Thomas Penzel

Donglin Xie, Qingshuo Zhao, Jingyu Wang et al.

Sleep disturbances are tightly linked to cardiovascular risk, yet polysomnography (PSG)-the clinical reference standard-remains resource-intensive and poorly suited for multi-night, home-based, and large-scale screening. Single-lead electrocardiography (ECG), already ubiquitous in Holter and patch-based devices, enables comfortable long-term acquisition and encodes sleep-relevant physiology through autonomic modulation and cardiorespiratory coupling. Here, we present a proof-of-concept Holter-to-Sleep framework that, using single-lead ECG as the sole input, jointly supports overnight sleep phenotyping and Holter-grade cardiac phenotyping within the same recording, and further provides an explicit analytic pathway for scalable cardio-sleep association studies. The framework is developed and validated on a pooled multi-center PSG sample of 10,439 studies spanning four public cohorts, with independent external evaluation to assess cross-cohort generalizability, and additional real-world feasibility assessment using overnight patch-ECG recordings via objective-subjective consistency analysis. This integrated design enables robust extraction of clinically meaningful overnight sleep phenotypes under heterogeneous populations and acquisition conditions, and facilitates systematic linkage between ECG-derived sleep metrics and arrhythmia-related Holter phenotypes. Collectively, the Holter-to-Sleep paradigm offers a practical foundation for low-burden, home-deployable, and scalable cardio-sleep monitoring and research beyond traditional PSG-centric workflows.

Zhuo Diao, Yueting Li, Jianpeng Wang et al.

Sleep staging is essential for the assessment of sleep quality and the diagnosis of sleep-related disorders. Conventional polysomnography (PSG), while considered the gold standard, is intrusive, labor-intensive, and unsuitable for long-term monitoring. This study evaluates the performance of the Sleepal AI Lamp, a contactless, radar-based consumer-grade sleep tracker, in comparison with gold-standard polysomnography (PSG), using a large-scale dataset comprising 1022 overnight recordings. We extract multi-scale respiratory and motion-related features from radar signals to train a frequency-augmented deep learning model. For the binary sleep-wake classification task, experimental results demonstrated that the model achieved an accuracy of 92.8% alongside a macro-averaged F1 score of 0.895. For four-stage classification (wake, light NREM (N1 + N2), deep NREM (N3), REM), the model achieved an accuracy of 78.5% with a Cohen's kappa coefficient of 0.695 in healthy individuals and maintained a stable accuracy of 77.2% with a kappa of 0.677 in a heterogeneous population including patients with varying severities of obstructive sleep apnea (OSA). These experimental results demonstrate that the sleep staging performance of the contactless Sleepal AI Lamp is in high agreement with expert-labeled PSG sleep stages. Our findings suggest that non-contact radar sensing, combined with advanced temporal modeling, can provide reliable sleep staging performance without requiring physical contact or wearable devices. Owing to its unobtrusive nature, ease of deployment, and robustness to long-term use, the contactless Sleepal AI Lamp shows strong potential for clinical screening, home-based sleep assessment, and continuous longitudinal sleep monitoring in real-world medical and healthcare applications.

Ryan J. Urbanowicz, Harsh Bandhey, Brendan T. Keenan et al.

While machine learning (ML) includes a valuable array of tools for analyzing biomedical data, significant time and expertise is required to assemble effective, rigorous, and unbiased pipelines. Automated ML (AutoML) tools seek to facilitate ML application by automating a subset of analysis pipeline elements. In this study we develop and validate a Simple, Transparent, End-to-end Automated Machine Learning Pipeline (STREAMLINE) and apply it to investigate the added utility of photography-based phenotypes for predicting obstructive sleep apnea (OSA); a common and underdiagnosed condition associated with a variety of health, economic, and safety consequences. STREAMLINE is designed to tackle biomedical binary classification tasks while adhering to best practices and accommodating complexity, scalability, reproducibility, customization, and model interpretation. Benchmarking analyses validated the efficacy of STREAMLINE across data simulations with increasingly complex patterns of association. Then we applied STREAMLINE to evaluate the utility of demographics (DEM), self-reported comorbidities (DX), symptoms (SYM), and photography-based craniofacial (CF) and intraoral (IO) anatomy measures in predicting any OSA or moderate/severe OSA using 3,111 participants from Sleep Apnea Global Interdisciplinary Consortium (SAGIC). OSA analyses identified a significant increase in ROC-AUC when adding CF to DEM+DX+SYM to predict moderate/severe OSA. A consistent but non-significant increase in PRC-AUC was observed with the addition of each subsequent feature set to predict any OSA, with CF and IO yielding minimal improvements. Application of STREAMLINE to OSA data suggests that CF features provide additional value in predicting moderate/severe OSA, but neither CF nor IO features meaningfully improved the prediction of any OSA beyond established demographics, comorbidity and symptom characteristics.

Benedikt Holm, Arnar Óskarsson, Björn Elvar Þorleifsson et al.

Manual scoring of polysomnography (PSG) is a time intensive task, prone to inter scorer variability that can impact diagnostic reliability. This study investigates the integration of decision support systems (DSS) into PSG scoring workflows, focusing on their effects on accuracy, scoring time, and potential biases toward recommendations from artificial intelligence (AI) compared to human generated recommendations. Using a novel online scoring platform, we conducted a repeated measures study with sleep technologists, who scored traditional and self applied PSGs. Participants were occasionally presented with recommendations labeled as either human or AI generated. We found that traditional PSGs tended to be scored slightly more accurately than self applied PSGs, but this difference was not statistically significant. Correct recommendations significantly improved scoring accuracy for both PSG types, while incorrect recommendations reduced accuracy. No significant bias was observed toward or against AI generated recommendations compared to human generated recommendations. These findings highlight the potential of AI to enhance PSG scoring reliability. However, ensuring the accuracy of AI outputs is critical to maximizing its benefits. Future research should explore the long term impacts of DSS on scoring workflows and strategies for integrating AI in clinical practice.