Proof of concept: Screening for REM sleep behaviour disorder with a minimal set of sensors.

OBJECTIVE: Rapid-Eye-Movement (REM) sleep behaviour disorder (RBD) is an early predictor of Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy. This study investigated the use of a minimal set of sensors to achieve effective screening for RBD in the population, integrating automated sleep staging (three state) followed by RBD detection without the need for cumbersome electroencephalogram (EEG) sensors. METHODS: Polysomnography signals from 50 participants with RBD and 50 age-matched healthy controls were used to evaluate this study. Three stage sleep classification was achieved using a random forest classifier and features derived from a combination of cost-effective and easy to use sensors, namely electrocardiogram (ECG), electrooculogram (EOG), and electromyogram (EMG) channels. Subsequently, RBD detection was achieved using established and new metrics derived from ECG and EMG channels. RESULTS: The EOG and EMG combination provided the optimal minimalist fully-automated performance, achieving 0.57 ± 0.19 kappa (3 stage) for sleep staging and an RBD detection accuracy of 0.90 ± 0.11, (sensitivity and specificity of 0.88 ± 0.13 and 0.92 ± 0.098, respectively). A single ECG sensor achieved three state sleep staging with 0.28 ± 0.06 kappa and RBD detection accuracy of 0.62 ± 0.10. CONCLUSIONS: This study demonstrates the feasibility of using signals from a single EOG and EMG sensor to detect RBD using fully-automated techniques. SIGNIFICANCE: This study proposes a cost-effective, practical, and simple RBD identification support tool using only two sensors (EMG and EOG); ideal for screening purposes.

Detection of REM sleep behaviour disorder by automated polysomnography analysis.

OBJECTIVE: Evidence suggests Rapid-Eye-Movement (REM) Sleep Behaviour Disorder (RBD) is an early predictor of Parkinson's disease. This study proposes a fully-automated framework for RBD detection consisting of automated sleep staging followed by RBD identification. METHODS: Analysis was assessed using a limited polysomnography montage from 53 participants with RBD and 53 age-matched healthy controls. Sleep stage classification was achieved using a Random Forest (RF) classifier and 156 features extracted from electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG) channels. For RBD detection, a RF classifier was trained combining established techniques to quantify muscle atonia with additional features that incorporate sleep architecture and the EMG fractal exponent. RESULTS: Automated multi-state sleep staging achieved a 0.62 Cohen's Kappa score. RBD detection accuracy improved from 86% to 96% (compared to individual established metrics) when using manually annotated sleep staging. Accuracy remained high (92%) when using automated sleep staging. CONCLUSIONS: This study outperforms established metrics and demonstrates that incorporating sleep architecture and sleep stage transitions can benefit RBD detection. This study also achieved automated sleep staging with a level of accuracy comparable to manual annotation. SIGNIFICANCE: This study validates a tractable, fully-automated, and sensitive pipeline for RBD identification that could be translated to wearable take-home technology.

SeqSleepNet: End-to-End Hierarchical Recurrent Neural Network for Sequence-to-Sequence Automatic Sleep Staging.

Automatic sleep staging has been often treated as a simple classification problem that aims at determining the label of individual target polysomnography epochs one at a time. In this paper, we tackle the task as a sequence-to-sequence classification problem that receives a sequence of multiple epochs as input and classifies all of their labels at once. For this purpose, we propose a hierarchical recurrent neural network named SeqSleepNet (source code is available at http://github.com/pquochuy/SeqSleepNet). At the epoch processing level, the network consists of a filterbank layer tailored to learn frequency-domain filters for preprocessing and an attention-based recurrent layer designed for short-term sequential modeling. At the sequence processing level, a recurrent layer placed on top of the learned epoch-wise features for long-term modeling of sequential epochs. The classification is then carried out on the output vectors at every time step of the top recurrent layer to produce the sequence of output labels. Despite being hierarchical, we present a strategy to train the network in an end-to-end fashion. We show that the proposed network outperforms the state-of-the-art approaches, achieving an overall accuracy, macro F1-score, and Cohen's kappa of 87.1%, 83.3%, and 0.815 on a publicly available dataset with 200 subjects.

Joint Classification and Prediction CNN Framework for Automatic Sleep Stage Classification.

Correctly identifying sleep stages is important in diagnosing and treating sleep disorders. This paper proposes a joint classification-and-prediction framework based on convolutional neural networks (CNNs) for automatic sleep staging, and, subsequently, introduces a simple yet efficient CNN architecture to power the framework. Given a single input epoch, the novel framework jointly determines its label (classification) and its neighboring epochs' labels (prediction) in the contextual output. While the proposed framework is orthogonal to the widely adopted classification schemes, which take one or multiple epochs as contextual inputs and produce a single classification decision on the target epoch, we demonstrate its advantages in several ways. First, it leverages the dependency among consecutive sleep epochs while surpassing the problems experienced with the common classification schemes. Second, even with a single model, the framework has the capacity to produce multiple decisions, which are essential in obtaining a good performance as in ensemble-of-models methods, with very little induced computational overhead. Probabilistic aggregation techniques are then proposed to leverage the availability of multiple decisions. To illustrate the efficacy of the proposed framework, we conducted experiments on two public datasets: Sleep-EDF Expanded (Sleep-EDF), which consists of 20 subjects, and Montreal Archive of Sleep Studies (MASS) dataset, which consists of 200 subjects. The proposed framework yields an overall classification accuracy of 82.3% and 83.6%, respectively. We also show that the proposed framework not only is superior to the baselines based on the common classification schemes but also outperforms existing deep-learning approaches. To our knowledge, this is the first work going beyond the standard single-output classification to consider multitask neural networks for automatic sleep staging. This framework provides avenues for further studies of different neural-network architectures for automatic sleep staging.

Multichannel Sleep Stage Classification and Transfer Learning using Convolutional Neural Networks.

Current sleep medicine relies on the supervised analysis of polysomnographic measurements, comprising amongst others electroencephalogram (EEG), electromyogram (EMG), and electrooculogram (EOG) signals. Convolutional neural networks (CNN) provide an interesting framework to automated classification of sleep based on these raw waveforms. In this study, we compare existing CNN approaches to four databases of pathological and physiological subjects. The best performing model resulted in Cohen's Kappa of $\kappa = 0 .75$ on healthy subjects and $\kappa = 0 .64$ on patients suffering from a variety of sleep disorders. Further, we show the advantages of additional sensor data (i.e., EOG and EMG). Deep learning approaches require a lot of data which is scarce for less prevalent diseases. For this, we propose a transfer learning procedure by pretraining a model on large public data and fine-tune this on each subject from a smaller dataset. This procedure is demonstrated using a private REM Behaviour Disorder database, improving sleep classification by 24.4%.

DNN Filter Bank Improves 1-Max Pooling CNN for Single-Channel EEG Automatic Sleep Stage Classification.

We present in this paper an efficient convolutional neural network (CNN) running on time-frequency image features for automatic sleep stage classification. Opposing to deep architectures which have been used for the task, the proposed CNN is much simpler However, the CNN's convolutional layer is able to support convolutional kernels with different sizes, and therefore, capable of learning features at multiple temporal resolutions. In addition, the 1-max pooling strategy is employed at the pooling layer to better capture the shift-invariance property of EEG signals. We further propose a method to discriminatively learn a frequency-domain filter bank with a deep neural network (DNN) to preprocess the time-frequency image features. Our experiments show that the proposed 1-max pooling CNN performs comparably with the very deep CNNs in the literature on the Sleep- EDF dataset. Preprocessing the time-frequency image features with the learned filter bank before presenting them to the CNN leads to significant improvements on the classification accuracy, setting the state- of-the-art performance on the dataset.

Automatic Sleep Stage Classification Using Single-Channel EEG: Learning Sequential Features with Attention-Based Recurrent Neural Networks.

We propose in this work a feature learning approach using deep bidirectional recurrent neural networks (RNNs) with attention mechanism for single-channel automatic sleep stage classification. We firstly decompose an EEG epoch into multiple small frames and subsequently transform them into a sequence of frame-wise feature vectors. Given the training sequences, the attention-based RNN is trained in a sequence-to-label fashion for sleep stage classification. Due to discriminative training, the network is expected to encode information of an input sequence into a high-level feature vector after the attention layer. We, therefore, treat the trained network as a feature extractor and extract these feature vectors for classification which is accomplished by a linear SVM classifier. We also propose a discriminative method to learn a filter bank with a DNN for preprocessing purpose. Filtering the frame-wise feature vectors with the learned filter bank beforehand leads to further improvement on the classification performance. The proposed approach demonstrates good performance on the Sleep-EDF dataset.

Automating the Detection of REM Sleep Behaviour Disorder.

This study aims to develop automated diagnostic tools to aid in the identification of rapid-eye-movement (REM) sleep behaviour disorder (RBD). Those diagnosed with RBD enact their dreams and therefore present an abnormal characteristic of movement during REM sleep. Several methods have been proposed for RBD detection that use electromyogram (EMG) recordings and manually annotated sleep stages to objectively quantify abnormal REM movement. In this work we further develop these proven techniques with additional features that incorporate the relationship of muscle movement between sleep stages and general sleep architecture. Performance is evaluated using polysomnography (PSG) recordings from 43 aged-matched healthy controls and subjects diagnosed with RBD obtained from multiple institutions and publicly available resources. Using a random forest classifier with established and additional features, the performance of RBD detection was shown to improve upon established metrics (achieving 88% accuracy, 91% sensitivity, and 86% specificity).