Childhood adversity and suicidal ideation in older Korean adults: unraveling the mediating mechanisms of mental health, physical health, and social relationships.

BACKGROUND: Suicide rates in older adults are much higher than those in younger age groups. Given the rapid increase in the proportion of older adults in Korea and the high suicide rate of this age group, it is worth investigating the mechanism of suicidal ideation for older adults. Generally, adverse childhood experiences are positively associated with suicidal ideation; however, it is not fully understood what mediating relationships are linked to the association between these experiences and current suicidal ideation. METHODS: The data from 685 older Korean adults were analyzed utilizing logistic regression, path analyses, and structural equation modeling. Based on our theoretical background and the empirical findings of previous research, we examined three separate models with mental health, physical health, and social relationship mediators. After that, we tested a combined model including all mediators. We also tested another combined model with mediation via mental health moderated by physical health and social relationships. RESULTS: The univariate logistic regression results indicated that childhood adversity was positively associated with suicidal ideation in older adults. However, multivariate logistic regression results demonstrated that the direct effect of childhood adversity became nonsignificant after accounting all variables. Three path models presented significant mediation by depression and social support in the association between childhood adversity and suicidal ideation. However, combined structural equation models demonstrated that only mediation by a latent variable of mental health problems was statistically significant. Social relationships moderated the path from mental health problems to suicidal ideation. CONCLUSIONS: Despite several limitations, this study has clinical implications for the development of effective strategies to mitigate suicidal ideation. In particular, effectively screening the exposure to adverse childhood experiences, early identification and treatment of depressive symptoms can play a crucial role in weakening the association between childhood adversity and suicidal ideation in older adults.

Developing prediction algorithms for late-life depression using wearable devices: a cohort study protocol.

INTRODUCTION: Despite the high prevalence of major depressive disorder (MDD) among the elderly population, the rate of treatment is low due to stigmas and barriers to medical access. Wearable devices such as smartphones and smartwatches can help to screen MDD symptoms earlier in a natural setting while forgoing these concerns. However, previous research using wearable devices has mostly targeted the younger population. By collecting longitudinal data using wearable devices from the elderly population, this research aims to produce prediction algorithms for late-life depression and to develop strategies that strengthen medical access in community care systems. METHODS AND ANALYSIS: The current cohort study recruited a subsample of 685 elderly people from the Korean Genome and Epidemiology Study-Cardiovascular Disease Association Study, a national large cohort established in 2004. The current study has been conducted over a 3-year period to explore the development patterns of late-life depression. Participants have completed three annual face-to-face interviews (baseline, the first follow-up and the second follow-up) and 2 years of app-based surveys and passive sensing data collection. All the data collection will end at the second follow-up interview. The collected self-report, observational and passive sensing data will be primarily analysed by machine learning. ETHICS AND DISSEMINATION: This study protocol has been reviewed and approved by the Yonsei University Mirae Campus Institutional Review Board (1041849-2 02 111 SB-180-06) in South Korea. All participants provided written informed consent. The findings of this research will be disseminated by academic publications and conference presentations.

Childhood adversity and late-life depression: moderated mediation model of stress and social support.

Background: As life expectancy increases, understanding the mechanism for late-life depression and finding a crucial moderator becomes more important for mental health in older adults. Childhood adversity increases the risk of clinical depression even in old age. Based on the stress sensitivity theory and stress-buffering effects, stress would be a significant mediator, while social support can be a key moderator in the mediation pathways. However, few studies have tested this moderated mediation model with a sample of older adults. This study aims to reveal the association between childhood adversity and late-life depression in older adults, taking into consideration the effects of stress and social support. Methods: This study used several path models to analyze the data from 622 elderly participants who were never diagnosed with clinical depression. Results: We found that childhood adversity increases the odds ratio of depression by approximately 20% in older adults. Path model with mediation demonstrates that stress fully mediates the pathway from childhood adversity to late-life depression. Path model with moderated mediation also illustrates that social support significantly weakens the association between childhood adversity and perceived stress. Conclusion: This study provides empirical evidence to reveal a more detailed mechanism for late-life depression. Specifically, this study identifies one crucial risk factor and one protective factor, stress and social support, respectively. This brings insight into prevention of late-life depression among those who have experienced childhood adversity.

A Prediction Algorithm for Hypoglycemia Based on Support Vector Machine Using Glucose Level and Electrocardiogram.

A prediction algorithm for hypoglycemic events is proposed using glucose levels and electrocardiogram (ECG) with support vector machine (SVM). We extracted the corrected QT interval and five heart rate variability parameters from the ECG, along with glucose level from a continuous glucose monitoring system (CGMS). This feature set is used as input to the SVM, and hypoglycemic events are predicted every 5 min using the trained SVM model for up to 30 min in advance. The proposed algorithm was developed and evaluated for nine Type-1 diabetes patients in the D1NAMO dataset. The prediction sensitivity, specificity, and accuracy values for the test set were 91.1%, 87.0%, and 89.0% (10 min before); 88.0%, 84.3%, and 86.2% (20 min before); 80.1%, 83.3%, and 81.7% (30 min before), respectively. These results show higher performance of the proposed method compared to previous studies and suggest the possibility of predicting hypoglycemia in advance.

Deep Learning for Automatic Detection of Periodic Limb Movement Disorder Based on Electrocardiogram Signals.

In this study, a deep learning model (deepPLM) is shown to automatically detect periodic limb movement syndrome (PLMS) based on electrocardiogram (ECG) signals. The designed deepPLM model consists of four 1D convolutional layers, two long short-term memory units, and a fully connected layer. The Osteoporotic Fractures in Men sleep (MrOS) study dataset was used to construct the model, including training, validating, and testing the model. A single-lead ECG signal of the polysomnographic recording was used for each of the 52 subjects (26 controls and 26 patients) in the MrOS dataset. The ECG signal was normalized and segmented (10 s duration), and it was divided into a training set (66,560 episodes), a validation set (16,640 episodes), and a test set (20,800 episodes). The performance evaluation of the deepPLM model resulted in an F1-score of 92.0%, a precision score of 90.0%, and a recall score of 93.0% for the control set, and 92.0%, 93.0%, and 90.0%, respectively, for the patient set. The results demonstrate the possibility of automatic PLMS detection in patients by using the deepPLM model based on a single-lead ECG. This could be an alternative method for PLMS screening and a helpful tool for home healthcare services for the elderly population.

Deep Convolutional Recurrent Model for Automatic Scoring Sleep Stages Based on Single-Lead ECG Signal.

BACKGROUND: Sleep stage scoring, which is an essential step in the quantitative analysis of sleep monitoring, relies on human experts and is therefore subjective and time-consuming; thus, an easy and accurate method is needed for the automatic scoring of sleep stages. METHODS: In this study, we constructed a deep convolutional recurrent (DCR) model for the automatic scoring of sleep stages based on a raw single-lead electrocardiogram (ECG). The DCR model uses deep convolutional and recurrent neural networks to apply the complex and cyclic rhythms of human sleep. It consists of three convolutional and two recurrent layers and is optimized by dropout and batch normalization. The constructed DCR model was evaluated using multiclass classification, including five-class sleep stages (wake, N1, N2, N3, and rapid eye movement (REM)) and three-class sleep stages (wake, non-REM (NREM), and REM), using a raw single-lead ECG signal. The single-lead ECG signal was collected from 112 subjects in two groups: control (52 subjects) and sleep apnea (60 subjects). The single-lead ECG signal was preprocessed, segmented at a duration of 30 s, and divided into a training set of 89 subjects and test set of 23 subjects. RESULTS: We achieved an overall accuracy of 74.2% for five classes and 86.4% for three classes. CONCLUSIONS: These results show the DCR model's superior performance over those in the previous studies, highlighting that the model can be an alternative tool for sleep monitoring and sleep screening.

A Prediction Model of Incident Cardiovascular Disease in Patients with Sleep-Disordered Breathing.

(1) Purpose: this study proposes a method of prediction of cardiovascular diseases (CVDs) that can develop within ten years in patients with sleep-disordered breathing (SDB). (2) Methods: For the design and evaluation of the algorithm, the Sleep Heart Health Study (SHHS) data from the 3367 participants were divided into a training set, validation set, and test set in the ratio of 5:3:2. From the data during a baseline period when patients did not have any CVD, we extracted 18 features from electrography (ECG) based on signal processing methods, 30 ECG features based on artificial intelligence (AI), ten clinical risk factors for CVD. We trained the model and evaluated it by using CVD outcomes result, monitored in follow-ups. The optimal feature vectors were selected through statistical analysis and support vector machine recursive feature elimination (SVM-RFE) of the extracted feature vectors. Features based on AI, a novel proposal from this study, showed excellent performance out of all selected feature vectors. In addition, new parameters based on AI were possibly meaningful predictors for CVD, when used in addition to the predictors for CVD that are already known. The selected features were used as inputs to the prediction model based on SVM for CVD, determining the development of CVD-free, coronary heart disease (CHD), heart failure (HF), or stroke within ten years. (3) Results: As a result, the respective recall and precision values were 82.9% and 87.5% for CVD-free; 71.9% and 63.8% for CVD; 57.2% and 55.4% for CHD; 52.6% and 40.8% for HF; 52.4% and 44.6% for stroke. The F1-score between CVD and CVD-free was 76.5%, and it was 59.1% in class four. (4) Conclusion: In conclusion, our results confirm the excellence of the prediction model for CVD in patients with SDB and verify the possibility of prediction within ten years of the CVDs that may occur in patients with SDB.

Identification of Sleep Apnea Severity Based on Deep Learning from a Short-term Normal ECG.

BACKGROUND: This paper proposes a novel method for automatically identifying sleep apnea (SA) severity based on deep learning from a short-term normal electrocardiography (ECG) signal. METHODS: A convolutional neural network (CNN) was used as an identification model and implemented using a one-dimensional convolutional, pooling, and fully connected layer. An optimal architecture is incorporated into the CNN model for the precise identification of SA severity. A total of 144 subjects were studied. The nocturnal single-lead ECG signal was collected, and the short-term normal ECG was extracted from them. The short-term normal ECG was segmented for a duration of 30 seconds and divided into two datasets for training and evaluation. The training set consists of 82,952 segments (66,360 training set, 16,592 validation set) from 117 subjects, while the test set has 20,738 segments from 27 subjects. RESULTS: F1-score of 98.0% was obtained from the test set. Mild and moderate SA can be identified with an accuracy of 99.0%. CONCLUSION: The results showed the possibility of automatically identifying SA severity based on a short-term normal ECG signal.

Estimation of Arterial Blood Pressure Based on Artificial Intelligence Using Single Earlobe Photoplethysmography during Cardiopulmonary Resuscitation.

This study investigates the feasibility of estimation of blood pressure (BP) using a single earlobe photoplethysmography (Ear PPG) during cardiopulmonary resuscitation (CPR). We have designed a system that carries out Ear PPG for estimation of BP. In particular, the BP signals are estimated according to a long short-term memory (LSTM) model using an Ear PPG. To investigate the proposed method, two statistical analyses were conducted for comparison between BP measured by the micromanometer-based gold standard method (BPMEAS) and the Ear PPG-based proposed method (BPEST) for swine cardiac model. First, Pearson's correlation analysis showed high positive correlations (r = 0.92, p < 0.01) between BPMEAS and BPEST. Second, the paired-samples t-test on the BP parameters (systolic and diastolic blood pressure) of the two methods indicated no significant differences (p > 0.05). Therefore, the proposed method has the potential for estimation of BP for CPR biofeedback based on LSTM using a single Ear PPG.

Multi-Class Classification of Sleep Apnea/Hypopnea Events Based on Long Short-Term Memory Using a Photoplethysmography Signal.

In this study, we proposed a new method for multi-class classification of sleep apnea/hypopnea events based on a long short-term memory (LSTM) using photoplethysmography (PPG) signals. The three-layer LSTM model was used with batch-normalization and dropout to classify the multi-class events including normal, apnea, and hypopnea. The PPG signals, which were measured by the nocturnal polysomnography with 7 h from 82 patients suffered from sleep apnea, were used to model training and evaluation. The performance of the proposed method was evaluated on the training set from 63 patients and test set from 13 patients. The results of the LSTM model showed the following high performances: the positive predictive value of 94.16% for normal, 81.38% for apnea, and 97.92% for hypopnea; sensitivity of 86.03% for normal, 91.24% for apnea, and 99.38% for hypopnea events. The proposed method had especially higher performance of hypopnea classification which had been a drawback of previous studies. Furthermore, it can be applied to a system that can classify sleep apnea/hypopnea and normal events automatically without expert's intervention at home.

Deep learning approaches for automatic detection of sleep apnea events from an electrocardiogram.

BACKGROUND AND OBJECTIVE: This study demonstrates deep learning approaches with an aim to find the optimal method to automatically detect sleep apnea (SA) events from an electrocardiogram (ECG) signal. METHODS: Six deep learning approaches were designed and implemented for automatic detection of SA events including deep neural network (DNN), one-dimensional (1D) convolutional neural networks (CNN), two-dimensional (2D) CNN, recurrent neural networks (RNN), long short-term memory, and gated-recurrent unit (GRU). Designed deep learning models were analyzed and compared in the performances. The ECG signal was pre-processed, normalized, and segmented into 10 s intervals. Subsequently, the signal was converted into a 2D form for analysis in the 2D CNN model. A dataset collected from 86 patients with SA was used. The training set comprised data from 69 of the patients, while the test set contained data from the remaining 17 patients. RESULTS: The accuracy of the best-performing model was 99.0%, and the 1D CNN and GRU models had 99.0% recall rates. CONCLUSIONS: The designed deep learning approaches performed better than those developed and tested in previous studies in terms of detecting SA events, and they could distinguish between apnea and hypopnea events using an ECG signal. The deep learning approaches such as 1D CNN and GRU can be helpful tools to automatically detect SA in sleep apnea screening and related studies.

Automatic Prediction of Atrial Fibrillation Based on Convolutional Neural Network Using a Short-term Normal Electrocardiogram Signal.

BACKGROUND: In this study, we propose a method for automatically predicting atrial fibrillation (AF) based on convolutional neural network (CNN) using a short-term normal electrocardiogram (ECG) signal. METHODS: We designed a CNN model and optimized it by dropout and normalization. One-dimensional convolution, max-pooling, and fully-connected multiple perceptron were used to analyze the short-term normal ECG. The ECG signal was preprocessed and segmented to train and evaluate the proposed CNN model. The training and test sets consisted of the two AF and one normal dataset from the MIT-BIH database. RESULTS: The proposed CNN model for the automatic prediction of AF achieved a high performance with a sensitivity of 98.6%, a specificity of 98.7%, and an accuracy of 98.7%. CONCLUSION: The results show the possibility of automatically predicting AF based on the CNN model using a short-term normal ECG signal. The proposed CNN model for the automatic prediction of AF can be a helpful tool for the early diagnosis of AF in healthcare fields.

Multiclass classification of obstructive sleep apnea/hypopnea based on a convolutional neural network from a single-lead electrocardiogram.

OBJECTIVE: In this paper, we propose a convolutional neural network (CNN)-based deep learning architecture for multiclass classification of obstructive sleep apnea and hypopnea (OSAH) using single-lead electrocardiogram (ECG) recordings. OSAH is the most common sleep-related breathing disorder. Many subjects who suffer from OSAH remain undiagnosed; thus, early detection of OSAH is important. APPROACH: In this study, automatic classification of three classes-normal, hypopnea, and apnea-based on a CNN is performed. An optimal six-layer CNN model is trained on a training dataset (45 096 events) and evaluated on a test dataset (11 274 events). The training set (69 subjects) and test set (17 subjects) were collected from 86 subjects with length of approximately 6 h and segmented into 10 s durations. MAIN RESULTS: The proposed CNN model reaches a mean [Formula: see text]-score of 93.0 for the training dataset and 87.0 for the test dataset. SIGNIFICANCE: Thus, proposed deep learning architecture achieved a high performance for multiclass classification of OSAH using single-lead ECG recordings. The proposed method can be employed in screening of patients suspected of having OSAH.

Automated Detection of Obstructive Sleep Apnea Events from a Single-Lead Electrocardiogram Using a Convolutional Neural Network.

In this study, we propose a method for the automated detection of obstructive sleep apnea (OSA) from a single-lead electrocardiogram (ECG) using a convolutional neural network (CNN). A CNN model was designed with six optimized convolution layers including activation, pooling, and dropout layers. One-dimensional (1D) convolution, rectified linear units (ReLU), and max pooling were applied to the convolution, activation, and pooling layers, respectively. For training and evaluation of the CNN model, a single-lead ECG dataset was collected from 82 subjects with OSA and was divided into training (including data from 63 patients with 34,281 events) and testing (including data from 19 patients with 8571 events) datasets. Using this CNN model, a precision of 0.99%, a recall of 0.99%, and an F1-score of 0.99% were attained with the training dataset; these values were all 0.96% when the CNN was applied to the testing dataset. These results show that the proposed CNN model can be used to detect OSA accurately on the basis of a single-lead ECG. Ultimately, this CNN model may be used as a screening tool for those suspected to suffer from OSA.

Cardiopulmonary Coupling Analysis Using Home Sleep Monitoring System Based on Air Mattress.

This study investigates the feasibility of cardiopulmonary coupling (CPC) using home sleep monitoring system. We have designed a system to measure respiratory signals and normal-to-normal (NN) interval series in a non-contact based on air mattress. Then, CPC analysis was conducted using extracted respiratory signals and NN interval series, and six CPC parameters were extracted (VLFC, LFC, HFC, e-LFC, e-LFCNB and e-LFCBB). To evaluate the proposed method, two statistical analyses were conducted between the CPC parameters extracted by the electrocardiogram-based conventional method and the air mattress-based proposed method for five patients with obstructive sleep apnea and hypopnea (OSAH). Wilcoxon's signed rank test on the CPC parameters of the two methods indicated no significant differences (p > 0.05) and Spearman's rank correlation analysis showed high positive correlations (r ≥ 0.7, p < 0.05) between the two methods. Therefore, the proposed method has the potential for performing CPC analysis using air mattress-based system.

Estimating sleep parameters using nasal pressure signals applicable to continuous positive airway pressure devices.

OBJECTIVE: This paper proposes a method for classifying sleep-wakefulness and estimating sleep parameters using nasal pressure signals applicable to a continuous positive airway pressure (CPAP) device. APPROACH: In order to classify the sleep-wakefulness states of patients with sleep-disordered breathing (SDB), apnea-hypopnea and snoring events are first detected. Epochs detected as SDB are classified as sleep, and time-domain- and frequency-domain-based features are extracted from the epochs that are detected as normal breathing. Subsequently, sleep-wakefulness is classified using a support vector machine (SVM) classifier in the normal breathing epoch. Finally, four sleep parameters-sleep onset, wake after sleep onset, total sleep time and sleep efficiency-are estimated based on the classified sleep-wakefulness. In order to develop and test the algorithm, 110 patients diagnosed with SDB participated in this study. Ninety of the subjects underwent full-night polysomnography (PSG) and twenty underwent split-night PSG. The subjects were divided into 50 patients of a training set (full/split: 42/8), 30 of a validation set (full/split: 24/6) and 30 of a test set (full/split: 24/6). MAIN RESULTS: In the experiments conducted, sleep-wakefulness classification accuracy was found to be 83.2% in the test set, compared with the PSG scoring results of clinical experts. Furthermore, all four sleep parameters showed higher correlations than the results obtained via PSG (r ⩾ 0.84, p < 0.05). In order to determine whether the proposed method is applicable to CPAP, sleep-wakefulness classification performances were evaluated for each CPAP in the split-night PSG data. The results indicate that the accuracy and sensitivity of sleep-wakefulness classification by CPAP variation shows no statistically significant difference (p < 0.05). SIGNIFICANCE: The contributions made in this study are applicable to the automatic classification of sleep-wakefulness states in CPAP devices and evaluation of the quality of sleep.

Obstructive Sleep Apnea Screening Using a Piezo-Electric Sensor.

In this study, we propose a novel method for obstructive sleep apnea (OSA) detection using a piezo-electric sensor. OSA is a relatively common sleep disorder. However, more than 80% of OSA patients remain undiagnosed. We investigated the feasibility of OSA assessment using a single-channel physiological signal to simplify the OSA screening. We detected both snoring and heartbeat information by using a piezo-electric sensor, and snoring index (SI) and features based on pulse rate variability (PRV) analysis were extracted from the filtered piezo-electric sensor signal. A support vector machine (SVM) was used as a classifier to detect OSA events. The performance of the proposed method was evaluated on 45 patients from mild, moderate, and severe OSA groups. The method achieved a mean sensitivity, specificity, and accuracy of 72.5%, 74.2%, and 71.5%; 85.8%, 80.5%, and 80.0%; and 70.3%, 77.1%, and 71.9% for the mild, moderate, and severe groups, respectively. Finally, these results not only show the feasibility of OSA detection using a piezo-electric sensor, but also illustrate its usefulness for monitoring sleep and diagnosing OSA.

Design of a stimulation protocol to predict temperature distribution in subcutaneous tissue using the finite element model.

Moxibustion is a traditional Oriental medicine therapy that treats the symptoms of a disease with thermal stimulation. However, it is difficult to control the strength of the thermal or chemical stimulus generated by the various types and amounts of moxa and to prevent energy loss through the skin. To overcome these problems, we previously developed a method to efficiently provide RF thermal stimulation to subcutaneous tissue. In this paper, we propose a finite element model (FEM) to predict temperature distributions in subcutaneous tissue after radio-frequency thermal stimulation. To evaluate the performance of the developed FEM, temperature distributions were obtained from the FEM, and in vivo experiments were conducted using the RF stimulation system at subcutaneous tissue depths of 5 and 10 mm in the femoral region of a rabbit model. High correlation coefficients between simulated and actual temperature distributions-0.98 at 5 mm and 0.99 at 10 mm-were obtained, despite some slight errors in the temperature distribution at each depth. These results demonstrate that the FEM described here can be used to determine thermal stimulation profiles produced by RF stimulation of subcutaneous tissue.

New Rule-Based Algorithm for Real-Time Detecting Sleep Apnea and Hypopnea Events Using a Nasal Pressure Signal.

We developed a rule-based algorithm for automatic real-time detection of sleep apnea and hypopnea events using a nasal pressure signal. Our basic premise was that the performance of our new algorithm using the nasal pressure signal would be comparable to that using other sensors as well as manual annotation labeled by a technician on polysomnography study. We investigated fifty patients with sleep apnea-hypopnea syndrome (age: 56.8 ± 10.5 years, apnea-hypopnea index (AHI): 36.2 ± 18.1/h) during full night PSG recordings at the sleep center. The algorithm was comprised of pre-processing with a median filter, amplitude computation and apnea-hypopnea detection parts. We evaluated the performance of the algorithm a confusion matric for each event and statistical analyses for AHI. Our evaluation achieved a good performance, with a sensitivity of 86.4 %, and a positive predictive value of 84.5 % for detection of apnea and hypopnea regardless of AHI severity. Our results indicated a high correlation with the manually labeled apnea-hypopnea events during PSG, with a correlation coefficient of r = 0.94 (p < 0.0001) and a mean difference of -2.9 ± 11.6 per hour. The proposed new algorithm could provide significant clinical and computational insights to design a PSG analysis system and a continuous positive airway pressure (CPAP) device for screening sleep quality related in patients with sleep apnea-hypopnea syndrome.