In clinical, manually scoring by technician is the major method for sleep arousal detection. This method is time-consuming and subjective. This study aimed to achieve an end-to-end sleep-arousal events detection by constructing a convolutional neural network based on multi-scale convolutional layers and self-attention mechanism, and using 1 min single-channel electroencephalogram (EEG) signals as its input. Compared with the performance of the baseline model, the results of the proposed method showed that the mean area under the precision-recall curve and area under the receiver operating characteristic were both improved by 7%. Furthermore, we also compared the effects of single modality and multi-modality on the performance of the proposed model. The results revealed the power of single-channel EEG signals in automatic sleep arousal detection. However, the simple combination of multi-modality signals may be counterproductive to the improvement of model performance. Finally, we also explored the scalability of the proposed model and transferred the model into the automated sleep staging task in the same dataset. The average accuracy of 73% also suggested the power of the proposed method in task transferring. This study provides a potential solution for the development of portable sleep monitoring and paves a way for the automatic sleep data analysis using the transfer learning method.
Sleep ; Sleep Stages ; Arousal ; Data Analysis ; Electroencephalography

Polysomnography (PSG) monitoring is an important method for clinical diagnosis of diseases such as insomnia, apnea and so on. In order to solve the problem of time-consuming and energy-consuming sleep stage staging of sleep disorder patients using manual frame-by-frame visual judgment PSG, this study proposed a deep learning algorithm model combining convolutional neural networks (CNN) and bidirectional gate recurrent neural networks (Bi GRU). A dynamic sparse self-attention mechanism was designed to solve the problem that gated recurrent neural networks (GRU) is difficult to obtain accurate vector representation of long-distance information. This study collected 143 overnight PSG data of patients from Shanghai Mental Health Center with sleep disorders, which were combined with 153 overnight PSG data of patients from the open-source dataset, and selected 9 electrophysiological channel signals including 6 electroencephalogram (EEG) signal channels, 2 electrooculogram (EOG) signal channels and a single mandibular electromyogram (EMG) signal channel. These data were used for model training, testing and evaluation. After cross validation, the accuracy was (84.0±2.0)%, and Cohen's kappa value was 0.77±0.50. It showed better performance than the Cohen's kappa value of physician score of 0.75±0.11. The experimental results show that the algorithm model in this paper has a high staging effect in different populations and is widely applicable. It is of great significance to assist clinicians in rapid and large-scale PSG sleep automatic staging.
Humans ; Polysomnography ; China ; Sleep Stages ; Sleep ; Algorithms

The method of using deep learning technology to realize automatic sleep staging needs a lot of data support, and its computational complexity is also high. In this paper, an automatic sleep staging method based on power spectral density (PSD) and random forest is proposed. Firstly, the PSDs of six characteristic waves (K complex wave, δ wave, θ wave, α wave, spindle wave, β wave) in electroencephalogram (EEG) signals were extracted as the classification features, and then five sleep states (W, N1, N2, N3, REM) were automatically classified by random forest classifier. The whole night sleep EEG data of healthy subjects in the Sleep-EDF database were used as experimental data. The effects of using different EEG signals (Fpz-Cz single channel, Pz-Oz single channel, Fpz-Cz + Pz-Oz dual channel), different classifiers (random forest, adaptive boost, gradient boost, Gaussian naïve Bayes, decision tree, K-nearest neighbor), and different training and test set divisions (2-fold cross-validation, 5-fold cross-validation, 10-fold cross-validation, single subject) on the classification effect were compared. The experimental results showed that the effect was the best when the input was Pz-Oz single-channel EEG signal and the random forest classifier was used, no matter how the training set and test set were transformed, the classification accuracy was above 90.79%. The overall classification accuracy, macro average F1 value, and Kappa coefficient could reach 91.94%, 73.2% and 0.845 respectively at the highest, which proved that this method was effective and not susceptible to data volume, and had good stability. Compared with the existing research, our method is more accurate and simpler, and is suitable for automation.
Humans ; Random Forest ; Bayes Theorem ; Sleep Stages ; Sleep ; Electroencephalography/methods*

The existing automatic sleep staging algorithms have the problems of too many model parameters and long training time, which in turn results in poor sleep staging efficiency. Using a single channel electroencephalogram (EEG) signal, this paper proposed an automatic sleep staging algorithm for stochastic depth residual networks based on transfer learning (TL-SDResNet). Firstly, a total of 30 single-channel (Fpz-Cz) EEG signals from 16 individuals were selected, and after preserving the effective sleep segments, the raw EEG signals were pre-processed using Butterworth filter and continuous wavelet transform to obtain two-dimensional images containing its time-frequency joint features as the input data for the staging model. Then, a ResNet50 pre-trained model trained on a publicly available dataset, the sleep database extension stored in European data format (Sleep-EDFx) was constructed, using a stochastic depth strategy and modifying the output layer to optimize the model structure. Finally, transfer learning was applied to the human sleep process throughout the night. The algorithm in this paper achieved a model staging accuracy of 87.95% after conducting several experiments. Experiments show that TL-SDResNet50 can accomplish fast training of a small amount of EEG data, and the overall effect is better than other staging algorithms and classical algorithms in recent years, which has certain practical value.
Humans ; Sleep Stages ; Algorithms ; Sleep ; Wavelet Analysis ; Electroencephalography/methods* ; Machine Learning

Sleep staging is the basis for solving sleep problems. There's an upper limit for the classification accuracy of sleep staging models based on single-channel electroencephalogram (EEG) data and features. To address this problem, this paper proposed an automatic sleep staging model that mixes deep convolutional neural network (DCNN) and bi-directional long short-term memory network (BiLSTM). The model used DCNN to automatically learn the time-frequency domain features of EEG signals, and used BiLSTM to extract the temporal features between the data, fully exploiting the feature information contained in the data to improve the accuracy of automatic sleep staging. At the same time, noise reduction techniques and adaptive synthetic sampling were used to reduce the impact of signal noise and unbalanced data sets on model performance. In this paper, experiments were conducted using the Sleep-European Data Format Database Expanded and the Shanghai Mental Health Center Sleep Database, and achieved an overall accuracy rate of 86.9% and 88.9% respectively. When compared with the basic network model, all the experimental results outperformed the basic network, further demonstrating the validity of this paper's model, which can provide a reference for the construction of a home sleep monitoring system based on single-channel EEG signals.
China ; Sleep Stages ; Sleep ; Electroencephalography ; Databases, Factual

Sleep stage classification is a necessary fundamental method for the diagnosis of sleep diseases, which has attracted extensive attention in recent years. Traditional methods for sleep stage classification, such as manual marking methods and machine learning algorithms, have the limitations of low efficiency and defective generalization. Recently, deep neural networks have shown improved results by the capability of learning complex pattern in the sleep data. However, these models ignore the intra-temporal sequential information and the correlation among all channels in each segment of the sleep data. To solve these problems, a hybrid attention temporal sequential network model is proposed in this paper, choosing recurrent neural network to replace traditional convolutional neural network, and extracting temporal features of polysomnography from the perspective of time. Furthermore, intra-temporal attention mechanism and channel attention mechanism are adopted to achieve the fusion of the intra-temporal representation and the fusion of channel-correlated representation. And then, based on recurrent neural network and inter-temporal attention mechanism, this model further realized the fusion of inter-temporal contextual representation. Finally, the end-to-end automatic sleep stage classification is accomplished according to the above hybrid representation. This paper evaluates the proposed model based on two public benchmark sleep datasets downloaded from open-source website, which include a number of polysomnography. Experimental results show that the proposed model could achieve better performance compared with ten state-of-the-art baselines. The overall accuracy of sleep stage classification could reach 0.801, 0.801 and 0.717, respectively. Meanwhile, the macro average F1-scores of the proposed model could reach 0.752, 0.728 and 0.700. All experimental results could demonstrate the effectiveness of the proposed model.
Electroencephalography ; Neural Networks, Computer ; Polysomnography ; Sleep ; Sleep Stages

Objective: To investigate theaccuracy of artificial intelligence sleep staging model in patients with habitual snoring and obstructive sleep apnea hypopnea syndrome (OSAHS) based on single-channel EEG collected from different locations of the head. Methods: The clinical data of 114 adults with habitual snoring and OSAHS who visited to the Sleep Medicine Center of Beijing Tongren Hospital from September 2020 to March of 2021 were analyzed retrospectively, including 93 males and 21 females, aging from 20 to 64 years old. Eighty-five adults with OSAHS and 29 subjects with habitual snoring were included. Sleep staging analysis was performed on the single lead EEG signals of different locations (FP2-M1, C4-M1, F3-M2, ROG-M1, O1-M2) using the deep learning segmentation model trained by previous data. Manual scoring results were used as the gold standard to analyze the consistency rate of results and the influence of different categories of disease. Results: EEG data in 124 747 30-second epochs were taken as the testing dataset. The model accuracy of distinguishing wake/sleep was 92.3%,92.6%,93.5%,89.2% and 83.0% respectively,based on EEG channel Fp2-M1, C4-M1, F3-M2, REOG-M1 or O1-M2. The mode accuracy of distinguishing wake/REM/NREM and wake/REM/N1-2/SWS , was 84.7% and 80.1% respectively based on channel Fp2-M1, which located in forehead skin. The AHI calculated based on total sleep time derived from the model and gold standard were 13.6[4.30,42.5] and 14.2[4.8,42.7], respectively (Z=-2.477, P=0.013), and the kappa coefficient was 0.977. Conclusions: The autonomic sleep staging via a deep neural network model based on forehead single-channel EEG (Fp2-M1) has a good consistency in the identification sleep stage in a population with habitual snoring and OSAHS with different categories. The AHI calculated based on this model has high consistency with manual scoring.
Adult ; Artificial Intelligence ; Electroencephalography ; Female ; Humans ; Male ; Middle Aged ; Neural Networks, Computer ; Retrospective Studies ; Sleep ; Sleep Stages ; Young Adult

With progress in sensors and communication technologies, the range of sleep monitoring is extending from professional clinics into our usual home environments. Information from conventional overnight polysomnographic recordings can be derived from much simpler devices and methods. The gold standard of sleep monitoring is laboratory polysomnography, which classifi es brain states based mainly on EEGs. Single-channel EEGs have been used for sleep stage scoring with accuracies of 84.9%. Actigraphy can estimate sleep effi ciency with an accuracy of 86.0%. Sleep scoring based on respiratory dynamics provides accuracies of 89.2% and 70.9% for identifying sleep stages and sleep effi ciency, respectively, and a correlation coeffi cient of 0.94 for apnea–hypopnea detection. Modulation of autonomic balance during the sleep stages are well recognized and widely used for simpler sleep scoring and sleep parameter estimation. This modulation can be recorded by several types of cardiovascular measurements, including ECG, PPG, BCG, and PAT, and the results showed accuracies up to 96.5% and 92.5% for sleep effi ciency and OSA severity detection, respectively. Instead of using recordings for the entire night, less than 5 min ECG recordings have used for sleep effi ciency and AHI estimation and resulted in high correlations of 0.94 and 0.99, respectively. These methods are based on their own models that relate sleep dynamics with a limited number of biological signals. Parameters representing sleep quality and disturbed breathing are estimated with high accuracies that are close to the results obtained by polysomnography. These unconstrained technologies, making sleep monitoring easier and simpler, will enhance qualities of life by expanding the range of ubiquitous healthcare.
Actigraphy ; Brain ; Delivery of Health Care ; Electrocardiography ; Electroencephalography ; Mycobacterium bovis ; Polysomnography ; Respiration ; Sleep Stages

OBJECTIVES.: To investigate the apnea-hypopnea index (AHI) according to the sleep stage in more detail after control of posture. METHODS.: Patients who underwent nocturnal polysomnography between December 2007 and July 2018 were retrospectively evaluated. Inclusion criteria were as follows: age >18 years, sleep efficacy >80%, and patients who underwent polysomnography only in the supine position (100% of the time). Patients were classified into different groups according to the methods: the first, rapid eye movement (REM)-dominant group (AHIREM/AHINREM >2), non-rapid eye movement (NREM)-dominant group (AHINREM/AHIREM >2), and non-dominant group; and the second, light sleep group (AHIN1N2>AHISWS) and slow wave sleep (SWS) group (AHISWS>AHIN1N2). RESULTS.: A total of 234 patients (mean age, 47.4±13.9 years) were included in the study. There were 108 patients (46.2%) in the REM-dominant group, 88 (37.6%) in the non-dominant group, and 38 (16.2%) in the NREM-dominant group. The AHI was significantly higher in the NREM-dominant group than in the REM-dominant group (32.9±22.9 events/hr vs. 18.3±9.5 events/hr, respectively). There were improvements in the AHI from stage 1 to SWS in NREM sleep with the highest level in REM sleep. A higher AHISWS than AHIN1N2 was found in 16 of 234 patients (6.8%); however, there were no significant predictors of these unexpected results except AHI. CONCLUSION.: Our results demonstrated the highest AHI during REM sleep stage in total participants after control of posture. However, there were 16.2% of patients showed NREM-dominant pattern (AHINREM/AHIREM >2) and 6.8% of patients showed higher AHISWS than AHIN1N2. Therefore, each group might have a different pathophysiology of obstructive sleep apnea (OSA), and we need to consider this point when we treat the patients with OSA.
Eye Movements ; Humans ; Polysomnography ; Posture ; Retrospective Studies ; Sleep Apnea, Obstructive ; Sleep Stages ; Sleep, REM ; Supine Position

PURPOSE: To determine if self-administered transcutaneous tibial nerve stimulation (TTNS) is a feasible treatment option for neurogenic bladder among people with spinal cord injury (SCI) who utilize intermittent catheterization for bladder management. METHODS: Four-week observational trial in chronic SCI subjects performing intermittent catheterization with incontinence episodes using TTNS at home daily for 30 minutes. Those using anticholinergic bladder medications were given a weaning schedule to begin at week 2. Primary outcomes were compliance and satisfaction. Secondary outcomes included change in bladder medications, efficacy based on bladder diary, adverse events, and incontinence quality of life (I-QoL) survey.
Appointments and Schedules ; Catheterization ; Catheters ; Compliance ; Humans ; Mouth ; Quality of Life ; Sleep Stages ; Spinal Cord Injuries ; Spinal Cord ; Tibial Nerve ; Transcutaneous Electric Nerve Stimulation ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urodynamics ; Weaning