Automatic sleep staging from single-channel electroencephalography (EEG) using artificial intelligence (AI) is emerging as an alternative to costly and time-consuming manual scoring using multi-channel polysomnography. However, current AI methods, mainly deep learning models such as convolutional neural network (CNN) and long short-term memory (LSTM), struggle to detect the N1 sleep stage, which is challenging due to its rarity and ambiguous nature compared to other stages. Here we propose SSC-SleepNet, an automatic sleep staging algorithm aimed at improving the learning of N1 sleep. SSC-SleepNet employs a pseudo-Siamese neural network architecture owing to its capability in one- or few-shot learning with contrastive loss. SSC-SleepNet consists of two branches of neural networks: a squeeze-and-excitation residual network branch and a CNN-LSTM branch. These two branches are used to generate latent features of the EEG epoch. The adaptive loss function of SSC-SleepNet uses a weighing factor to combine weighted cross-entropy loss and focal loss to specifically address the class imbalance issue inherent in sleep staging. The proposed new loss function dynamically assigns a higher penalty to misclassified N1 sleep stages, which can improve the model's learning capability for this minority class. Four datasets were used for sleep staging experiments. In the Sleep-EDF-SC, Sleep-EDF-X, Sleep Heart Health Study, and Haaglanden Medisch Centrum datasets, SSC-SleepNet achieved macro F1-scores of 84.5%, 89.6%, 89.5%, and 85.4% for all sleep stages, and N1 sleep stage F1-scores of 60.2%, 58.3%, 57.8%, and 55.2%, respectively. Our proposed deep learning model outperformed most existing models in automatic sleep staging using single-channel EEG signals. In particular, N1 detection performance has been markedly improved compared to the state-of-the-art models.

Video-based actigraphy is a non-contact technology that measures body movement through video recordings, commonly expressed as activity count. It has been widely used to assess infant sleep. One validated method for video-based actigraphy is the three-dimensional recursive search (3DRS). However, its sleep-wake classification performance in preterm infants is only moderately satisfactory, necessitating methods to improve it. This paper proposes an enhanced approach to compute activity count for video-based actigraphy in evaluating sleep patterns in preterm infants. The proposed technique involves applying exponentially weighted moving average (EWMA) to continuous activity count to reduce abrupt variations and false detection of wakefulness. Additionally, the 3DRS protocol we previously utilized is proprietary, limiting its accessibility to the public and its widespread adoption. To overcome this limitation, we have investigated the efficacy of an open-source algorithm known as background subtraction (BS), which, in our previous work, has demonstrated superior performance in body motion detection in preterm infants. To evaluate the performance of the proposed method, a dataset consisting of video recordings from five hospitalized preterm infants was used. The activity counts obtained from 3DRS, and BS were compared in terms of their ability to classify sleep and wake states using a linear discriminant classifier. The results obtained through leave-one-patient-out cross-validation revealed a significant improvement in the classification of sleep and wake states in preterm infants for both methods when the EWMA were applied to the activity counts. The mean Cohen's kappa coefficients were found to be 0.58 for 3DRS and 0.51 for BS. Despite BS exhibited comparatively lower performance than 3DRS, it can still be considered a viable alternative for acquiring video-based actigraphy data in the assessment of sleep of preterm infants.

The aim of this study is to develop an explainable late-onset sepsis (LOS) prediction algorithm using continuous multi-channel physiological signals that can be applied to a patient monitor for preterm infants in a neonatal intensive care unit (NICU). The algorithm uses features on heart rate variability (HRV), respiration, and motion, based on electrocardiogram (ECG) and chest impedance (CI). In this study, 127 preterm infants were included, of whom 59 were bloodculture-proven LOS patients and 68 were control patients. Features in 24 hours before the onset of sepsis (LOS group), and an age-matched onset time point (control group) were extracted and fed into machine learning classifiers with gestational age and birth weight. We compared the prediction performance of several well-known classifiers using features from different signal channels (HRV, respiration, and motion) individually as well as their combinations. The prediction performance was evaluated using the area under the receiver-operating-characteristics curve (AUC). The best performance was achieved by an extreme gradient boosting classifier combining features from all signal channels, with an AUC of 0.88, a positive predictive value of 0.80, and a negative predictive value of 0.83 during the 6 hours preceding LOS onset. This feasibility study demonstrates the complementary predictive value of motion information in addition to cardiorespiratory information for LOS prediction. Furthermore, visualization of how each feature in the individual patient impacts the algorithm decision strengthen its interpretability. In clinical practice, it is important to motivate clinical interventions and this visualization method can help to support the clinical decision.

Sleep is a natural phenomenon controlled by the central nervous system. The sleep-wake pattern, which functions as an essential indicator of neurophysiological organization in the neonatal period, has profound meaning in the prediction of cognitive diseases and brain maturity. In recent years, unobtrusive sleep monitoring and automatic sleep staging have been intensively studied for adults, but much less for neonates. This work aims to investigate a novel video-based unobtrusive method for neonatal sleep-wake classification by analyzing the behavioral changes in the neonatal facial region. A hybrid model is proposed to monitor the sleep-wake patterns of human neonates. The model combines two algorithms: deep convolutional neural network (DCNN) and support vector machine (SVM), where DCNN works as a trainable feature extractor and SVM as a classifier. Data was collected from nineteen Chinese neonates at the Children's Hospital of Fudan University, Shanghai, China. The classification results are compared with the gold standard of video-electroencephalography scored by pediatric neurologists. Validations indicate that the proposed hybrid DCNN-SVM model achieved reliable performances in classifying neonatal sleep and wake states in RGB video frames (with the face region detected), with an accuracy of 93.8 ± 2.2% and an F1-score 0.93 ± 0.3.

This paper presents an actigraphy-based approach for sleep/wake detection for insomniacs. Due to its relative unobtrusiveness, actigraphy is often used to estimate overnight sleep-wake patterns in clinical practice. However, its performance has been shown to be limited in subjects with sleep complaints such as insomniacs. Quantifying activity counts on 30-s epoch basis, as usually done in regular actigraphy, may lead to an underestimation of wake periods where the subject shows reduced body movements. We therefore propose a new actigraphic feature to characterize the `possibility' of epochs being asleep (or awake) before or after its nearest epoch with a very high activity levels. It is expected to correctly identify some wake epochs when they are very close to the high activity epochs, although they can be motionless. A data set containing 25 insomnia subjects and a linear discriminant classifier were used to test our approach in this study. Leave-one-subject-out cross validation results show that combining the new and the traditional actigraphic features led to a markedly improved performance in sleep/wake detection compared to that using the traditional feature only, with an increase in Cohen's kappa from 0.49 to 0.55.

This paper explores the probabilistic properties of sleep stage sequences and transitions to improve the performance of sleep stage detection using cardiorespiratory features. A new classifier, based on conditional random fields, is used in different sleep stage detection tasks (N3, NREM, REM, and wake) in night-time recordings of electrocardiogram and respiratory inductance plethysmography of healthy subjects. Using a dataset of 342 polysomnographic recordings of healthy subjects, among which 135 with regular sleep architecture, it outperforms hidden Markov models and Bayesian linear discriminants in all tasks, achieving an average accuracy of 87.38% and kappa of 0.41 (87.27% and 0.49 for regular subjects) for N3 detection, 78.71% and 0.55 (80.34% and 0.56 for regular subjects) for NREM detection, 88.49% and 0.51 (87.35% and 0.57 for regular subjects) for REM, and 85.69% and 0.51 (90.42% and 0.52 for regular subjects) for wake. In comparison with the state of the art, and having been tested on a much larger dataset, the classifier was found to outperform most of the work reported in the literature for some of the tasks, in particular for subjects with regular sleep architecture. It achieves a comparable accuracy for N3, higher accuracy and kappa for REM, and higher accuracy and comparable kappa for NREM than the best performing classifiers described in the literature.

Human slow wave sleep (SWS) during bedtime is paramount for energy conservation and memory consolidation. This study aims at automatically detecting SWS from nocturnal sleep using cardiorespiratory signals that can be acquired with unobtrusive sensors in a home-based scenario. From the signals, time-dependent features are extracted for continuous 30-s epochs. To reduce the measuring noise, body motion artifacts, and/or within-subject variability in physiology conveyed by the features, and thus, enhance the detection performance, we propose to smooth the features over each night using a spline fitting method. In addition, it was found that the changes in cardiorespiratory activity precede the transitions between SWS and the other sleep stages (non-SWS). To this matter, a novel scheme is proposed that performs the SWS detection for each epoch using the feature values prior to that epoch. Experiments were conducted with a large dataset of 325 overnight polysomnography (PSG) recordings using a linear discriminant classifier and tenfold cross validation. Features were selected with a correlation-based method. Results show that the performance in classifying SWS and non-SWS can be significantly improved when smoothing the features and using the preceding feature values of 5-min earlier. We achieved a Cohen's Kappa coefficient of 0.57 (at an accuracy of 88.8%) using only six selected features for 257 recordings with a minimum of 30-min overnight SWS that were considered representative of their habitual sleeping pattern at home. These features included the standard deviation, low-frequency spectral power, and detrended fluctuation of heartbeat intervals as well as the variations of respiratory frequency and upper and lower respiratory envelopes. A marked drop in Kappa to 0.21 was observed for the other nights with SWS time of less than 30 min, which were found to more likely occur in elderly. This will be the future challenge in cardiorespiratory-based SWS detection.

This paper presents an active topology for power decoupling in single-phase ac-dc converters, featuring the effective suppression of low-frequency power ripple which is an inherent problem in single-phase energy conversion systems. This topology is composed of an H-bridge circuit and a ripple power-decoupling circuit. The ripple power-decoupling circuit shares one bridge arm with the H-bridge circuit so it has less additional components: just one IGBT, one diode, and an energy-storage inductor. Its modulation strategy is properly devised to coordinate the operation of decoupling circuit and H-bridge circuit. To enhance the power-decoupling performance, a direct ripple power-cancellation method based on energy-storage inductor is proposed. A multiresonant controller with feed-forward control is introduced for fast and precise current tracking. The effectiveness of this topology has been verified by detailed simulation studies as well as the laboratory prototype experiment results.

This paper proposes the use of dynamic warping (DW) methods for improving automatic sleep and wake classification using actigraphy and respiratory effort. DW is an algorithm that finds an optimal nonlinear alignment between two series allowing scaling and shifting. It is widely used to quantify (dis)similarity between two series. To compare the respiratory effort between sleep and wake states by means of (dis)similarity, we constructed two novel features based on DW. For a given epoch of a respiratory effort recording, the features search for the optimally aligned epoch within the same recording in time and frequency domain. This is expected to yield a high (or low) similarity score when this epoch is sleep (or wake). Since the comparison occurs throughout the entire-night recording of a subject, it may reduce the effects of within- and between-subject variations of the respiratory effort, and thus help discriminate between sleep and wake states. The DW-based features were evaluated using a linear discriminant classifier on a dataset of 15 healthy subjects. Results show that the DW-based features can provide a Cohen's Kappa coefficient of agreement κ = 0.59 which is significantly higher than the existing respiratory-based features and is comparable to actigraphy. After combining the actigraphy and the DW-based features, the classifier achieved a κ of 0.66 and an overall accuracy of 95.7%, outperforming an earlier actigraphy- and respiratory-based feature set ( κ = 0.62). The results are also comparable with those obtained using an actigraphy- and cardiorespiratory-based feature set but have the important advantage that they do not require an ECG signal to be recorded.

This paper describes a method to adapt the spectral features extracted from heart rate variability (HRV) for sleep and wake classification. HRV series can be derived from electrocardiogram (ECG) signals obtained from single-night polysomnography (PSG) recordings. Traditionally, the HRV spectral features are extracted from the spectrum of an HRV series with fixed boundaries specifying bands of very low frequency (VLF), low frequency (LF), and high frequency (HF). However, because they are fixed, they may fail to accurately reflect certain aspects of autonomic nervous activity, which in turn may limit their discriminative power when using HRV spectral features, e.g., in sleep and wake classification. This is in part related to the fact that the sympathetic tone (partially reflected in the LF band) and the respiratory activity (modulated in the HF band) will vary over time. In order to minimize the impact of these differences, we adapt the HRV spectral boundaries using time-frequency analysis. Experiments conducted on a dataset acquired from 15 healthy subjects show that the discriminative power of the adapted HRV spectral features are significantly increased when classifying sleep and wake. Additionally, this method also provides a significant improvement of the overall classification performance when used in combination with some other (non-spectral) HRV features.