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      Sleep staging using nocturnal sound analysis

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      1 , , 2 , 1
      Scientific Reports
      Nature Publishing Group UK

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          Abstract

          Sleep staging is essential for evaluating sleep and its disorders. Most sleep studies today incorporate contact sensors that may interfere with natural sleep and may bias results. Moreover, the availability of sleep studies is limited, and many people with sleep disorders remain undiagnosed. Here, we present a pioneering approach for rapid eye movement (REM), non-REM, and wake staging (macro-sleep stages, MSS) estimation based on sleep sounds analysis. Our working hypothesis is that the properties of sleep sounds, such as breathing and movement, within each MSS are different. We recorded audio signals, using non-contact microphones, of 250 patients referred to a polysomnography (PSG) study in a sleep laboratory. We trained an ensemble of one-layer, feedforward neural network classifiers fed by time-series of sleep sounds to produce real-time and offline analyses. The audio-based system was validated and produced an epoch-by-epoch (standard 30-sec segments) agreement with PSG of 87% with Cohen’s kappa of 0.7. This study shows the potential of audio signal analysis as a simple, convenient, and reliable MSS estimation without contact sensors.

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          Most cited references40

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          Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine.

          Based on a review of literature and consensus, the Portable Monitoring Task Force of the American Academy of Sleep Medicine (AASM) makes the following recommendations: unattended portable monitoring (PM) for the diagnosis of obstructive sleep apnea (OSA) should be performed only in conjunction with a comprehensive sleep evaluation. Clinical sleep evaluations using PM must be supervised by a practitioner with board certification in sleep medicine or an individual who fulfills the eligibility criteria for the sleep medicine certification examination. PM may be used as an alternative to polysomnography (PSG) for the diagnosis of OSA in patients with a high pretest probability of moderate to severe OSA. PM is not appropriate for the diagnosis of OSA in patients with significant comorbid medical conditions that may degrade the accuracy of PM. PM is not appropriate for the diagnostic evaluation of patients suspected of having comorbid sleep disorders. PM is not appropriate for general screening of asymptomatic populations. PM may be indicated for the diagnosis of OSA in patients for whom in-laboratory PSG is not possible by virtue of immobility, safety, or critical illness. PM may also be indicated to monitor the response to non-CPAP treatments for sleep apnea. At a minimum, PM must record airflow, respiratory effort, and blood oxygenation. The airflow, effort, and oximetric biosensors conventionally used for in-laboratory PSG should be used in PM. The Task Force recommends that PM testing be performed under the auspices of an AASM-accredited comprehensive sleep medicine program with written policies and procedures. An experienced sleep technologist/technician must apply the sensors or directly educate patients in sensor application. The PM device must allow for display of raw data with the capability of manual scoring or editing of automated scoring by a qualified sleep technician/technologist. A board certified sleep specialist, or an individual who fulfills the eligibility criteria for the sleep medicine certification examination, must review the raw data from PM using scoring criteria consistent with current published AASM standards. Under the conditions specified above, PM may be used for unattended studies in the patient's home. Afollow-up visit to review test results should be performed for all patients undergoing PM. Negative or technically inadequate PM tests in patients with a high pretest probability of moderate to severe OSA should prompt in-laboratory polysomnography.
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            Associations of frequent sleep insufficiency with health-related quality of life and health behaviors.

            Sleep-related problems, which affect 50-70 million Americans, involve all areas of life, including cognitive performance, emotional well-being, work and leisure-time activities, and general physical and mental well-being. We examined the association of insufficient sleep with health-related quality of life (HRQOL) and health behaviors. Data were obtained from the Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit telephone survey of the non-institutionalized US population aged >or =18 years. In 2002, HRQOL measures were administered in 18 states and the District of Columbia, yielding complete responses to questions regarding sleep and demographic characteristics from 98% of study participants (n=79,625). An estimated 26% of adults reported frequent (> or =14 days in the past 30 days) sleep insufficiency. They were significantly more likely than those without frequent sleep insufficiency to report fair/poor general health, frequent physical distress, frequent mental distress, activity limitations, depressive symptoms, anxiety, and pain. In addition, they were significantly more likely to smoke, to be physically inactive, to be obese, and, among men, to drink heavily. Insufficient sleep is associated with a variety of adverse health behaviors and impairment in all HRQOL domains investigated. Accordingly, assessment of sleep appears to be an important component of general medical care. Moreover, expanded assessment of sleep in the general population may provide a better understanding of prevalence of impaired sleep and its many implications.
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              Access to diagnosis and treatment of patients with suspected sleep apnea.

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                Author and article information

                Contributors
                elirandafna@gmail.com
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                7 September 2018
                7 September 2018
                2018
                : 8
                : 13474
                Affiliations
                [1 ]ISNI 0000 0004 1937 0511, GRID grid.7489.2, Department of Biomedical Engineering, Faculty of Engineering, , Ben-Gurion University of the Negev, ; Beer–Sheva, Israel
                [2 ]Sleep-Wake Disorders Unit, Soroka University Medical Center, and Department of Physiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer–Sheva, Israel
                Article
                31748
                10.1038/s41598-018-31748-0
                6128888
                30194402
                810069b5-f6e8-4414-82d7-6c134dc7c2c1
                © The Author(s) 2018

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 22 February 2018
                : 22 August 2018
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