Electroencephalography (EEG) allows monitoring of brain activity, providing insights into the functional dynamics of various brain regions and their roles in cognitive processes. EEG is a cornerstone in sleep research, serving as the primary modality of polysomnography, the gold standard in the field. However, EEG signals are prone to artifacts caused by both internal (device-specific) factors and external (environmental) interferences. As sleep studies are becoming larger, most rely on automatic sleep staging, a process highly susceptible to artifacts, leading to erroneous sleep scores. This paper addresses this challenge by introducing eegFloss, an open-source Python package to utilize eegUsability, a novel machine learning (ML) model designed to detect segments with artifacts in sleep EEG recordings. eegUsability has been trained and evaluated on manually artifact-labeled EEG data collected from 15 participants over 127 nights using the Zmax headband. It demonstrates solid overall classification performance (F1-score is approximately 0.85, Cohens kappa is 0.78), achieving a high recall rate of approximately 94% in identifying channel-wise usable EEG data, and extends beyond Zmax. Additionally, eegFloss offers features such as automatic time-in-bed detection using another ML model named eegMobility, filtering out certain artifacts, and generating hypnograms and sleep statistics. By addressing a fundamental challenge faced by most sleep studies, eegFloss can enhance the precision and rigor of their analysis as well as the accuracy and reliability of their outcomes.
Despite advances in deep learning for automatic sleep staging, clinical adoption remains limited due to challenges in fair model evaluation, generalization across diverse datasets, model bias, and variability in human annotations. We present SLEEPYLAND, an open-source sleep staging evaluation framework designed to address these barriers. It includes more than 220'000 hours in-domain (ID) sleep recordings, and more than 84'000 hours out-of-domain (OOD) sleep recordings, spanning a broad range of ages, sleep-wake disorders, and hardware setups. We release pre-trained models based on high-performing SoA architectures and evaluate them under standardized conditions across single- and multi-channel EEG/EOG configurations. We introduce SOMNUS, an ensemble combining models across architectures and channel setups via soft voting. SOMNUS achieves robust performance across twenty-four different datasets, with macro-F1 scores between 68.7% and 87.2%, outperforming individual models in 94.9% of cases. Notably, SOMNUS surpasses previous SoA methods, even including cases where compared models were trained ID while SOMNUS treated the same data as OOD. Using a subset of the BSWR (N=6'633), we quantify model biases linked to age, gender, AHI, and PLMI, showing that while ensemble improves robustness, no model architecture consistently minimizes bias in performance and clinical markers estimation. In evaluations on OOD multi-annotated datasets (DOD-H, DOD-O), SOMNUS exceeds the best human scorer, i.e., MF1 85.2% vs 80.8% on DOD-H, and 80.2% vs 75.9% on DOD-O, better reproducing the scorer consensus than any individual expert (k = 0.89/0.85 and ACS = 0.95/0.94 for healthy/OSA cohorts). Finally, we introduce ensemble disagreement metrics - entropy and inter-model divergence based - predicting regions of scorer disagreement with ROC AUCs up to 0.828, offering a data-driven proxy for human uncertainty.
Distribution shift poses a significant challenge in machine learning, particularly in biomedical applications using data collected across different subjects, institutions, and recording devices, such as sleep data. While existing normalization layers, BatchNorm, LayerNorm and InstanceNorm, help mitigate distribution shifts, when applied over the time dimension they ignore the dependencies and auto-correlation inherent to the vector coefficients they normalize. In this paper, we propose PSDNorm that leverages Monge mapping and temporal context to normalize feature maps in deep learning models for signals. Notably, the proposed method operates as a test-time domain adaptation technique, addressing distribution shifts without additional training. Evaluations with architectures based on U-Net or transformer backbones trained on 10K subjects across 10 datasets, show that PSDNorm achieves state-of-the-art performance on unseen left-out datasets while being 4-times more data-efficient than BatchNorm.
Automation of sleep analysis, including both macrostructural (sleep stages) and microstructural (e.g., sleep spindles) elements, promises to enable large-scale sleep studies and to reduce variance due to inter-rater incongruencies. While individual steps, such as sleep staging and spindle detection, have been studied separately, the feasibility of automating multi-step sleep analysis remains unclear. Here, we evaluate whether a fully automated analysis using state-of-the-art machine learning models for sleep staging (RobustSleepNet) and subsequent spindle detection (SUMOv2) can replicate findings from an expert-based study of bipolar disorder. The automated analysis qualitatively reproduced key findings from the expert-based study, including significant differences in fast spindle densities between bipolar patients and healthy controls, accomplishing in minutes what previously took months to complete manually. While the results of the automated analysis differed quantitatively from the expert-based study, possibly due to biases between expert raters or between raters and the models, the models individually performed at or above inter-rater agreement for both sleep staging and spindle detection. Our results demonstrate that fully automated approaches have the potential to facilitate large-scale sleep research. We are providing public access to the tools used in our automated analysis by sharing our code and introducing SomnoBot, a privacy-preserving sleep analysis platform.
Gold-standard sleep scoring is based on epoch-based assignment of sleep stages based on a combination of EEG, EOG and EMG signals. However, a polysomnographic recording consists of many other signals that could be used for sleep staging, including cardio-respiratory modalities. Leveraging this signal variety would offer important advantages, for example increasing reliability, resilience to signal loss, and application to long-term non-obtrusive recordings. We developed a deep generative model for automatic sleep staging from a plurality of sensors and any -- arbitrary -- combination thereof. We trained a score-based diffusion model using a dataset of 1947 expert-labelled overnight recordings with 36 different signals, and achieved zero-shot inference on any sensor set by leveraging a novel Bayesian factorization of the score function across the sensors. On single-channel EEG, the model reaches the performance limit in terms of polysomnography inter-rater agreement (5-class accuracy 85.6%, Cohen's kappa 0.791). Moreover, the method offers full flexibility to use any sensor set, for example finger photoplethysmography, nasal flow and thoracic respiratory movements, (5-class accuracy 79.0%, Cohen's kappa of 0.697), or even derivations very unconventional for sleep staging, such as tibialis and sternocleidomastoid EMG (5-class accuracy 71.0%, kappa 0.575). Additionally, we propose a novel interpretability metric in terms of information gain per sensor and show this is linearly correlated with classification performance. Finally, our model allows for post-hoc addition of entirely new sensor modalities by merely training a score estimator on the novel input instead of having to retrain from scratch on all inputs.
Polysomnography (PSG) signals are essential for studying sleep processes and diagnosing sleep disorders. Analyzing PSG data through deep neural networks (DNNs) for automated sleep monitoring has become increasingly feasible. However, the limited availability of datasets for certain sleep events often leads to DNNs focusing on a single task with a single-sourced training dataset. As a result, these models struggle to transfer to new sleep events and lack robustness when applied to new datasets. To address these challenges, we propose PSG-MAE, a mask autoencoder (MAE) based pre-training framework. By performing self-supervised learning on a large volume of unlabeled PSG data, PSG-MAE develops a robust feature extraction network that can be broadly applied to various sleep event monitoring tasks. Unlike conventional MAEs, PSG-MAE generates complementary masks across PSG channels, integrates a multichannel signal reconstruction method, and employs a self-supervised inter-channel contrastive learning (ICCL) strategy. This approach enables the encoder to capture temporal features from each channel while simultaneously learning latent relationships between channels, thereby enhancing the utilization of multichannel information. Experimental results show that PSG-MAE effectively captures both temporal details and inter-channel information from PSG signals. When the encoder pre-trained through PSG-MAE is fine-tuned with downstream feature decomposition networks, it achieves an accuracy of 83.7% for sleep staging and 90.45% for detecting obstructive sleep apnea, which highlights the framework's robustness and broad applicability.
Manual scoring of polysomnography (PSG) is a time intensive task, prone to inter scorer variability that can impact diagnostic reliability. This study investigates the integration of decision support systems (DSS) into PSG scoring workflows, focusing on their effects on accuracy, scoring time, and potential biases toward recommendations from artificial intelligence (AI) compared to human generated recommendations. Using a novel online scoring platform, we conducted a repeated measures study with sleep technologists, who scored traditional and self applied PSGs. Participants were occasionally presented with recommendations labeled as either human or AI generated. We found that traditional PSGs tended to be scored slightly more accurately than self applied PSGs, but this difference was not statistically significant. Correct recommendations significantly improved scoring accuracy for both PSG types, while incorrect recommendations reduced accuracy. No significant bias was observed toward or against AI generated recommendations compared to human generated recommendations. These findings highlight the potential of AI to enhance PSG scoring reliability. However, ensuring the accuracy of AI outputs is critical to maximizing its benefits. Future research should explore the long term impacts of DSS on scoring workflows and strategies for integrating AI in clinical practice.
Sleep is an essential component of human physiology, contributing significantly to overall health and quality of life. Accurate sleep staging and disorder detection are crucial for assessing sleep quality. Studies in the literature have proposed PSG-based approaches and machine-learning methods utilizing single-modality signals. However, existing methods often lack multimodal, multilabel frameworks and address sleep stages and disorders classification separately. In this paper, we propose a 1D-Vision Transformer for simultaneous classification of sleep stages and sleep disorders. Our method exploits the sleep disorders' correlation with specific sleep stage patterns and performs a simultaneous identification of a sleep stage and sleep disorder. The model is trained and tested using multimodal-multilabel sensory data (including photoplethysmogram, respiratory flow, and respiratory effort signals). The proposed method shows an overall accuracy (cohen's Kappa) of 78% (0.66) for five-stage sleep classification and 74% (0.58) for sleep apnea classification. Moreover, we analyzed the encoder attention weights to clarify our models' predictions and investigate the influence different features have on the models' outputs. The result shows that identified patterns, such as respiratory troughs and peaks, make a higher contribution to the final classification process.
This paper introduces a lightweight vision transformer aimed at automatic sleep staging in a wearable device. The model is trained on the MASS SS3 dataset and achieves an accuracy of 82.9% on a 4-stage classification task with only 31.6k weights. The model is implemented in hardware and synthesized in 65nm CMOS. The accelerator consumes 6.54mW of dynamic power and 11.0mW of leakage power over 45.6ms. Using aggressive power gating while the accelerator is idle, it is calculated that the effective power consumption is 0.56mW. The accelerator uses only 0.754mm2 of silicon and has a clock frequency of 379MHz. These metrics are possible thanks to a layer-dependent fixed-point format and data width and a window average filter on the final softmax layer of the vision transformer.
Sleep staging is a key method for assessing sleep quality and diagnosing sleep disorders. However, current deep learning methods face challenges: 1) postfusion techniques ignore the varying contributions of different modalities; 2) unprocessed sleep data can interfere with frequency-domain information. To tackle these issues, this paper proposes a gated multimodal temporal neural network for multidomain sleep data, including heart rate, motion, steps, EEG (Fpz-Cz, Pz-Oz), and EOG from WristHR-Motion-Sleep and SleepEDF-78. The model integrates: 1) a pre-processing module for feature alignment, missing value handling, and EEG de-trending; 2) a feature extraction module for complex sleep features in the time dimension; and 3) a dynamic fusion module for real-time modality weighting.Experiments show classification accuracies of 85.03% on SleepEDF-78 and 94.54% on WristHR-Motion-Sleep datasets. The model handles heterogeneous datasets and outperforms state-of-the-art models by 1.00%-4.00%.
Objective: The aim of the study is to develop a novel method for improved diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) in clinical or home settings, with the focus on achieving diagnostic performance comparable to the gold-standard polysomnography (PSG) with significantly reduced monitoring burden. Methods: We propose a method using millimeter-wave radar and pulse oximeter for OSAHS diagnosis (ROSA). It contains a sleep apnea-hypopnea events (SAE) detection network, which directly predicts the temporal localization of SAE, and a sleep staging network, which predicts the sleep stages throughout the night, based on radar signals. It also fuses oxygen saturation (SpO2) information from the pulse oximeter to adjust the score of SAE detected by radar. Results: Experimental results on a real-world dataset (>800 hours of overnight recordings, 100 subjects) demonstrated high agreement (ICC=0.9870) on apnea-hypopnea index (AHI) between ROSA and PSG. ROSA also exhibited excellent diagnostic performance, exceeding 90% in accuracy across AHI diagnostic thresholds of 5, 15 and 30 events/h. Conclusion: ROSA improves diagnostic accuracy by fusing millimeter-wave radar and pulse oximeter data. It provides a reliable and low-burden solution for OSAHS diagnosis. Significance: ROSA addresses the limitations of high complexity and monitoring burden associated with traditional PSG. The high accuracy and low burden of ROSA show its potential to improve the accessibility of OSAHS diagnosis among population.
Automatic sleep staging based on electroencephalography (EEG) and electromyography (EMG) signals is an important aspect of sleep-related research. Current sleep staging methods suffer from two major drawbacks. First, there are limited information interactions between modalities in the existing methods. Second, current methods do not develop unified models that can handle different sources of input. To address these issues, we propose a novel sleep stage scoring model sDREAMER, which emphasizes cross-modality interaction and per-channel performance. Specifically, we develop a mixture-of-modality-expert (MoME) model with three pathways for EEG, EMG, and mixed signals with partially shared weights. We further propose a self-distillation training scheme for further information interaction across modalities. Our model is trained with multi-channel inputs and can make classifications on either single-channel or multi-channel inputs. Experiments demonstrate that our model outperforms the existing transformer-based sleep scoring methods for multi-channel inference. For single-channel inference, our model also outperforms the transformer-based models trained with single-channel signals.
Large language models (LLMs) exhibit remarkable capabilities in visual inspection of medical time-series data, achieving proficiency comparable to human clinicians. However, their broad scope limits domain-specific precision, and proprietary weights hinder fine-tuning for specialized datasets. In contrast, small specialized models (SSMs) excel in targeted tasks but lack the contextual reasoning required for complex clinical decision-making. To address these challenges, we propose ConMIL (Conformalized Multiple Instance Learning), a decision-support SSM that integrates seamlessly with LLMs. By using Multiple Instance Learning (MIL) to identify clinically significant signal segments and conformal prediction for calibrated set-valued outputs, ConMIL enhances LLMs' interpretative capabilities for medical time-series analysis. Experimental results demonstrate that ConMIL significantly improves the performance of state-of-the-art LLMs, such as ChatGPT4.0 and Qwen2-VL-7B. Specifically, \ConMIL{}-supported Qwen2-VL-7B achieves 94.92% and 96.82% precision for confident samples in arrhythmia detection and sleep staging, compared to standalone LLM accuracy of 46.13% and 13.16%. These findings highlight the potential of ConMIL to bridge task-specific precision and broader contextual reasoning, enabling more reliable and interpretable AI-driven clinical decision support.
In practical sleep stage classification, a key challenge is the variability of EEG data across different subjects and environments. Differences in physiology, age, health status, and recording conditions can lead to domain shifts between data. These domain shifts often result in decreased model accuracy and reliability, particularly when the model is applied to new data with characteristics different from those it was originally trained on, which is a typical manifestation of negative transfer. To address this, we propose SelectiveFinetuning in this paper. Our method utilizes a pretrained Multi Resolution Convolutional Neural Network (MRCNN) to extract EEG features, capturing the distinctive characteristics of different sleep stages. To mitigate the effect of domain shifts, we introduce a domain aligning mechanism that employs Earth Mover Distance (EMD) to evaluate and select source domain data closely matching the target domain. By finetuning the model with selective source data, our SelectiveFinetuning enhances the model's performance on target domain that exhibits domain shifts compared to the data used for training. Experimental results show that our method outperforms existing baselines, offering greater robustness and adaptability in practical scenarios where data distributions are often unpredictable.
Study Objectives: We investigate Mamba-based deep learning approaches for sleep staging on signals from ANNE One (Sibel Health, Evanston, IL), a non-intrusive dual-module wireless wearable system measuring chest electrocardiography (ECG), accelerometry, and temperature, and finger photoplethysmography (PPG) and temperature. Methods: We obtained wearable sensor recordings from 360 adults undergoing concurrent polysomnography (PSG) at a tertiary care sleep lab. Each PSG recording was manually scored and these annotations served as ground truth labels for training and evaluation of our models. PSG and wearable sensor data were automatically aligned using their ECG channels with manual confirmation by visual inspection. We trained Mamba-based models with convolutional-recurrent neural network (CRNN) and the recurrent neural network (RNN) architectures on these recordings. Ensembling of model variants with similar architectures was performed. Results: Our best approach, after ensembling, attains a 3-class (wake, non rapid eye movement [NREM] sleep, rapid eye movement [REM] sleep) balanced accuracy of 84.02%, F1 score of 84.23%, Cohen's $\kappa$ of 72.89%, and a Matthews correlation coefficient (MCC) score of 73.00%; a 4-class (wake, NREM stage 1/2 [N1/N2], NREM stage 3 [N3], REM) balanced accuracy of 75.30%, F1 score of 74.10%, Cohen's $\kappa$ of 61.51%, and MCC score of 61.95%; a 5-class (wake, N1, N2, N3, REM) balanced accuracy of 65.11%, F1 score of 66.15%, Cohen's $\kappa$ of 53.23%, MCC score of 54.38%. Conclusions: Deep learning models can infer major sleep stages from the ANNE One, a wearable system without electroencephalography (EEG), and can be successfully applied to data from adults attending a tertiary care sleep clinic.
The non-stationary nature of electroencephalography (EEG) introduces distribution shifts across domains (e.g., days and subjects), posing a significant challenge to EEG-based neurotechnology generalization. Without labeled calibration data for target domains, the problem is a source-free unsupervised domain adaptation (SFUDA) problem. For scenarios with constant label distribution, Riemannian geometry-aware statistical alignment frameworks on the symmetric positive definite (SPD) manifold are considered state-of-the-art. However, many practical scenarios, including EEG-based sleep staging, exhibit label shifts. Here, we propose a geometric deep learning framework for SFUDA problems under specific distribution shifts, including label shifts. We introduce a novel, realistic generative model and show that prior Riemannian statistical alignment methods on the SPD manifold can compensate for specific marginal and conditional distribution shifts but hurt generalization under label shifts. As a remedy, we propose a parameter-efficient manifold optimization strategy termed SPDIM. SPDIM uses the information maximization principle to learn a single SPD-manifold-constrained parameter per target domain. In simulations, we demonstrate that SPDIM can compensate for the shifts under our generative model. Moreover, using public EEG-based brain-computer interface and sleep staging datasets, we show that SPDIM outperforms prior approaches.
Sleep staging is a challenging task, typically manually performed by sleep technologists based on electroencephalogram and other biosignals of patients taken during overnight sleep studies. Recent work aims to leverage automated algorithms to perform sleep staging not based on electroencephalogram signals, but rather based on the airflow signals of subjects. Prior work uses ideas from topological data analysis (TDA), specifically Hermite function expansions of persistence curves (HEPC) to featurize airflow signals. However, finite order HEPC captures only partial information. In this work, we propose Fourier approximations of persistence curves (FAPC), and use this technique to perform sleep staging based on airflow signals. We analyze performance using an XGBoost model on 1155 pediatric sleep studies taken from the Nationwide Children's Hospital Sleep DataBank (NCHSDB), and find that FAPC methods provide complimentary information to HEPC methods alone, leading to a 4.9% increase in performance over baseline methods.
In this paper, we address the challenges in automatic sleep stage classification, particularly the high computational cost, inadequate modeling of bidirectional temporal dependencies, and class imbalance issues faced by Transformer-based models. To address these limitations, we propose BiT-MamSleep, a novel architecture that integrates the Triple-Resolution CNN (TRCNN) for efficient multi-scale feature extraction with the Bidirectional Mamba (BiMamba) mechanism, which models both short- and long-term temporal dependencies through bidirectional processing of EEG data. Additionally, BiT-MamSleep incorporates an Adaptive Feature Recalibration (AFR) module and a temporal enhancement block to dynamically refine feature importance, optimizing classification accuracy without increasing computational complexity. To further improve robustness, we apply optimization techniques such as Focal Loss and SMOTE to mitigate class imbalance. Extensive experiments on four public datasets demonstrate that BiT-MamSleep significantly outperforms state-of-the-art methods, particularly in handling long EEG sequences and addressing class imbalance, leading to more accurate and scalable sleep stage classification.
Sleep monitoring plays a crucial role in maintaining good health, with sleep staging serving as an essential metric in the monitoring process. Traditional methods, utilizing medical sensors like EEG and ECG, can be effective but often present challenges such as unnatural user experience, complex deployment, and high costs. Ballistocardiography~(BCG), a type of piezoelectric sensor signal, offers a non-invasive, user-friendly, and easily deployable alternative for long-term home monitoring. However, reliable BCG-based sleep staging is challenging due to the limited sleep monitoring data available for BCG. A restricted training dataset prevents the model from generalization across populations. Additionally, transferring to BCG faces difficulty ensuring model robustness when migrating from other data sources. To address these issues, we introduce SleepNetZero, a zero-shot learning based approach for sleep staging. To tackle the generalization challenge, we propose a series of BCG feature extraction methods that align BCG components with corresponding respiratory, cardiac, and movement channels in PSG. This allows models to be trained on large-scale PSG datasets that are diverse in population. For the migration challenge, we employ data augmentation techniques, significantly enhancing generalizability. We conducted extensive training and testing on large datasets~(12393 records from 9637 different subjects), achieving an accuracy of 0.803 and a Cohen's Kappa of 0.718. ZeroSleepNet was also deployed in real prototype~(monitoring pads) and tested in actual hospital settings~(265 users), demonstrating an accuracy of 0.697 and a Cohen's Kappa of 0.589. To the best of our knowledge, this work represents the first known reliable BCG-based sleep staging effort and marks a significant step towards in-home health monitoring.
Study Objectives: To evaluate the agreement between the millimeter-wave radar-based device and polysomnography (PSG) in diagnosis of obstructive sleep apnea (OSA) and classification of sleep stage in children. Methods: 281 children, aged 1 to 18 years, who underwent sleep monitoring between September and November 2023 at the Sleep Center of Beijing Children's Hospital, Capital Medical University, were recruited in the study. All enrolled children underwent sleep monitoring by PSG and the millimeter-wave radar-based device, QSA600, simultaneously. QSA600 recordings were automatically analyzed using a deep learning model meanwhile the PSG data was manually scored. Results: The Obstructive Apnea-Hypopnea Index (OAHI) obtained from QSA600 and PSG demonstrates a high level of agreement with an intraclass correlation coefficient of 0.945 (95% CI: 0.93 to 0.96). Bland-Altman analysis indicates that the mean difference of OAHI between QSA600 and PSG is -0.10 events/h (95% CI: -11.15 to 10.96). The deep learning model evaluated through cross-validation showed good sensitivity (81.8%, 84.3% and 89.7%) and specificity (90.5%, 95.3% and 97.1%) values for diagnosing children with OAHI>1, OAHI>5 and OAHI>10. The area under the receiver operating characteristic curve is 0.923, 0.955 and 0.988, respectively. For sleep stage classification, the model achieved Kappa coefficients of 0.854, 0.781, and 0.734, with corresponding overall accuracies of 95.0%, 84.8%, and 79.7% for Wake-sleep classification, Wake-REM-Light-Deep classification, and Wake-REM-N1-N2 N3 classification, respectively. Conclusions: QSA600 has demonstrated high agreement with PSG in diagnosing OSA and performing sleep staging in children. The device is portable, low-load and suitable for follow up and long-term pediatric sleep assessment.