Automated Sleep Apnea Detection in Raw Respiratory Signals Using Long Short-Term Memory Neural Networks

Sleep apnea is one of the most common sleep disorders and the consequences of undiagnosed sleep apnea can be very severe, ranging from increased blood pressure to heart failure. However, many people are often unaware of their condition. The gold standard for diagnosing sleep apnea is an overnight polysomnography in a dedicated sleep laboratory. Yet, these tests are expensive and beds are limited as trained staff needs to analyze the entire recording. An automated detection method would allow a faster diagnosis and more patients to be analyzed. Most algorithms for automated sleep apnea detection use a set of human-engineered features, potentially missing important sleep apnea markers. In this paper, we present an algorithm based on state-of-the-art deep learning models for automatically extracting features and detecting sleep apnea events in respiratory signals. The algorithm is evaluated on the Sleep-Heart-Health-Study-1 dataset and provides per-epoch sensitivity and specificity scores comparable to the state of the art. Furthermore, when these predictions are mapped to the apnea–hypopnea index, a considerable improvement in per-patient scoring is achieved over conventional methods. This paper presents a powerful aid for trained staff to quickly diagnose sleep apnea.

[1]  Irena Koprinska,et al.  Sleep Apnea Event Detection from Nasal Airflow Using Convolutional Neural Networks , 2017, ICONIP.

[2]  Patrick E. McSharry,et al.  Advanced Methods And Tools for ECG Data Analysis , 2006 .

[3]  W C Dement,et al.  The sleep apnea syndromes. , 1976, Annual review of medicine.

[4]  Carla E. Brodley,et al.  Class Imbalance, Redux , 2011, 2011 IEEE 11th International Conference on Data Mining.

[5]  Qi Cheng,et al.  Cardiorespiratory Model-Based Data-Driven Approach for Sleep Apnea Detection , 2018, IEEE Journal of Biomedical and Health Informatics.

[6]  Jürgen Schmidhuber,et al.  Long Short-Term Memory , 1997, Neural Computation.

[7]  S. Su,et al.  Classification methods to detect sleep apnea in adults based on respiratory and oximetry signals: a systematic review , 2018, Physiological measurement.

[8]  Weichao Zhao,et al.  Identifying sleep apnea syndrome using heart rate and breathing effort variation analysis based on ballistocardiography. , 2015, Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference.

[9]  M. Preisig,et al.  Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. , 2015, The Lancet. Respiratory medicine.

[10]  Dimitris Kanellopoulos,et al.  Handling imbalanced datasets: A review , 2006 .

[11]  Meir Kryger,et al.  Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. , 2004, Sleep.

[12]  P. de Chazal,et al.  Automatic classification of sleep apnea epochs using the electrocardiogram , 2000, Computers in Cardiology 2000. Vol.27 (Cat. 00CH37163).

[13]  M. H. Asyali,et al.  Sleep stage and obstructive apneaic epoch classification using single-lead ECG , 2010, Biomedical engineering online.

[14]  Tom Dhaene,et al.  Systematic Comparison of Respiratory Signals for the Automated Detection of Sleep Apnea , 2018, 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[15]  J. Concato,et al.  Obstructive sleep apnea as a risk factor for stroke and death. , 2005, The New England journal of medicine.

[16]  Ravi Narasimhan,et al.  Detection of sleep apnea on a per-second basis using respiratory signals , 2013, 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[17]  Feng Jiang,et al.  Recurrent Neural Network Based Classification of ECG Signal Features for Obstruction of Sleep Apnea Detection , 2017, 22017 IEEE International Conference on Computational Science and Engineering (CSE) and IEEE International Conference on Embedded and Ubiquitous Computing (EUC).

[18]  J. Victor Marcos,et al.  Assessment of four statistical pattern recognition techniques to assist in obstructive sleep apnoea diagnosis from nocturnal oximetry. , 2009, Medical engineering & physics.

[19]  K. P. Soman,et al.  Instantaneous heart rate as a robust feature for sleep apnea severity detection using deep learning , 2017, 2017 IEEE EMBS International Conference on Biomedical & Health Informatics (BHI).

[20]  Daniel Álvarez,et al.  Evaluation of Machine-Learning Approaches to Estimate Sleep Apnea Severity From At-Home Oximetry Recordings , 2019, IEEE Journal of Biomedical and Health Informatics.

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

[22]  Thomas Penzel,et al.  A Review of Obstructive Sleep Apnea Detection Approaches , 2019, IEEE Journal of Biomedical and Health Informatics.

[23]  Adelaide M. Arruda-Olson,et al.  Sleep Apnea and Cardiovascular Disease , 2003, Herz.

[24]  Quoc V. Le,et al.  Semi-supervised Sequence Learning , 2015, NIPS.

[25]  Atul Malhotra,et al.  Agreement in computer-assisted manual scoring of polysomnograms across sleep centers. , 2013, Sleep.

[26]  Eric Achten,et al.  Automated Assessment of Bone Age Using Deep Learning and Gaussian Process Regression , 2018, 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[27]  D. Hettrick,et al.  Bioimpedance in Cardiovascular Medicine , 2006 .

[28]  Donald R. Jones,et al.  Efficient Global Optimization of Expensive Black-Box Functions , 1998, J. Glob. Optim..

[29]  Hlaing Minn,et al.  Apnea MedAssist: Real-time Sleep Apnea Monitor Using Single-Lead ECG , 2011, IEEE Transactions on Information Technology in Biomedicine.

[30]  Matthew D. Zeiler ADADELTA: An Adaptive Learning Rate Method , 2012, ArXiv.

[31]  Nitish Srivastava,et al.  Dropout: a simple way to prevent neural networks from overfitting , 2014, J. Mach. Learn. Res..

[32]  Leo Breiman,et al.  Random Forests , 2001, Machine Learning.

[33]  T. Al-Ani,et al.  Long Short-Term Memory for apnea detection based on Heart Rate Variability , 2008, 2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[34]  Bessam Abdulrazak,et al.  Nonintrusive Vital Signs Monitoring for Sleep Apnea Patients: A Preliminary Study , 2018, IEEE Access.

[35]  J. Victor Marcos,et al.  Linear and nonlinear analysis of airflow recordings to help in sleep apnoea–hypopnoea syndrome diagnosis , 2012, Physiological measurement.

[36]  A. Chesson,et al.  The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Techinical Specifications , 2007 .

[37]  Xi Zhang,et al.  An Obstructive Sleep Apnea Detection Approach Using a Discriminative Hidden Markov Model From ECG Signals , 2016, IEEE Transactions on Biomedical Engineering.

[38]  Zoltán Benyó,et al.  A novel method for the detection of apnea and hypopnea events in respiration signals , 2002, IEEE Transactions on Biomedical Engineering.

[39]  V. Somers,et al.  Sympathetic activity in obese subjects with and without obstructive sleep apnea. , 1998, Circulation.

[40]  N. Collop Scoring variability between polysomnography technologists in different sleep laboratories. , 2002, Sleep medicine.

[41]  Giuseppe De Pietro,et al.  An Automatic Rules Extraction Approach to Support OSA Events Detection in an mHealth System , 2014, IEEE Journal of Biomedical and Health Informatics.

[42]  J. Samet,et al.  The Sleep Heart Health Study: design, rationale, and methods. , 1997, Sleep.

[43]  Haibo He,et al.  Learning from Imbalanced Data , 2009, IEEE Transactions on Knowledge and Data Engineering.

[44]  Charles Elkan,et al.  Learning to Diagnose with LSTM Recurrent Neural Networks , 2015, ICLR.

[45]  Filip De Turck,et al.  Accurate prediction of blood culture outcome in the intensive care unit using long short-term memory neural networks , 2019, Artif. Intell. Medicine.

[46]  G. Moody,et al.  Clinical Validation of the ECG-Derived Respiration (EDR) Technique , 2008 .

[47]  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.

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

[49]  V. Somers,et al.  Sympathetic nerve activity in obstructive sleep apnoea. , 2003, Acta physiologica Scandinavica.

[50]  D. Dey,et al.  Real-Time Adaptive Apnea and Hypopnea Event Detection Methodology for Portable Sleep Apnea Monitoring Devices , 2013, IEEE Transactions on Biomedical Engineering.

[51]  A. Akobeng,et al.  Understanding diagnostic tests 3: receiver operating characteristic curves , 2007, Acta paediatrica.

[52]  Jasper Snoek,et al.  Practical Bayesian Optimization of Machine Learning Algorithms , 2012, NIPS.

[53]  Ahmet Akbaş,et al.  Sleep apnea classification based on respiration signals by using ensemble methods. , 2015, Bio-medical materials and engineering.

[54]  Helena Chmura Kraemer,et al.  Measurement error in visually scored electrophysiological data: respiration during sleep , 1984, Journal of Neuroscience Methods.