Sleep profoundly affects our health, and sleep deficiency or disorders can cause physical and mental problems. Despite significant findings from previous studies, challenges persist in optimizing deep learning models, especially in multi-modal learning for high-accuracy sleep stage classification. Our research introduces MC2SleepNet (Multi-modal Cross-masking with Contrastive learning for Sleep stage classification Network). It aims to facilitate the effective collaboration between Convolutional Neural Networks (CNNs) and Transformer architectures for multi-modal training with the help of contrastive learning and cross-masking. Raw single channel EEG signals and corresponding spectrogram data provide differently characterized modalities for multi-modal learning. Our MC2SleepNet has achieved state-of-the-art performance with an accuracy of both 84.6% on the SleepEDF-78 and 88.6% accuracy on the Sleep Heart Health Study (SHHS). These results demonstrate the effective generalization of our proposed network across both small and large datasets.

Sleep monitoring plays a crucial role in maintaining good health, with sleep staging serving as an essential metric in the monitoring process. Traditional methods, utilizing medical sensors like EEG and ECG, can be effective but often present challenges such as unnatural user experience, complex deployment, and high costs. Ballistocardiography~(BCG), a type of piezoelectric sensor signal, offers a non-invasive, user-friendly, and easily deployable alternative for long-term home monitoring. However, reliable BCG-based sleep staging is challenging due to the limited sleep monitoring data available for BCG. A restricted training dataset prevents the model from generalization across populations. Additionally, transferring to BCG faces difficulty ensuring model robustness when migrating from other data sources. To address these issues, we introduce SleepNetZero, a zero-shot learning based approach for sleep staging. To tackle the generalization challenge, we propose a series of BCG feature extraction methods that align BCG components with corresponding respiratory, cardiac, and movement channels in PSG. This allows models to be trained on large-scale PSG datasets that are diverse in population. For the migration challenge, we employ data augmentation techniques, significantly enhancing generalizability. We conducted extensive training and testing on large datasets~(12393 records from 9637 different subjects), achieving an accuracy of 0.803 and a Cohen's Kappa of 0.718. ZeroSleepNet was also deployed in real prototype~(monitoring pads) and tested in actual hospital settings~(265 users), demonstrating an accuracy of 0.697 and a Cohen's Kappa of 0.589. To the best of our knowledge, this work represents the first known reliable BCG-based sleep staging effort and marks a significant step towards in-home health monitoring.

Traditional sleep staging categorizes sleep and wakefulness into five coarse-grained classes, overlooking subtle variations within each stage. It provides limited information about the probability of arousal and may hinder the diagnosis of sleep disorders, such as insomnia. To address this issue, we propose a deep-learning method for automatic and scalable annotation of sleep depth index using existing sleep staging labels. Our approach is validated using polysomnography from over ten thousand recordings across four large-scale cohorts. The results show a strong correlation between the decrease in sleep depth index and the increase in arousal likelihood. Several case studies indicate that the sleep depth index captures more nuanced sleep structures than conventional sleep staging. Sleep biomarkers extracted from the whole-night sleep depth index exhibit statistically significant differences with medium-to-large effect sizes across groups of varied subjective sleep quality and insomnia symptoms. These sleep biomarkers also promise utility in predicting the severity of obstructive sleep apnea, particularly in severe cases. Our study underscores the utility of the proposed method for continuous sleep depth annotation, which could reveal more detailed structures and dynamics within whole-night sleep and yield novel digital biomarkers beneficial for sleep health.

Obstructive sleep apnea (OSA) is frequent and responsible for cardiovascular complications and excessive daytime sleepiness. It is underdiagnosed due to the difficulty to access the gold standard for diagnosis, polysomnography (PSG). Alternative methods using smartphone sensors could be useful to increase diagnosis. The objective is to assess the performances of Apneal, an application that records the sound using a smartphone's microphone and movements thanks to a smartphone's accelerometer and gyroscope, to estimate patients' AHI. In this article, we perform a monocentric proof-of-concept study with a first manual scoring step, and then an automatic detection of respiratory events from the recorded signals using a sequential deep-learning model which was released internally at Apneal at the end of 2022 (version 0.1 of Apneal automatic scoring of respiratory events), in adult patients during in-hospital polysomnography.46 patients (women 34 per cent, mean BMI 28.7 kg per m2) were included. For AHI superior to 15, sensitivity of manual scoring was 0.91, and positive predictive value (PPV) 0.89. For AHI superior to 30, sensitivity was 0.85, PPV 0.94. We obtained an AUC-ROC of 0.85 and an AUC-PR of 0.94 for the identification of AHI superior to 15, and AUC-ROC of 0.95 and AUC-PR of 0.93 for AHI superior to 30. Promising results are obtained for the automatic annotations of events.This article shows that manual scoring of smartphone-based signals is possible and accurate compared to PSG-based scorings. Automatic scoring method based on a deep learning model provides promising results. A larger multicentric validation study, involving subjects with different SAHS severity is required to confirm these results.

The progression of deep learning and the widespread adoption of sensors have facilitated automatic multi-view fusion (MVF) about the cardiovascular system (CVS) signals. However, prevalent MVF model architecture often amalgamates CVS signals from the same temporal step but different views into a unified representation, disregarding the asynchronous nature of cardiovascular events and the inherent heterogeneity across views, leading to catastrophic view confusion. Efficient training strategies specifically tailored for MVF models to attain comprehensive representations need simultaneous consideration. Crucially, real-world data frequently arrives with incomplete views, an aspect rarely noticed by researchers. Thus, the View-Centric Transformer (VCT) and Multitask Masked Autoencoder (M2AE) are specifically designed to emphasize the centrality of each view and harness unlabeled data to achieve superior fused representations. Additionally, we systematically define the missing-view problem for the first time and introduce prompt techniques to aid pretrained MVF models in flexibly adapting to various missing-view scenarios. Rigorous experiments involving atrial fibrillation detection, blood pressure estimation, and sleep staging-typical health monitoring tasks-demonstrate the remarkable advantage of our method in MVF compared to prevailing methodologies. Notably, the prompt technique requires finetuning less than 3% of the entire model's data, substantially fortifying the model's resilience to view missing while circumventing the need for complete retraining. The results demonstrate the effectiveness of our approaches, highlighting their potential for practical applications in cardiovascular health monitoring. Codes and models are released at URL.

Monitoring sleep states is essential for evaluating sleep quality and diagnosing sleep disorders. Traditional manual staging is time-consuming and prone to subjective bias, often resulting in inconsistent outcomes. Here, we developed an automated model for sleep staging and disorder classification to enhance diagnostic accuracy and efficiency. Considering the characteristics of polysomnography (PSG) multi-lead sleep monitoring, we designed a multimodal sleep state classification model, MSSC-BiMamba, that combines an Efficient Channel Attention (ECA) mechanism with a Bidirectional State Space Model (BSSM). The ECA module allows for weighting data from different sensor channels, thereby amplifying the influence of diverse sensor inputs. Additionally, the implementation of bidirectional Mamba (BiMamba) enables the model to effectively capture the multidimensional features and long-range dependencies of PSG data. The developed model demonstrated impressive performance on sleep stage classification tasks on both the ISRUC-S3 and ISRUC-S1 datasets, respectively containing data with healthy and unhealthy sleep patterns. Also, the model exhibited a high accuracy for sleep health prediction when evaluated on a combined dataset consisting of ISRUC and Sleep-EDF. Our model, which can effectively handle diverse sleep conditions, is the first to apply BiMamba to sleep staging with multimodal PSG data, showing substantial gains in computational and memory efficiency over traditional Transformer-style models. This method enhances sleep health management by making monitoring more accessible and extending advanced healthcare through innovative technology.

Sleep is a complex physiological process evaluated through various modalities recording electrical brain, cardiac, and respiratory activities. We curate a large polysomnography dataset from over 14,000 participants comprising over 100,000 hours of multi-modal sleep recordings. Leveraging this extensive dataset, we developed SleepFM, the first multi-modal foundation model for sleep analysis. We show that a novel leave-one-out approach for contrastive learning significantly improves downstream task performance compared to representations from standard pairwise contrastive learning. A logistic regression model trained on SleepFM's learned embeddings outperforms an end-to-end trained convolutional neural network (CNN) on sleep stage classification (macro AUROC 0.88 vs 0.72 and macro AUPRC 0.72 vs 0.48) and sleep disordered breathing detection (AUROC 0.85 vs 0.69 and AUPRC 0.77 vs 0.61). Notably, the learned embeddings achieve 48% top-1 average accuracy in retrieving the corresponding recording clips of other modalities from 90,000 candidates. This work demonstrates the value of holistic multi-modal sleep modeling to fully capture the richness of sleep recordings. SleepFM is open source and available at https://github.com/rthapa84/sleepfm-codebase.

Sleep staging is a clinically important task for diagnosing various sleep disorders, but remains challenging to deploy at scale because it because it is both labor-intensive and time-consuming. Supervised deep learning-based approaches can automate sleep staging but at the expense of large labeled datasets, which can be unfeasible to procure for various settings, e.g., uncommon sleep disorders. While self-supervised learning (SSL) can mitigate this need, recent studies on SSL for sleep staging have shown performance gains saturate after training with labeled data from only tens of subjects, hence are unable to match peak performance attained with larger datasets. We hypothesize that the rapid saturation stems from applying a sub-optimal pretraining scheme that pretrains only a portion of the architecture, i.e., the feature encoder, but not the temporal encoder; therefore, we propose adopting an architecture that seamlessly couples the feature and temporal encoding and a suitable pretraining scheme that pretrains the entire model. On a sample sleep staging dataset, we find that the proposed scheme offers performance gains that do not saturate with amount of labeled training data (e.g., 3-5\% improvement in balanced sleep staging accuracy across low- to high-labeled data settings), reducing the amount of labeled training data needed for high performance (e.g., by 800 subjects). Based on our findings, we recommend adopting this SSL paradigm for subsequent work on SSL for sleep staging.

Analyzing electroencephalographic (EEG) time series can be challenging, especially with deep neural networks, due to the large variability among human subjects and often small datasets. To address these challenges, various strategies, such as self-supervised learning, have been suggested, but they typically rely on extensive empirical datasets. Inspired by recent advances in computer vision, we propose a pretraining task termed "frequency pretraining" to pretrain a neural network for sleep staging by predicting the frequency content of randomly generated synthetic time series. Our experiments demonstrate that our method surpasses fully supervised learning in scenarios with limited data and few subjects, and matches its performance in regimes with many subjects. Furthermore, our results underline the relevance of frequency information for sleep stage scoring, while also demonstrating that deep neural networks utilize information beyond frequencies to enhance sleep staging performance, which is consistent with previous research. We anticipate that our approach will be advantageous across a broad spectrum of applications where EEG data is limited or derived from a small number of subjects, including the domain of brain-computer interfaces.

Study Objectives: Polysomnography (PSG) currently serves as the benchmark for evaluating sleep disorders. Its discomfort, impracticality for home-use, and introduction of bias in sleep quality assessment necessitate the exploration of less invasive, cost-effective, and portable alternatives. One promising contender is the in-ear-EEG sensor, which offers advantages in terms of comfort, fixed electrode positions, resistance to electromagnetic interference, and user-friendliness. This study aims to establish a methodology to assess the similarity between the in-ear-EEG signal and standard PSG. Methods: We assess the agreement between the PSG and in-ear-EEG derived hypnograms. We extract features in the time- and frequency- domain from PSG and in-ear-EEG 30-second epochs. We only consider the epochs where the PSG-scorers and the in-ear-EEG-scorers were in agreement. We introduce a methodology to quantify the similarity between PSG derivations and the single-channel in-ear-EEG. The approach relies on a comparison of distributions of selected features -- extracted for each sleep stage and subject on both PSG and the in-ear-EEG signals -- via a Jensen-Shannon Divergence Feature-based Similarity Index (JSD-FSI). Results: We found a high intra-scorer variability, mainly due to the uncertainty the scorers had in evaluating the in-ear-EEG signals. We show that the similarity between PSG and in-ear-EEG signals is high (JSD-FSI: 0.61 +/- 0.06 in awake, 0.60 +/- 0.07 in NREM and 0.51 +/- 0.08 in REM), and in line with the similarity values computed independently on standard PSG-channel-combinations. Conclusions: In-ear-EEG is a valuable solution for home-based sleep monitoring, however further studies with a larger and more heterogeneous dataset are needed.