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.

Polysomnography signals are highly heterogeneous, varying in modality composition (e.g., EEG, EOG, ECG), channel availability (e.g., frontal, occipital EEG), and acquisition protocols across datasets and clinical sites. Most existing models that process polysomnography data rely on a fixed subset of modalities or channels and therefore neglect to fully exploit its inherently multimodal nature. We address this limitation by introducing NAP (Neural Aggregator of Predictions), an attention-based model which learns to combine multiple prediction streams using a tri-axial attention mechanism that captures temporal, spatial, and predictor-level dependencies. NAP is trained to adapt to different input dimensions. By aggregating outputs from frozen, pretrained single-channel models, NAP consistently outperforms individual predictors and simple ensembles, achieving state-of-the-art zero-shot generalization across multiple datasets. While demonstrated in the context of automated sleep staging from polysomnography, the proposed approach could be extended to other multimodal physiological applications.

Sleep apnea is a serious sleep-related breathing disorder that is common and can impact health if left untreated. Currently the traditional method for screening and diagnosis is overnight polysomnography. Polysomnography is expensive and takes a lot of time, and is not practical for screening large groups of people. In this paper, we explored a more accessible option, using respiratory audio recordings to spot signs of apnea.We utilized 18 audio files.The approach involved converting breathing sounds into spectrograms, balancing the dataset by oversampling apnea segments, and applying class weights to reduce bias toward the majority class. The model reached a recall of 90.55 for apnea detection. Intentionally, prioritizing catching apnea events over general accuracy. Despite low precision,the high recall suggests potential as a low-cost screening tool that could be used at home or in basic clinical setups, potentially helping identify at-risk individuals much earlier.

Sleep apnea, a prevalent sleep disorder, involves repeated episodes of breathing interruptions during sleep, leading to various health complications, including cognitive impairments, high blood pressure, heart disease, stroke, and even death. One of the main challenges in diagnosing and treating sleep apnea is identifying individuals at risk. The current gold standard for diagnosis, Polysomnography (PSG), is costly, labor intensive, and inconvenient, often resulting in poor quality sleep data. This paper presents a novel approach to the detection of sleep apnea using a Convolutional Neural Network (CNN) trained on single channel EEG data. The proposed CNN achieved an accuracy of 85.1% and a Matthews Correlation Coefficient (MCC) of 0.22, demonstrating a significant potential for home based applications by addressing the limitations of PSG in automated sleep apnea detection. Key contributions of this work also include the development of a comprehensive preprocessing pipeline with an Infinite Impulse Response (IIR) Butterworth filter, a dataset construction method providing broader temporal context, and the application of SMOTETomek to address class imbalance. This research underscores the feasibility of transitioning from traditional laboratory based diagnostics to more accessible, automated home based solutions, improving patient outcomes and broadening the accessibility of sleep disorder diagnostics.

This study proposes a novel lightweight neural network model leveraging features extracted from electrocardiogram (ECG) and respiratory signals for early OSA screening. ECG signals are used to generate feature spectrograms to predict sleep stages, while respiratory signals are employed to detect sleep-related breathing abnormalities. By integrating these predictions, the method calculates the apnea-hypopnea index (AHI) with enhanced accuracy, facilitating precise OSA diagnosis. The method was validated on three publicly available sleep apnea databases: the Apnea-ECG database, the UCDDB dataset, and the MIT-BIH Polysomnographic database. Results showed an overall OSA detection accuracy of 0.978, highlighting the model's robustness. Respiratory event classification achieved an accuracy of 0.969 and an area under the receiver operating characteristic curve (ROC-AUC) of 0.98. For sleep stage classification, in UCDDB dataset, the ROC-AUC exceeded 0.85 across all stages, with recall for Sleep reaching 0.906 and specificity for REM and Wake states at 0.956 and 0.937, respectively. This study underscores the potential of integrating lightweight neural networks with multi-signal analysis for accurate, portable, and cost-effective OSA screening, paving the way for broader adoption in home-based and wearable health monitoring systems.

The appreciation and utilisation of risk and uncertainty can play a key role in helping to solve some of the many ethical issues that are posed by AI. Understanding the uncertainties can allow algorithms to make better decisions by providing interrogatable avenues to check the correctness of outputs. Allowing algorithms to deal with variability and ambiguity with their inputs means they do not need to force people into uncomfortable classifications. Provenance enables algorithms to know what they know preventing possible harms. Additionally, uncertainty about provenance highlights the trustworthiness of algorithms. It is essential to compute with what we know rather than make assumptions that may be unjustified or untenable. This paper provides a perspective on the need for the importance of risk and uncertainty in the development of ethical AI, especially in high-risk scenarios. It argues that the handling of uncertainty, especially epistemic uncertainty, is critical to ensuring that algorithms do not cause harm and are trustworthy and ensure that the decisions that they make are humane.

Continuous monitoring and accurate detection of complex sleep patterns associated to different sleep-related conditions is essential, not only for enhancing sleep quality but also for preventing the risk of developing chronic illnesses associated to unhealthy sleep. Despite significant advances in research, achieving versatile recognition of various unhealthy and sub-healthy sleep patterns with simple wearable devices at home remains a significant challenge. Here, we report a robust and durable ultrasensitive strain sensor array printed on a smart garment, in its collar region. This solution allows detecting subtle vibrations associated with multiple sleep patterns at the extrinsic laryngeal muscles. Equipped with a deep learning neural network, it can precisely identify six sleep states-nasal breathing, mouth breathing, snoring, bruxism, central sleep apnea (CSA), and obstructive sleep apnea (OSA)-with an impressive accuracy of 98.6%, all without requiring specific positioning. We further demonstrate its explainability and generalization capabilities in practical applications. Explainable artificial intelligence (XAI) visualizations reflect comprehensive signal pattern analysis with low bias. Transfer learning tests show that the system can achieve high accuracy (overall accuracy of 95%) on new users with very few-shot learning (less than 15 samples per class). The scalable manufacturing process, robustness, high accuracy, and excellent generalization of the smart garment make it a promising tool for next-generation continuous sleep monitoring.

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.

Cardiovascular diseases (CVDs) are notably prevalent among patients with obstructive sleep apnea (OSA), posing unique challenges in predicting CVD progression due to the intricate interactions of comorbidities. Traditional models typically lack the necessary dynamic and longitudinal scope to accurately forecast CVD trajectories in OSA patients. This study introduces a novel multi-level phenotypic model to analyze the progression and interplay of these conditions over time, utilizing data from the Wisconsin Sleep Cohort, which includes 1,123 participants followed for decades. Our methodology comprises three advanced steps: (1) Conducting feature importance analysis through tree-based models to underscore critical predictive variables like total cholesterol, low-density lipoprotein (LDL), and diabetes. (2) Developing a logistic mixed-effects model (LGMM) to track longitudinal transitions and pinpoint significant factors, which displayed a diagnostic accuracy of 0.9556. (3) Implementing t-distributed Stochastic Neighbor Embedding (t-SNE) alongside Gaussian Mixture Models (GMM) to segment patient data into distinct phenotypic clusters that reflect varied risk profiles and disease progression pathways. This phenotypic clustering revealed two main groups, with one showing a markedly increased risk of major adverse cardiovascular events (MACEs), underscored by the significant predictive role of nocturnal hypoxia and sympathetic nervous system activity from sleep data. Analysis of transitions and trajectories with t-SNE and GMM highlighted different progression rates within the cohort, with one cluster progressing more slowly towards severe CVD states than the other. This study offers a comprehensive understanding of the dynamic relationship between CVD and OSA, providing valuable tools for predicting disease onset and tailoring treatment approaches.

The ability to assess sleep at home, capture sleep stages, and detect the occurrence of apnea (without on-body sensors) simply by analyzing the radio waves bouncing off people's bodies while they sleep is quite powerful. Such a capability would allow for longitudinal data collection in patients' homes, informing our understanding of sleep and its interaction with various diseases and their therapeutic responses, both in clinical trials and routine care. In this article, we develop an advanced machine learning algorithm for passively monitoring sleep and nocturnal breathing from radio waves reflected off people while asleep. Validation results in comparison with the gold standard (i.e., polysomnography) (n=849) demonstrate that the model captures the sleep hypnogram (with an accuracy of 81% for 30-second epochs categorized into Wake, Light Sleep, Deep Sleep, or REM), detects sleep apnea (AUROC = 0.88), and measures the patient's Apnea-Hypopnea Index (ICC=0.95; 95% CI = [0.93, 0.97]). Notably, the model exhibits equitable performance across race, sex, and age. Moreover, the model uncovers informative interactions between sleep stages and a range of diseases including neurological, psychiatric, cardiovascular, and immunological disorders. These findings not only hold promise for clinical practice and interventional trials but also underscore the significance of sleep as a fundamental component in understanding and managing various diseases.