Andrew Lim

Nasim Montazeri, Stone Yang, Dominik Luszczynski et al.

Study Objectives: Wrist accelerometry is widely used for inferring sleep-wake state. Previous works demonstrated poor wake detection, without cross-device generalizability and validation in different age range and sleep disorders. We developed a robust deep learning model for to detect sleep-wakefulness from triaxial accelerometry and evaluated its validity across three devices and in a large adult population spanning a wide range of ages with and without sleep disorders. Methods: We collected wrist accelerometry simultaneous to polysomnography (PSG) in 453 adults undergoing clinical sleep testing at a tertiary care sleep laboratory, using three devices. We extracted features in 30-second epochs and trained a 3-class model to detect wake, sleep, and sleep with arousals, which was then collapsed into wake vs. sleep using a decision tree. To enhance wake detection, the model was specifically trained on randomly selected subjects with low sleep efficiency and/or high arousal index from one device recording and then tested on the remaining recordings. Results: The model showed high performance with F1 Score of 0.86, sensitivity (sleep) of 0.87, and specificity (wakefulness) of 0.78, and significant and moderate correlation to PSG in predicting total sleep time (R=0.69) and sleep efficiency (R=0.63). Model performance was robust to the presence of sleep disorders, including sleep apnea and periodic limb movements in sleep, and was consistent across all three models of accelerometer. Conclusions: We present a deep model to detect sleep-wakefulness from actigraphy in adults with relative robustness to the presence of sleep disorders and generalizability across diverse commonly used wrist accelerometers.

Dominik Luszczynski, Richard Fei Yin, Nicholas Afonin et al.

Objectives: We present and evaluate a Mamba-based deep-learning model for diagnosis and event-level characterization of sleep disordered breathing based on signals from the ANNE One, a non-intrusive dual-module wireless wearable system measuring chest electrocardiography, triaxial accelerometry, chest and finger temperature, and finger phototplethysmography. Methods: We obtained concurrent PSG and wearable sensor recordings from 384 adults attending a tertiary care sleep laboratory. Respiratory events in the PSG were manually annotated in accordance with AASM guidelines. Wearable sensor and PSG recordings were automatically aligned based on the ECG signal, alignment confirmed by visual inspection, and PSG-derived respiratory event labels were used to train and evaluate a deep sequential neural network based on the Mamba architecture. Results: In 57 recordings in our test set (mean age 56, mean AHI 10.8, 43.86\% female) the model-predicted AHI was highly correlated with that derived form the PSG labels (R=0.95, p=8.3e-30, men absolute error 2.83). This performance did not vary with age or sex. At a threshold of AHI$>$5, the model had a sensitivity of 0.96, specificity of 0.87, and kappa of 0.82, and at a threshold of AHI$>$15, the model had a sensitivity of 0.86, specificity of 0.98, and kappa of 0.85. At the level of 30-sec epochs, the model had a sensitivity of 0.93 and specificity of 0.95, with a kappa of 0.68 regarding whether any given epoch contained a respiratory event. Conclusions: Applied to data from the ANNE One, a Mamba-based deep learning model can accurately predict AHI and identify SDB at clinically relevant thresholds, achieves good epoch- and event-level identification of individual respiratory events, and shows promise at physiological characterization of these events including event type (central vs. other) and event duration.

Andrew H. Zhang, Alex He-Mo, Richard Fei Yin et al.

Study Objectives: We investigate a Mamba-based deep learning approach for sleep staging on signals from ANNE One (Sibel Health, Evanston, IL), a non-intrusive dual-module wireless wearable system measuring chest electrocardiography (ECG), triaxial accelerometry, and chest temperature, and finger photoplethysmography and finger temperature. Methods: We obtained wearable sensor recordings from 357 adults undergoing concurrent polysomnography (PSG) at a tertiary care sleep lab. Each PSG recording was manually scored and these annotations served as ground truth labels for training and evaluation of our models. PSG and wearable sensor data were automatically aligned using their ECG channels with manual confirmation by visual inspection. We trained a Mamba-based recurrent neural network architecture on these recordings. Ensembling of model variants with similar architectures was performed. Results: After ensembling, the model attains a 3-class (wake, non rapid eye movement [NREM] sleep, rapid eye movement [REM] sleep) balanced accuracy of 84.02%, F1 score of 84.23%, Cohen's $κ$ of 72.89%, and a Matthews correlation coefficient (MCC) score of 73.00%; a 4-class (wake, light NREM [N1/N2], deep NREM [N3], REM) balanced accuracy of 75.30%, F1 score of 74.10%, Cohen's $κ$ of 61.51%, and MCC score of 61.95%; a 5-class (wake, N1, N2, N3, REM) balanced accuracy of 65.11%, F1 score of 66.15%, Cohen's $κ$ of 53.23%, MCC score of 54.38%. Conclusions: Our Mamba-based deep learning model can successfully infer major sleep stages from the ANNE One, a wearable system without electroencephalography (EEG), and can be applied to data from adults attending a tertiary care sleep clinic.