Automated Prediction of the Apnea-Hypopnea Index from Nocturnal Oximetry Recordings

Nocturnal polysomnography (PSG) is the gold-standard for sleep apnea-hypopnea syndrome (SAHS) diagnosis. It provides the value of the apnea-hypopnea index (AHI), which is used to evaluate SAHS severity. However, PSG is costly, complex, and time-consuming. We present a novel approach for automatic estimation of the AHI from nocturnal oxygen saturation (SaO2) recordings and the results of an assessment study designed to characterize its performance. A set of 240 SaO2 signals was available for the assessment study. The data were divided into training (96 signals) and test (144 signals) sets for model optimization and validation, respectively. Fourteen time-domain and frequency-domain features were used to quantify the effect of SAHS on SaO2 recordings. Regression analysis was performed to estimate the functional relationship between the extracted features and the AHI. Multiple linear regression (MLR) and multilayer perceptron (MLP) neural networks were evaluated. The MLP algorithm achieved the highest performance with an intraclass correlation coefficient (ICC) of 0.91. The proposed MLP-based method could be used as an accurate and cost-effective procedure for SAHS diagnosis in the absence of PSG.

[1]  T. Young,et al.  Epidemiology of obstructive sleep apnea: a population health perspective. , 2002, American journal of respiratory and critical care medicine.

[2]  D. Navajas,et al.  Accuracy of thermistors and thermocouples as flow-measuring devices for detecting hypopnoeas. , 1998, The European respiratory journal.

[3]  C. Heneghan,et al.  Multimodal detection of sleep apnoea using electrocardiogram and oximetry signals , 2009, Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences.

[4]  W A Whitelaw,et al.  Automated analysis of digital oximetry in the diagnosis of obstructive sleep apnoea , 2000, Thorax.

[5]  Roberto Hornero,et al.  Radial basis function classifiers to help in the diagnosis of the obstructive sleep apnoea syndrome from nocturnal oximetry , 2008, Medical & Biological Engineering & Computing.

[6]  W. M. Anderson,et al.  Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. , 2007, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[7]  W. Flemons,et al.  Access to diagnosis and treatment of patients with suspected sleep apnea. , 2004, American journal of respiratory and critical care medicine.

[8]  Heekuck Oh,et al.  Neural Networks for Pattern Recognition , 1993, Adv. Comput..

[9]  D. Shucard,et al.  Validity of neural network in sleep apnea. , 1999, Sleep.

[10]  Thomas Penzel,et al.  Sleep Apnea Screening by Autoregressive Models From a Single ECG Lead , 2009, IEEE Transactions on Biomedical Engineering.

[11]  A. Rechtschaffen A manual of standardized terminology, techniques and scoring system for sleep of human subjects , 1968 .

[12]  Martin Fodslette Møller,et al.  A scaled conjugate gradient algorithm for fast supervised learning , 1993, Neural Networks.

[13]  D. S. Morillo,et al.  Poincaré analysis of an overnight arterial oxygen saturation signal applied to the diagnosis of sleep apnea hypopnea syndrome , 2009, Physiological measurement.

[14]  J. Fleiss,et al.  Intraclass correlations: uses in assessing rater reliability. , 1979, Psychological bulletin.

[15]  P. Welch The use of fast Fourier transform for the estimation of power spectra: A method based on time averaging over short, modified periodograms , 1967 .

[16]  Roberto Hornero,et al.  Utility of multilayer perceptron neural network classifiers in the diagnosis of the obstructive sleep apnoea syndrome from nocturnal oximetry , 2008, Comput. Methods Programs Biomed..

[17]  D. Kristo,et al.  Overnight pulse oximetry for sleep-disordered breathing in adults: a review. , 2001, Chest.

[18]  Roberto Hornero,et al.  Utility of Approximate Entropy From Overnight Pulse Oximetry Data in the Diagnosis of the Obstructive Sleep Apnea Syndrome , 2007, IEEE Transactions on Biomedical Engineering.

[19]  Roberto Hornero,et al.  Multivariate Analysis of Blood Oxygen Saturation Recordings in Obstructive Sleep Apnea Diagnosis , 2010, IEEE Transactions on Biomedical Engineering.

[20]  Roberto Hornero,et al.  Automated detection of obstructive sleep apnoea syndrome from oxygen saturation recordings using linear discriminant analysis , 2010, Medical & Biological Engineering & Computing.

[21]  Abraham Lempel,et al.  On the Complexity of Finite Sequences , 1976, IEEE Trans. Inf. Theory.

[22]  Nicolas Roche,et al.  Prospective testing of two models based on clinical and oximetric variables for prediction of obstructive sleep apnea. , 2002, Chest.

[23]  D. L. Hudson,et al.  Applying continuous chaotic modeling to cardiac signal analysis , 1996 .

[24]  B. Grant,et al.  Prediction of the apnea-hypopnea index from overnight pulse oximetry. , 2003, Chest.

[25]  L. Hang,et al.  Comparison of the indices of oxyhemoglobin saturation by pulse oximetry in obstructive sleep apnea hypopnea syndrome. , 2009, Chest.

[26]  Ian T. Nabney,et al.  Netlab: Algorithms for Pattern Recognition , 2002 .

[27]  Christopher M. Bishop,et al.  Neural networks for pattern recognition , 1995 .

[28]  W. Kinnear,et al.  Sleep on the cheap: the role of overnight oximetry in the diagnosis of sleep apnoea hypopnoea syndrome , 1999, Thorax.

[29]  J. Haze,et al.  Obstructive sleep apnea. , 1987, Cranio : the journal of craniomandibular practice.

[30]  D. Abásolo,et al.  Nonlinear characteristics of blood oxygen saturation from nocturnal oximetry for obstructive sleep apnoea detection , 2006, Physiological measurement.

[31]  F. Kianifard Applied Multivariate Data Analysis, Volume I: Regression and Experimental Design , 1992 .

[32]  J. Jobson Applied Multivariate Data Analysis , 1995 .

[33]  J. R. Parker,et al.  Rank and response combination from confusion matrix data , 2001, Inf. Fusion.

[34]  S. Hyakin,et al.  Neural Networks: A Comprehensive Foundation , 1994 .

[35]  T. Young,et al.  Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. , 1997, Sleep.

[36]  Don D. Sin,et al.  Getting the Most Out of Nocturnal Pulse Oximetry , 2003 .

[37]  V. Somers,et al.  Cardiopulmonary Consequences of Obstructive Sleep Apnea , 2005, Seminars in respiratory and critical care medicine.

[38]  Jose R. Rodriguez,et al.  Utility of oxygen saturation and heart rate spectral analysis obtained from pulse oximetric recordings in the diagnosis of sleep apnea syndrome. , 2003, Chest.

[39]  Kurt Hornik,et al.  Approximation capabilities of multilayer feedforward networks , 1991, Neural Networks.

[40]  K. Ferguson,et al.  Neural network prediction of obstructive sleep apnea from clinical criteria. , 1999, Chest.

[41]  E. Wolpert A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. , 1969 .

[42]  Steven M. Pincus Assessing Serial Irregularity and Its Implications for Health , 2001, Annals of the New York Academy of Sciences.