chronological age of the subjects. We finally strengthen a well-known finding that using data from multiple data centers always results in a better performing model compared with training on a single cohort. Indeed, we show that this latter statement is still valid even by increasing the size and the heterogeneity of the single data cohort. In all our experiments we used 28528 polysomnography studies from 13 different clinical studies

Automated Sleep Scoring, Deep Learning and Physician Supervision

Sleep plays a crucial role in human well-being. Polysomnography is used in sleep medicine as a diagnostic tool, so as to objectively analyze the quality of sleep. Sleep scoring is the procedure of extracting sleep cycle information from the whole-night electrophysiological signals. The scoring is done worldwide by the sleep physicians according to the official American Academy of Sleep Medicine (AASM) scoring manual. In the last decades, a wide variety of deep learning based algorithms have been proposed to automatise the sleep scoring task. In this thesis we study the reasons why these algorithms fail to be introduced in the daily clinical routine, with the perspective of bridging the existing gap between the automatic sleep scoring models and the sleep physicians. In this light, the primary step is the design of a simplified sleep scoring architecture, also providing an estimate of the model uncertainty. Beside achieving results on par with most up-to-date scoring systems, we demonstrate the efficiency of ensemble learning based algorithms, together with label smoothing techniques, in both enhancing the performance and calibrating the simplified scoring model. We introduced an uncertainty estimate procedure, so as to identify the most challenging sleep stage predictions, and to quantify the disagreement between the predictions given by the model and the annotation given by the physicians. In this thesis we also propose a novel method to integrate the inter-scorer variability into the training procedure of a sleep scoring model. We clearly show that a deep learning model is able to encode this variability, so as to better adapt to the consensus of a group of scorers-physicians. We finally address the generalization ability of a deep learning based sleep scoring system, further studying its resilience to the sleep complexity and to the AASM scoring rules. We can state that there is no need to train the algorithm strictly following the AASM guidelines. Most importantly, using data from multiple data centers results in a better performing model compared with training on a single data cohort. The variability among different scorers and data centers needs to be taken into account, more than the variability among sleep disorders

Sleep monitoring using ear-centered setups: Investigating the influence from electrode configurations.

Modern sleep monitoring development is shifting towards the use of unobtrusive sensors combined with algorithms for automatic sleep scoring. Many different combinations of wet and dry electrodes, ear-centered, forehead-mounted or headband-inspired designs have been proposed, alongside an ever growing variety of machine learning algorithms for automatic sleep scoring. OBJECTIVE: Among candidate positions, those in the facial area and around the ears have the benefit of being relatively hairless, and in our view deserve extra attention. In this paper, we seek to determine the limits to sleep monitoring quality within this spatial constraint. METHODS: We compare 13 different, realistic sensor setups derived from the same data set and analysed with the same pipeline. RESULTS: All setups which include both a lateral and an EOG derivation show similar, state-of-the-art performance, with average Cohen's kappa values of at least 0.80. CONCLUSION: If large electrode distances are used, positioning is not critical for achieving large sleep-related signal-to-noise-ratio, and hence accurate sleep scoring. SIGNIFICANCE: We argue that with the current competitive performance of automated staging approaches, there is a need for establishing an improved benchmark beyond current single human rater scoring

A Multi Constrained Transformer-BiLSTM Guided Network for Automated Sleep Stage Classification from Single-Channel EEG

Sleep stage classification from electroencephalogram (EEG) is significant for the rapid evaluation of sleeping patterns and quality. A novel deep learning architecture, ``DenseRTSleep-II'', is proposed for automatic sleep scoring from single-channel EEG signals. The architecture utilizes the advantages of Convolutional Neural Network (CNN), transformer network, and Bidirectional Long Short Term Memory (BiLSTM) for effective sleep scoring. Moreover, with the addition of a weighted multi-loss scheme, this model is trained more implicitly for vigorous decision-making tasks. Thus, the model generates the most efficient result in the SleepEDFx dataset and outperforms different state-of-the-art (IIT-Net, DeepSleepNet) techniques by a large margin in terms of accuracy, precision, and F1-score

SleePyCo: Automatic Sleep Scoring with Feature Pyramid and Contrastive Learning

Automatic sleep scoring is essential for the diagnosis and treatment of sleep disorders and enables longitudinal sleep tracking in home environments. Conventionally, learning-based automatic sleep scoring on single-channel electroencephalogram (EEG) is actively studied because obtaining multi-channel signals during sleep is difficult. However, learning representation from raw EEG signals is challenging owing to the following issues: 1) sleep-related EEG patterns occur on different temporal and frequency scales and 2) sleep stages share similar EEG patterns. To address these issues, we propose a deep learning framework named SleePyCo that incorporates 1) a feature pyramid and 2) supervised contrastive learning for automatic sleep scoring. For the feature pyramid, we propose a backbone network named SleePyCo-backbone to consider multiple feature sequences on different temporal and frequency scales. Supervised contrastive learning allows the network to extract class discriminative features by minimizing the distance between intra-class features and simultaneously maximizing that between inter-class features. Comparative analyses on four public datasets demonstrate that SleePyCo consistently outperforms existing frameworks based on single-channel EEG. Extensive ablation experiments show that SleePyCo exhibits enhanced overall performance, with significant improvements in discrimination between the N1 and rapid eye movement (REM) stages.Comment: 14 pages, 3 figures, 8 table

STQS:Interpretable multi-modal Spatial-Temporal-seQuential model for automatic Sleep scoring

Sleep scoring is an important step for the detection of sleep disorders and usually performed by visual analysis. Since manual sleep scoring is time consuming, machine-learning based approaches have been proposed. Though efficient, these algorithms are black-box in nature and difficult to interpret by clinicians. In this paper, we propose a deep learning architecture for multi-modal sleep scoring, investigate the model's decision making process, and compare the model's reasoning with the annotation guidelines in the AASM manual. Our architecture, called STQS, uses convolutional neural networks (CNN) to automatically extract spatio-temporal features from 3 modalities (EEG, EOG and EMG), a bidirectional long short-term memory (Bi-LSTM) to extract sequential information, and residual connections to combine spatio-temporal and sequential features. We evaluated our model on two large datasets, obtaining an accuracy of 85% and 77% and a macro F1 score of 79% and 73% on SHHS and an in-house dataset, respectively. We further quantify the contribution of various architectural components and conclude that adding LSTM layers improves performance over a spatio-temporal CNN, while adding residual connections does not. Our interpretability results show that the output of the model is well aligned with AASM guidelines, and therefore, the model's decisions correspond to domain knowledge. We also compare multi-modal models and single-channel models and suggest that future research should focus on improving multi-modal models

Automatic sleep staging of EEG signals: recent development, challenges, and future directions.

Modern deep learning holds a great potential to transform clinical studies of human sleep. Teaching a machine to carry out routine tasks would be a tremendous reduction in workload for clinicians. Sleep staging, a fundamental step in sleep practice, is a suitable task for this and will be the focus in this article. Recently, automatic sleep-staging systems have been trained to mimic manual scoring, leading to similar performance to human sleep experts, at least on scoring of healthy subjects. Despite tremendous progress, we have not seen automatic sleep scoring adopted widely in clinical environments. This review aims to provide the shared view of the authors on the most recent state-of-the-art developments in automatic sleep staging, the challenges that still need to be addressed, and the future directions needed for automatic sleep scoring to achieve clinical value