Kaare B. Mikkelsen

Huy Phan, Kristian P. Lorenzen, Elisabeth Heremans et al.

Human sleep is cyclical with a period of approximately 90 minutes, implying long temporal dependency in the sleep data. Yet, exploring this long-term dependency when developing sleep staging models has remained untouched. In this work, we show that while encoding the logic of a whole sleep cycle is crucial to improve sleep staging performance, the sequential modelling approach in existing state-of-the-art deep learning models are inefficient for that purpose. We thus introduce a method for efficient long sequence modelling and propose a new deep learning model, L-SeqSleepNet, which takes into account whole-cycle sleep information for sleep staging. Evaluating L-SeqSleepNet on four distinct databases of various sizes, we demonstrate state-of-the-art performance obtained by the model over three different EEG setups, including scalp EEG in conventional Polysomnography (PSG), in-ear EEG, and around-the-ear EEG (cEEGrid), even with a single EEG channel input. Our analyses also show that L-SeqSleepNet is able to alleviate the predominance of N2 sleep (the major class in terms of classification) to bring down errors in other sleep stages. Moreover the network becomes much more robust, meaning that for all subjects where the baseline method had exceptionally poor performance, their performance are improved significantly. Finally, the computation time only grows at a sub-linear rate when the sequence length increases.

Jesper Strøm, Casper Skjærbæk, Natasha Becker Bertelsen et al.

Isolated REM sleep behavior disorder (iRBD) is a key prodromal marker of Parkinson's disease (PD), and video-polysomnography (vPSG) remains the diagnostic gold standard. However, manual sleep staging is particularly challenging in neurodegenerative diseases due to EEG abnormalities and fragmented sleep, making PSG assessments a bottleneck for deploying new RBD screening technologies at scale. We adapted U-Sleep, a deep neural network, for generalizable sleep staging in PD and iRBD. A pretrained U-Sleep model, based on a large, multisite non-neurodegenerative dataset (PUB; 19,236 PSGs across 12 sites), was fine-tuned on research datasets from two centers (Lundbeck Foundation Parkinson's Disease Research Center (PACE) and the Cologne-Bonn Cohort (CBC); 112 PD, 138 iRBD, 89 age-matched controls. The resulting model was evaluated on an independent dataset from the Danish Center for Sleep Medicine (DCSM; 81 PD, 36 iRBD, 87 sleep-clinic controls). A subset of PSGs with low agreement between the human rater and the model (Cohen's $κ$ < 0.6) was re-scored by a second blinded human rater to identify sources of disagreement. Finally, we applied confidence-based thresholds to optimize REM sleep staging. The pretrained model achieved mean $κ$ = 0.81 in PUB, but $κ$ = 0.66 when applied directly to PACE/CBC. By fine-tuning the model, we developed a generalized model with $κ$ = 0.74 on PACE/CBC (p < 0.001 vs. the pretrained model). In DCSM, mean and median $κ$ increased from 0.60 to 0.64 (p < 0.001) and 0.64 to 0.69 (p < 0.001), respectively. In the interrater study, PSGs with low agreement between the model and the initial scorer showed similarly low agreement between human scorers. Applying a confidence threshold increased the proportion of correctly identified REM sleep epochs from 85% to 95.5%, while preserving sufficient (> 5 min) REM sleep for 95% of subjects.

Mohammad Ahangarkiasari, Andreas Tind Damgaard, Casper Haurum et al.

Objective: Investigate whether hypnogram 'realism' can be used to guide an unsupervised method for handling arbitrary types of signal degradation in mobile sleep monitoring. Approach: Combining a pretrained, state-of-the-art 'u-sleep' model with a 'discriminator' network, we align features from a target domain with a feature space learned during pretraining. To test the approach, we distort the source domain with realistic signal degradations, to see how well the method can adapt to different types of degradation. We compare the performance of the resulting model with best-case models designed in a supervised manner for each type of transfer. Main Results: Depending on the type of distortion, we find that the unsupervised approach can increase Cohen's kappa with as little as 0.03 and up to 0.29, and that for all transfers, the method does not decrease performance. However, the approach never quite reaches the estimated theoretical optimal performance, and when tested on a real-life domain mismatch between two sleep studies, the benefit was insignificant. Significance: 'Discriminator-guided fine tuning' is an interesting approach to handling signal degradation for 'in the wild' sleep monitoring, with some promise. In particular, what it says about sleep data in general is interesting. However, more development will be necessary before using it 'in production'.

Nhan Duc Thanh Nguyen, Huy Phan, Kaare Mikkelsen et al.

Identifying auditory attention by comparing auditory stimuli and corresponding brain responses, is known as auditory attention decoding (AAD). The majority of AAD algorithms utilize the so-called envelope entrainment mechanism, whereby auditory attention is identified by how the envelope of the auditory stream drives variation in the electroencephalography (EEG) signal. However, neural processing can also be decoded based on endogenous cognitive responses, in this case, neural responses evoked by attention to specific words in a speech stream. This approach is largely unexplored in the field of AAD but leads to a single-word auditory attention decoding problem in which an epoch of an EEG signal timed to a specific word is labeled as attended or unattended. This paper presents a deep learning approach, based on EEGNet, to address this challenge. We conducted a subject-independent evaluation on an event-based AAD dataset with three different paradigms: word category oddball, word category with competing speakers, and competing speech streams with targets. The results demonstrate that the adapted model is capable of exploiting cognitive-related spatiotemporal EEG features and achieving at least 58% accuracy on the most realistic competing paradigm for the unseen subjects. To our knowledge, this is the first study dealing with this problem.

Huy Phan, Kaare Mikkelsen

Modern deep learning holds a great potential to transform clinical practice on human sleep. Teaching a machine to carry out routine tasks would be a tremendous reduction in workload for clinicians. Sleep staging, a fundamental step in sleep practice, is a suitable task for this and will be the focus in this article. Recently, automatic sleep staging systems have been trained to mimic manual scoring, leading to similar performance to human sleep experts, at least on scoring of healthy subjects. Despite tremendous progress, we have not seen automatic sleep scoring adopted widely in clinical environments. This review aims to give a shared view of the authors on the most recent state-of-the-art development in automatic sleep staging, the challenges that still need to be addressed, and the future directions for automatic sleep scoring to achieve clinical value.

Huy Phan, Kaare Mikkelsen, Oliver Y. Chén et al.

Background: Black-box skepticism is one of the main hindrances impeding deep-learning-based automatic sleep scoring from being used in clinical environments. Methods: Towards interpretability, this work proposes a sequence-to-sequence sleep-staging model, namely SleepTransformer. It is based on the transformer backbone and offers interpretability of the model's decisions at both the epoch and sequence level. We further propose a simple yet efficient method to quantify uncertainty in the model's decisions. The method, which is based on entropy, can serve as a metric for deferring low-confidence epochs to a human expert for further inspection. Results: Making sense of the transformer's self-attention scores for interpretability, at the epoch level, the attention scores are encoded as a heat map to highlight sleep-relevant features captured from the input EEG signal. At the sequence level, the attention scores are visualized as the influence of different neighboring epochs in an input sequence (i.e. the context) to recognition of a target epoch, mimicking the way manual scoring is done by human experts. Conclusion: Additionally, we demonstrate that SleepTransformer performs on par with existing methods on two databases of different sizes. Significance: Equipped with interpretability and the ability of uncertainty quantification, SleepTransformer holds promise for being integrated into clinical settings.