Detection of REM Sleep Behaviour Disorder by Automated Polysomnography Analysis

Evidence suggests Rapid-Eye-Movement (REM) Sleep Behaviour Disorder (RBD) is an early predictor of Parkinson's disease. This study proposes a fully-automated framework for RBD detection consisting of automated sleep staging followed by RBD identification. Analysis was assessed using a limited polysomnography montage from 53 participants with RBD and 53 age-matched healthy controls. Sleep stage classification was achieved using a Random Forest (RF) classifier and 156 features extracted from electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG) channels. For RBD detection, a RF classifier was trained combining established techniques to quantify muscle atonia with additional features that incorporate sleep architecture and the EMG fractal exponent. Automated multi-state sleep staging achieved a 0.62 Cohen's Kappa score. RBD detection accuracy improved by 10% to 96% (compared to individual established metrics) when using manually annotated sleep staging. Accuracy remained high (92%) when using automated sleep staging. This study outperforms established metrics and demonstrates that incorporating sleep architecture and sleep stage transitions can benefit RBD detection. This study also achieved automated sleep staging with a level of accuracy comparable to manual annotation. This study validates a tractable, fully-automated, and sensitive pipeline for RBD identification that could be translated to wearable take-home technology.Comment: 20 pages, 3 figure

A review of automated sleep stage scoring based on physiological signals for the new millennia

Background and Objective: Sleep is an important part of our life. That importance is highlighted by the multitude of health problems which result from sleep disorders. Detecting these sleep disorders requires an accurate interpretation of physiological signals. Prerequisite for this interpretation is an understanding of the way in which sleep stage changes manifest themselves in the signal waveform. With that understanding it is possible to build automated sleep stage scoring systems. Apart from their practical relevance for automating sleep disorder diagnosis, these systems provide a good indication of the amount of sleep stage related information communicated by a specific physiological signal. Methods: This article provides a comprehensive review of automated sleep stage scoring systems, which were created since the year 2000. The systems were developed for Electrocardiogram (ECG), Electroencephalogram (EEG), Electrooculogram (EOG), and a combination of signals. Results: Our review shows that all of these signals contain information for sleep stage scoring. Conclusions: The result is important, because it allows us to shift our research focus away from information extraction methods to systemic improvements, such as patient comfort, redundancy, safety and cost

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

The development and assessment of novel non-invasive methods of measuring sleep in dairy cows : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Animal Science at Massey University, Manawatū, New Zealand

Onet published article in Appendix C was removed for copyright reasons, but may be accessed via its source: Hunter, L.B., O’Connor, C., Haskell, M.J., Langford, F.M., Webster, J.R., & Stafford, K.J. 2021, September. Lying posture does not accurately indicate sleep stage in dairy cows. Applied Animal Behaviour Science, 242, 105427. https://doi.org/10.1016/j.applanim.2021.105427Sleep is important for animal health and welfare and there are many factors, for example, the environment, illness, or stress, that are likely to have an impact on cow sleep and consequently affect their welfare. Polysomnography (PSG) is considered the gold standard for precise identification of sleep stages. It consists of electrophysiological recordings of the brain activity, eye movements and muscle activity but is costly and difficult to use with cows on farm. Accordingly, the study of sleep in cows may be limited due to the impracticability of PSG. Alternative methods of assessing sleep have been developed for humans. Some such work has been conducted for cows, but this has yet to be validated with PSG. The main aim of this thesis was to investigate alternative methods to PSG to accurately detect sleep stages in dairy cows. Specifically, I aimed to develop a detailed 5-stage scoring system for assessing sleep stages from the cow PSG, to investigate the suitability of using lying postures and heart rate (HR) measures to assess sleep stages and to develop a model to accurately predict sleep stages using non-invasive measures in dairy cows compared with PSG. Two studies were conducted using 6 non-lactating dairy cows in an indoor housed environment in Scotland, and outdoors at pasture in New Zealand. PSG was recorded with each cow over a period of seven days. From these data a 5-stage sleep-scoring criteria with good reliability was developed which identified two stages of light sleep, two stages of deep sleep as well as awake and rumination stages. Video was recorded during sleep recordings and the cow’s behaviour was analysed and compared with the scored sleep stages from the PSG. Some sleep stages were found to occur mainly in specific lying postures; however, overall, postures were not useful indicators of sleep stages. Heart rate (HR) and heart rate variability (HRV) were measured using a Polar HR monitor ii and data logging device. Differences in the HR and HRV measures were found between the sleep stages, and the patterns of these changes were similar between both Scottish and NZ cows. Finally, machine learning models were developed using supervised learning methods to predict sleep stage from the HR and HRV measures as well as the surface EMG data recorded during PSG. The models were able to learn to recognize and accurately predict sleep stages compared with the PSG scoring. This research demonstrates that non-invasive alternatives can be used to identify sleep stages accurately in dairy cows compared with PSG. Further research is necessary with larger sample sizes and cows of various breeds and life stages; however, the success of the methods developed during this thesis demonstrates their suitability for the future measurement of sleep in cows and in the assessment of cow welfare

Predicting Subjective Sleep Quality Using Objective Measurements in Older Adults

Humans spend almost a third of their lives asleep. Sleep has a pivotal effect on job performance, memory, fatigue recovery, and both mental and physical health. Sleep quality (SQ) is a subjective experience and reported via patients’ self-reports. Predicting subjective SQ based on objective measurements can enhance diagnosis and treatment of SQ defects, especially in older adults who are subject to poor SQ. In this dissertation, we assessed enhancement of subjective SQ prediction using an easy-to-use E4 wearable device, machine learning techniques and identifying disease-specific risk factors of abnormal SQ in older adults. First, we designed a clinical decision support system to estimate SQ and feeling refreshed after sleep using data extracted from an E4 wearable device. Specifically, we processed four raw physiological signals of heart rate variability (HRV), electrodermal activity, body movement, and skin temperature using distinct signal processing methodologies. Following this, we extracted signal-specific features and selected a subset of the features using recursive feature elimination cross validation strategy to maximize the accuracy of SQ classifiers in predicting the SQ of older caregivers. Second, we investigated discovering more effective features in SQ prediction using HRV features which are not only effortlessly measurable but also can reflect sleep stage transitions and some sleep disorders. Evaluation of two interpretable machine learning methodologies and a convolutional neural network (CNN) methodology demonstrated the CNN outperforms by an accuracy of 0.6 in predicting light, medium, and deep SQ. This outcome verified the capability of using HRV features measurable by easy-to-use wearable devices, in predicting SQ. Finally, we scrutinized daytime sleepiness risk factors as a sign of abnormal SQ from four perspectives: sleep fragmented, sleep propensity, sleep resilience, and non-restorative sleep. The analysis demonstrates distinguishability of the main risk factors of excessive daytime sleepiness (EDS) between patients suffering from fragmented sleep (e.g. apnea) and sleep propensity. We identified the average area under oxygen desaturation curve corresponds to apnea/hypopnea event as a disease-specific risk factor of abnormal SQ. Our further daytime sleepiness prediction demonstrated the significant role of the founded disease-specific risk factor as well

Wearable in-ear pulse oximetry: theory and applications

Wearable health technology, most commonly in the form of the smart watch, is employed by millions of users worldwide. These devices generally exploit photoplethysmography (PPG), the non-invasive use of light to measure blood volume, in order to track physiological metrics such as pulse and respiration. Moreover, PPG is commonly used in hospitals in the form of pulse oximetry, which measures light absorbance by the blood at different wavelengths of light to estimate blood oxygen levels (SpO2). This thesis aims to demonstrate that despite its widespread usage over many decades, this sensor still possesses a wealth of untapped value. Through a combination of advanced signal processing and harnessing the ear as a location for wearable sensing, this thesis introduces several novel high impact applications of in-ear pulse oximetry and photoplethysmography. The aims of this thesis are accomplished through a three pronged approach: rapid detection of hypoxia, tracking of cognitive workload and fatigue, and detection of respiratory disease. By means of the simultaneous recording of in-ear and finger pulse oximetry at rest and during breath hold tests, it was found that in-ear SpO2 responds on average 12.4 seconds faster than the finger SpO2. This is likely due in part to the ear being in close proximity to the brain, making it a priority for oxygenation and thus making wearable in-ear SpO2 a good proxy for core blood oxygen. Next, the low latency of in-ear SpO2 was further exploited in the novel application of classifying cognitive workload. It was found that in-ear pulse oximetry was able to robustly detect tiny decreases in blood oxygen during increased cognitive workload, likely caused by increased brain metabolism. This thesis demonstrates that in-ear SpO2 can be used to accurately distinguish between different levels of an N-back memory task, representing different levels of mental effort. This concept was further validated through its application to gaming and then extended to the detection of driver related fatigue. It was found that features derived from SpO2 and PPG were predictive of absolute steering wheel angle, which acts as a proxy for fatigue. The strength of in-ear PPG for the monitoring of respiration was investigated with respect to the finger, with the conclusion that in-ear PPG exhibits far stronger respiration induced intensity variations and pulse amplitude variations than the finger. All three respiratory modes were harnessed through multivariate empirical mode decomposition (MEMD) to produce spirometry-like respiratory waveforms from PPG. It was discovered that these PPG derived respiratory waveforms can be used to detect obstruction to breathing, both through a novel apparatus for the simulation of breathing disorders and through the classification of chronic obstructive pulmonary disease (COPD) in the real world. This thesis establishes in-ear pulse oximetry as a wearable technology with the potential for immense societal impact, with applications from the classification of cognitive workload and the prediction of driver fatigue, through to the detection of chronic obstructive pulmonary disease. The experiments and analysis in this thesis conclusively demonstrate that widely used pulse oximetry and photoplethysmography possess a wealth of untapped value, in essence teaching the old PPG sensor new tricks.Open Acces

Automatic neonatal sleep stage classification:A comparative study

Sleep is an essential feature of living beings. For neonates, it is vital for their mental and physical development. Sleep stage cycling is an important parameter to assess neonatal brain and physical development. Therefore, it is crucial to administer newborn's sleep in the neonatal intensive care unit (NICU). Currently, Polysomnography (PSG) is used as a gold standard method for classifying neonatal sleep patterns, but it is expensive and requires a lot of human involvement. Over the last two decades, multiple researchers are working on automatic sleep stage classification algorithms using electroencephalography (EEG), electrocardiography (ECG), and video. In this study, we present a comprehensive review of existing algorithms for neonatal sleep, their limitations and future recommendations. Additionally, a brief comparison of the extracted features, classification algorithms and evaluation parameters is reported in the proposed study

Physiological Approach To Characterize Drowsiness In Simulated Flight Operations During Window Of Circadian Low

Drowsiness is a psycho-physiological transition from awake towards falling sleep and its detection is crucial in aviation industries. It is a common cause for pilot’s error due to unpredictable work hours, longer flight periods, circadian disruption, and insufficient sleep. The pilots’ are prone towards higher level of drowsiness during window of circadian low (2:00 am- 6:00 am). Airplanes require complex operations and lack of alertness increases accidents. Aviation accidents are much disastrous and early drowsiness detection helps to reduce such accidents. This thesis studied physiological signals during drowsiness from 18 commercially-rated pilots in flight simulator. The major aim of the study was to observe the feasibility of physiological signals to predict drowsiness. In chapter 3, the spectral behavior of electroencephalogram (EEG) was studied via power spectral density and coherence. The delta power reduced and alpha power increased significantly (

Machine learning algorithms development for sleep cycles detection and general physical activity based on biosignals

In this work, machine learning algorithms for automatic sleep cycles detection were developed. The features were selected based on the AASM manual, which is considered the gold standard for human technicians. These include features such as saturation of peripheral oxygen or others related to heart rate variation. As normally, the sleep phases naturally differ in frequency, to balance the classes within the dataset, we either oversampled the least common sleep stages or undersampled the most common, allowing for a less skewed performance favouring the most represented stages, while simultaneously improving worst-stage classification. For training the models we used MESA, a database containing 2056 full overnight unattended polysomnographies from a group of 2237 participants. With the goal of developing an algorithm that would only require a PPG device to be able to accurately predict sleep stages and quality, the main channels used from this dataset were SpO2 and PPG. Employing several popular Python libraries used for the development of machine learning and deep learning algorithms, we exhaustively explored the optimisation of the manifold parameters and hyperparameters conditioning both the training and architecture of these models in order for them to better fit our purposes. As a result of these strategies, we were able to develop a neural network model (Multilayer perceptron) with 80.50% accuracy, 0.7586 Cohen’s kappa, and 77.38% F1- score, for five sleep stages. The performance of our algorithm does not seem to be correlated with sleep quality or the number of transitional epochs in each recording, suggesting uniform performance regardless of the presence of sleep disorders. To test its performance in a different real-world scenario we compared the classifications attributed by a popular sleep stage classification android app, which collected information using a smartwatch, and our algorithm, using signals obtained from a device developed by PLUX. These algorithms displayed a strong level of agreement (90.96% agreement, 0.8663 Cohen’s kappa).Neste trabalho, foram desenvolvidos algoritmos de aprendizagem de máquinas para a detecção automática de ciclos de sono. Os sinais específicos captados durante a extração de características foram selecionados com base no manual AASM, que é considerado o padrão-ouro para técnicos. Estas incluem características como a saturação do oxigénio periférico ou outras relacionadas com a variação do ritmo cardíaco. A fim de equilibrar a frequência das classes dentro do conjunto de dados, ora se fez a sobreamostragem das fases menos comuns do sono, ora se fez a subamostragem das mais comuns, permitindo um desempenho menos enviesado em favor das fases mais representadas e, simultaneamente, melhorando a classificação das fases com pior desempenho. Para o treino dos modelos criados, utilizámos MESA, uma base de dados contendo 2056 polissonografias completas, feitas durante a noite e sem vigilância, de um grupo de 2237 participantes. Do conjunto de dados escolhido, os principais canais utilizados foram SpO2 e PPG, com o objetivo de desenvolver um algoritmo que apenas exigiria um dispositivo PPG para poder prever com precisão as fases e a qualidade do sono. Utilizando várias bibliotecas populares de Python para o desenvolvimento de algoritmos de aprendizagem de máquinas e de aprendizagem profunda, explorámos exaustivamente a optimização dos múltiplos parâmetros e hiperparâmetros que tanto condicionam a formação como a arquitetura destes modelos, de modo a que se ajustem melhor aos nossos propósitos. Como resultado disto, fomos capazes de desenvolver um modelo de rede neural (Multilayer perceptron) com 80.50% de precisão, 0.7586 kappa de Cohen e F1-score de 77.38%, para cinco fases de sono. O desempenho do nosso algoritmo não parece estar correlacionado com a qualidade do sono ou o número de épocas de transição em cada gravação, sugerindo um desempenho uniforme independentemente da presença de distúrbios do sono. Para testar o seu desempenho num cenário de mundo real diferente, comparámos as classificações atribuídas por uma aplicação Android de classificação de fases do sono popular, através da recolha de informação por um smartwatch, e o nosso algoritmo, utilizando sinais obtidos a partir de um dispositivo desenvolvido pela PLUX. Estes algoritmos demonstraram um forte nível de concordância (90.96% de concordância, 0.8663 kappa de Cohen)