Automated detection of sleep apnea in infants: A multi-modal approach

This study explores the use and applicability of two minimally invasive sensors, electrocardiogram (ECG) and pulse oximetry, in addressing the high costs and difficulty associated with the early detection of sleep apnea hypopnea syndrome in infants. An existing dataset of 396 scored overnight polysomnography recordings were used to train and test a linear discriminants classifier. The dataset contained data from healthy infants, infants diagnosed with sleep apnea, infants with siblings who had died from sudden infant death syndrome (SIDS) and pre-term infants. Features were extracted from the ECG and pulse-oximetry data and used to train the classifier. The performance of the classifier was evaluated using a leave-one-out cross-validation scheme and an accuracy of 66.7% was achieved, with a specificity of 67.0% and a sensitivity of 58.1%. Although the performance of the system is not yet at the level required for clinical use, this work forms an important step in demonstrating the validity and potential for such low-cost and minimally invasive diagnostic systems.

[1]  S. Connolly,et al.  CYCLICAL VARIATION OF THE HEART RATE IN SLEEP APNOEA SYNDROME Mechanisms, and Usefulness of 24 h Electrocardiography as a Screening Technique , 1984, The Lancet.

[2]  F. Gudé,et al.  Oximetry spectral analysis in the diagnosis of obstructive sleep apnoea. , 1999, Clinical science.

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

[4]  A. Pack,et al.  Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults. , 2003, Sleep.

[5]  Brian D. Ripley,et al.  Pattern Recognition and Neural Networks , 1996 .

[6]  D. S. Morillo,et al.  Automated frequency domain analysis of oxygen saturation as a screening tool for SAHS. , 2012, Medical engineering & physics.

[7]  E. Katz,et al.  Obstructive sleep apnea in infants. , 2012, American journal of respiratory and critical care medicine.

[8]  J. Stradling,et al.  The epidemiology of sleep apnoea. , 1996, Thorax.

[9]  R. Carney,et al.  A Simple Method to Identify Sleep Apnea Using Holter Recordings , 2003, Journal of cardiovascular electrophysiology.

[10]  C. Sullivan,et al.  Obstructive sleep apnea in infants: relation to family history of sudden infant death syndrome, apparent life-threatening events, and obstructive sleep apnea. , 2000, The Journal of pediatrics.

[11]  R. Chervin,et al.  Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years , 2012, Pediatrics.

[12]  Alexander G Logan,et al.  Prospective evaluation of nocturnal oximetry for detection of sleep-related breathing disturbances in patients with chronic heart failure. , 2005, Chest.

[13]  F. Sériès,et al.  Interpretation of home oximetry tracings. , 2002, Chest.

[14]  Varun Jeoti,et al.  ECG and blood oxygen level based Sleep Apnea study and detection , 2010, 2010 IEEE EMBS Conference on Biomedical Engineering and Sciences (IECBES).

[15]  K. Waters,et al.  Nocturnal Pulse Oximetry as an Abbreviated Testing Modality for Pediatric Obstructive Sleep Apnea , 2000 .

[16]  Charlie Strange,et al.  An official American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease. , 2012, American journal of respiratory and critical care medicine.

[17]  Michael R. Neuman,et al.  Infant polysomnography: Reliability , 1997 .

[18]  C. Heneghan,et al.  A portable automated assessment tool for sleep apnea using a combined Holter-oximeter. , 2008, Sleep.

[19]  B M Psaty,et al.  The medical cost of undiagnosed sleep apnea. , 1999, Sleep.

[20]  K. Richards,et al.  Oximeter performance: the influence of acquisition parameters. , 2002, Chest.

[21]  A. Akintunde,et al.  Snoring and obstructive sleep apnoea syndrome among hypertensive Nigerians: Prevalence and clinical correlates , 2012, The Pan African medical journal.

[22]  C L Marcus,et al.  Sleep-disordered breathing in children. , 2001, American journal of respiratory and critical care medicine.

[23]  Hlaing Minn,et al.  Real-Time Sleep Apnea Detection by Classifier Combination , 2012, IEEE Transactions on Information Technology in Biomedicine.

[24]  Michael R. Neuman,et al.  Comparison of apnea identified by respiratory inductance plethysmography with that detected by end-tidal CO2 or thermistor , 2000 .

[25]  J. Rich,et al.  All-Cause Mortality and Obstructive Sleep Apnea Severity Revisited , 2012, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[26]  Fang Han,et al.  Guideline : Sleep Apnea , Sleepiness , and Driving Risk in Noncommercial Drivers An Update of a 1994 Statement , 2013 .

[27]  V Pichot,et al.  Screening of obstructive sleep apnea syndrome by heart rate variability analysis. , 1999, Circulation.

[28]  D. Gozal Sleep-disordered breathing and school performance in children. , 1998, Pediatrics.

[29]  Conor Heneghan,et al.  Automated processing of the single-lead electrocardiogram for the detection of obstructive sleep apnoea , 2003, IEEE Transactions on Biomedical Engineering.

[30]  C. Hunt,et al.  Obstructive sleep apnea in infants and children. , 1982, The Journal of pediatrics.

[31]  M. Kryger,et al.  Nocturnal oximetry: is it a screening tool for sleep disorders? , 1995, Sleep.

[32]  E. Chiner,et al.  Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies? , 1999, Thorax.

[33]  W. Pankow,et al.  Sleep-disordered breathing and hypertension. , 2000, The New England journal of medicine.

[34]  Willis J. Tompkins,et al.  A Real-Time QRS Detection Algorithm , 1985, IEEE Transactions on Biomedical Engineering.

[35]  N Roche,et al.  Value of clinical, functional, and oximetric data for the prediction of obstructive sleep apnea in obese patients. , 1999, Chest.

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

[37]  E. Anteyi,et al.  Obstructive sleep apnea among adults in Nigeria. , 2009, Journal of the National Medical Association.

[38]  W. Pankow,et al.  Sleep-disordered breathing and hypertension. , 2000, The New England journal of medicine.

[39]  W C Dement,et al.  Respiration during sleep in children. , 1978, The Western journal of medicine.

[40]  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.

[41]  Eduardo Gil,et al.  Discrimination of Sleep-Apnea-Related Decreases in the Amplitude Fluctuations of PPG Signal in Children by HRV Analysis , 2009, IEEE Transactions on Biomedical Engineering.

[42]  M. Littner,et al.  Practice parameters for the indications for polysomnography and related procedures: an update for 2005. , 2005, Sleep.

[43]  C. Heneghan,et al.  Detection of obstructive sleep apnea in pediatric subjects using surface lead electrocardiogram features. , 2004, Sleep.

[44]  C. Mervis,et al.  Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. , 2003, Pediatrics.

[45]  Gregory Cohen,et al.  A multi-modal approach to sleep-wake classification in infants using minimally invasive sensors , 2014, Computing in Cardiology 2014.

[46]  Altamiro Costa-Pereira,et al.  Unattended sleep studies in pediatric OSA: A systematic review and meta‐analysis , 2015, The Laryngoscope.

[47]  David Gozal,et al.  Health-related quality of life and depressive symptoms in children with suspected sleep-disordered breathing. , 2004, Sleep.

[48]  T Kobayashi,et al.  Augmented very low frequency component of heart rate variability during obstructive sleep apnea. , 1996, Sleep.

[49]  Daniel Sánchez Morillo,et al.  Probabilistic neural network approach for the detection of SAHS from overnight pulse oximetry , 2012, Medical & Biological Engineering & Computing.