Developing an sleep scorer by using Biosignals in Matlab.: Evaluation for sleep apnea patients.

(1)

DEGREE PROJECT, INMASTER THESIS , SECOND LEVEL STOCKHOLM, SWEDEN 2015

Developing an sleep scorer by using

Biosignals in Matlab

EVALUATION FOR SLEEP APNEA PATIENTS.

SHHS DATABASE.

IGOR ALFREDO ARROYO PORRAS

KTH ROYAL INSTITUTE OF TECHNOLOGY STH SCHOOL OF TECHNOLOGY AND HEALTH

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

15 



(17)

(18)

17 -

-

(19)

18 Figure 1. Sleep Cycle

N1

REM

Wake

N2

N3

(20)

19 



(21)

20 



(22)

21 



𝑆𝑙𝑒𝑒𝑝𝐸𝑓𝑓(%) =

𝑇𝑜𝑡𝑎𝑙 𝑆𝑙𝑒𝑒𝑝 𝑇𝑖𝑚𝑒 𝑇𝑖𝑚𝑒 𝑓𝑟𝑜𝑚 𝑠𝑙𝑒𝑒𝑝 𝑜𝑛𝑠𝑒𝑡 𝑡𝑜 𝑚𝑜𝑟𝑛𝑖𝑛𝑔 𝑤𝑎𝑘𝑖𝑛𝑔

∗ 100

(23)

(24)

23 

(25)

24 



(26)

25 

(27)

(28)

27 δ

θ

α

(29)

28 

𝑀𝐴𝑉 =

1 𝑛

∑ |𝑓(𝑘)|

𝑛 𝑘=1



(30)

29 𝑆𝑇𝐷 = 𝜎 = √

1 𝑁

∑(𝑥

𝑖

− 𝜇)

2 𝑁 𝑖=1

𝜇 =

1 𝑁

∑ 𝑥

𝑖 𝑛 𝑖=1



𝑍𝐶𝑅 =

1 𝑇 − 1

∑ 𝑆𝑖𝑔𝑛(𝑠

𝑡

∗ 𝑠

𝑡−1

)

𝑇−1 𝑡=1

(31)

30 𝑘 =

𝑂𝑏𝑠𝑒𝑟𝑣𝑒𝑑 𝑎𝑔𝑟𝑒𝑒𝑚𝑒𝑛𝑡−𝐴𝑔𝑟𝑒𝑒𝑚𝑒𝑛𝑡 𝑏𝑦 𝑐ℎ𝑎𝑛𝑐𝑒

1−𝐴𝑔𝑟𝑒𝑒𝑚𝑒𝑛𝑡 𝑏𝑦 𝑐ℎ𝑎𝑛𝑐𝑒

𝑘 =

𝑃

𝑜

− 𝑃

𝑐

1 − 𝑃

𝑐

(32)

(33)

32 (𝑇𝑃𝑅)

𝑇𝑃𝑅 =

𝑇𝑟𝑢𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 (𝑇𝑃) 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 (𝑃)

.

(𝑆𝑃𝐶)

𝑆𝑃𝐶 =

𝑇𝑟𝑢𝑒 𝑛𝑒𝑔𝑎𝑡𝑖𝑣𝑒𝑠 (𝑇𝑁) 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒𝑠 (𝑁)

𝑃𝑃𝑉 =

𝑇𝑟𝑢𝑒 𝑝𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 (𝑇𝑃) 𝑇𝑟𝑢𝑒 𝑝𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 (𝑇𝑃) + 𝐹𝑎𝑙𝑠𝑒 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒𝑠 (𝐹𝑁)

.

𝐹𝑂𝑅 =

𝐹𝑎𝑙𝑠𝑒 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒 (𝐹𝑁) 𝑇𝑟𝑢𝑒 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒𝑠 (𝑇𝑁) + 𝐹𝑎𝑙𝑠𝑒 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒𝑠 (𝐹𝑁)

𝑁𝑃𝑉 =

𝑇𝑟𝑢𝑒 𝑛𝑒𝑔𝑎𝑡𝑖𝑣𝑒 (𝑇𝑁) 𝑇𝑟𝑢𝑒 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒 (𝑇𝑁)+ 𝐹𝑎𝑙𝑠𝑒 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒 (𝐹𝑁)

.

𝐹𝑃𝑅 =

𝐹𝑎𝑙𝑠𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒 (𝐹𝑃) 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒 (𝑁)

= 1 − 𝑆𝑃𝐶.

𝐹𝐷𝑅 =

𝐹𝑎𝑙𝑠𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒 (𝐹𝑃) 𝐹𝑎𝑙𝑠𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒 (𝐹𝑃) + 𝑇𝑟𝑢𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒 (𝑇𝑃)

.

𝐹𝑁𝑅 =

𝐹𝑎𝑙𝑠𝑒 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒 (𝐹𝑁) 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒 (𝑃)

.

𝐴𝐶𝐶 =

𝑇𝑟𝑢𝑒 𝑝𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 (𝑇𝑃)+ 𝑇𝑟𝑢𝑒 𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒𝑠 (𝑇𝑁) _{𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 (𝑃)+𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒𝑠 (𝑁)}

.

(34)

33 𝑃𝑟𝑒𝑣𝑎𝑙𝑒𝑛𝑐𝑒 =

𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 (𝑃) 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 (𝑃)+𝑁𝑒𝑔𝑎𝑡𝑖𝑣𝑒𝑠 (𝑁)

(𝐿𝑅 +) =

𝑇𝑟𝑢𝑒 𝑝𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 (𝑇𝑃) 𝐹𝑎𝑙𝑠𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 (𝐹𝑃)

.

(𝐿𝑅 −) =

𝑇𝑟𝑢𝑒 𝑝𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 (𝑇𝑃) 𝐹𝑎𝑙𝑠𝑒 𝑃𝑜𝑠𝑖𝑡𝑖𝑣𝑒𝑠 (𝐹𝑃)

𝐷𝑂𝑅 =

𝐿𝑅+ 𝐿𝑅−

.

(35)

(36)

(37)

36 



(38)

37

(39)

38 

(40)

39 

(41)

40 -

-



(42)

41 



-

(43)

42

(44)

43 Figure 15. Block diagram for detection of apnea

Yes

(45)

(46)

(47)

46 -

-

(48)

47 -

-

(49)

48 𝑇ℎ𝑟𝑒𝑠ℎ𝑜𝑙𝑑 = 𝑀𝑒𝑎𝑛 (𝑠𝑖𝑔𝑛𝑎𝑙) + 𝑋 ∗ 𝑆𝑇𝐷(𝑠𝑖𝑔𝑛𝑎𝑙)

0 0,2 0,4 0,6 0,8 1 0 0,2 0,4 0,6 0,8 1 SE N SIB IL IT Y 1-SPECIFICITY

ROC ANALYSIS

(50)

(51)

(52)

51

(53)

(54)

53 (a) Normal abdominal signal. Maximums are extracted and then is calculated their MAV.

(b) Obstructive apnea episode, example of the abdominal signal. Maximums are extracted and then is

(55)

54 (a). Oxygen Saturation before low pass filtering

,

(b).Oxygen saturation after low pass filtering at 0.15Hz

Figure 27. Sao2 low pass filtering

(56)

55 Confusion matrix for Sao2 of patient 1

Confusion matrix for Sao2 of patient 11

Figure 29. Confusion Matrixes for Sao2 desaturation detection

(57)

56

- - - - - - -

(58)

57 ε

ε

(59)

(60)

(61)

(62)

(63)

(64)

(65)

64

(66)

(67)

(68)

(69)

68

PSGAnnotation> <SoftwareVersion>Compumedics</SoftwareVersion> <EpochLength>30</EpochLength> <ScoredEvents> <ScoredEvent>

<EventConcept>Recording Start Time</EventConcept> <Start>0</Start> <Duration>32520</Duration> <ClockTime>17.09.96 21.00.00</ClockTime> </ScoredEvent> <ScoredEvent> <EventConcept>SignalArtifactEvent</EventConcept> <Duration>8</Duration> <Start>1895.0</Start> <Notes>SpO2 artifact</Notes> </ScoredEvent> <ScoredEvent> <EventConcept>SignalArtifactEvent</EventConcept> <Duration>18</Duration> <Start>1995.0</Start> <Notes>SpO2 artifact</Notes> </ScoredEvent> <ScoredEvent> <EventConcept>SignalArtifactEvent</EventConcept> <Duration>3</Duration> <Start>2026.0</Start> <Notes>SpO2 artifact</Notes> </ScoredEvent> <ScoredEvent> <EventConcept>SignalArtifactEvent</EventConcept> <Duration>12</Duration> <Start>2048.0</Start> <Notes>SpO2 artifact</Notes> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:SleepArousalFinding</EventConcept> <Duration>9.6</Duration> <Start>3550.1</Start> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:SleepArousalFinding</EventConcept>

(70)

69

<Duration>8.3</Duration> <Start>3579.1</Start> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:SleepArousalFinding</EventConcept> <Duration>7.1</Duration> <Start>3632.8</Start> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:HypopneaFinding</EventConcept> <Duration>28.1</Duration> <Start>3699.4</Start> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:HemoglobinOxygenDesaturationFinding</Ev entConcept> <Duration>28.1</Duration> <Start>3729.4</Start> <SpO2Nadir>96</SpO2Nadir> <SpO2Baseline>97.0</SpO2Baseline> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:SleepArousalFinding</EventConcept> <Duration>9.3</Duration> <Start>3756.2</Start> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:SleepArousalFinding</EventConcept> <Duration>12.6</Duration> <Start>3797.5</Start> </ScoredEvent> <ScoredEvent> <ScoredEvent> <EventConcept>SDO:SleepArousalFinding</EventConcept> <Duration>8.9</Duration> <Start>4333.9</Start> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:HypopneaFinding</EventConcept> <Duration>34.1</Duration> <Start>4685.6</Start> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:HemoglobinOxygenDesaturationFinding</Ev entConcept> <Duration>34.1</Duration> <Start>4715.6</Start> <SpO2Nadir>97</SpO2Nadir> <SpO2Baseline>98.0</SpO2Baseline> </ScoredEvent> . . .

(71)

70

<ScoredEvent> <EventConcept>SDO:WakeState</EventConcept> <Start>0.0</Start> <Duration>3390.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:NonRapidEyeMovementSleep-N1 </EventConcept> <Start>3390.0</Start> <Duration>30.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:WakeState</EventConcept> <Start>3420.0</Start> <Duration>90.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:NonRapidEyeMovementSleep-N1 < /EventConcept> <Start>3510.0</Start> <Duration>60.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:NonRapidEyeMovementSleep-N2 </EventConcept> <Start>3570.0</Start> <Duration>360.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:WakeState</EventConcept> <Start>3930.0</Start> <Duration>30.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:NonRapidEyeMovementSleep-N2 </EventConcept> <Start>3960.0</Start> <Duration>90.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:NonRapidEyeMovementSleep-N2 </EventConcept> <Start>9330.0</Start> <Duration>60.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:NonRapidEyeMovementSleep-N3 </EventConcept> <Start>9390.0</Start> <Duration>1140.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:NonRapidEyeMovementSleep-N2 </EventConcept> <Start>10530.0</Start> <Duration>300.0</Duration> </ScoredEvent> <ScoredEvent>

(72)

71

<EventConcept>SDO:NonRapidEyeMovementSleep-N3 </EventConcept> <Start>10830.0</Start> <Duration>60.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:NonRapidEyeMovementSleep-N3 </EventConcept> <Start>10950.0</Start> <Duration>60.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:NonRapidEyeMovementSleep-N2 </EventConcept> <Start>11010.0</Start> <Duration>180.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:RapidEyeMovementSleep</EventConcept <Start>12660.0</Start> <Duration>1620.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:NonRapidEyeMovementSleep-N2 </EventConcept> <Start>14280.0</Start> <Duration>210.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:RapidEyeMovementSleep</EventConcept <Start>14490.0</Start> <Duration>180.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:NonRapidEyeMovementSleep-N2 </EventConcept> <Start>14670.0</Start> <Duration>780.0</Duration> </ScoredEvent> <ScoredEvent> <EventConcept>SDO:WakeState</EventConcept> <Start>15450.0</Start> <Duration>30.0</Duration> </ScoredEvent> </ScoredEvents> </PSGAnnotation>

(73)

72

Subject: 1

Number Of 30 Second epochs: 1084

Epoch Scorer Visual Score Reason Respiratory disorders

1 Wake Wake 2 Wake Wake 3 Wake Wake 4 Wake Wake 5 Wake Wake 6 Wake Wake 7 Wake Wake 8 Wake Wake 9 Wake Wake 10 Wake Wake 11 Wake Wake 12 Wake Wake 13 Wake Wake 14 Wake Wake 15 Wake Wake 16 Wake Wake 17 Wake Wake 18 Wake Wake 19 Wake Wake 20 Wake Wake 21 Wake Wake 22 Wake Wake 23 Wake Wake 24 Wake Wake 25 Wake Wake 26 Wake Wake 27 Wake Wake 28 Wake Wake

Rem in Wake Stage

29 Wake N1

30 N1 N2 Delta + Theta>60% & low mean EMG

31 N2 N2

(74)

73

33 N2 Wake 34 N1 N1 35 N2 N2 SWdetection>20% 36 N3 N2 37 N2 N2 SWdetection>20% 38 N3 N2 39 N2 N2 SWdetection>20% 40 N3 N2 41 N3 N2 SWdetection>20% . . . . . . . . . 311 N2 N2

312 N2 Wake Continue with the last score Apnea/hypopnea detected

313 N2 Wake

314 N1 Wake

Apnea/hypopnea detected

315 Wake Wake

316 Wake Wake Apnea/hypopnea detected

317 Wake Wake

Continue with the last score

318 Wake N1

319 N1 N2 Delta + Theta>60% & low mean EMG

320 N1 N2 Continue with the last score

321 N2 N2

322 N2 N2

323 N2 N2

324 N3 N2

325 N2 Wake

326 N2 Wake Continue with the last score

327 N2 Wake

331 Wake Wake 332 Wake Wake 333 Wake Wake 334 Wake Wake 335 Wake Wake 336 Wake Wake 337 Wake Wake

338 Wake N1

339 Wake N1 Continue with the last score

341 N1 N1 342 N2 N2 343 N2 N2 344 N2 N2 345 N2 N2 . . . . . . . . . 458 N2 N2

459 N2 Wake

(75)

74

462 N1 REM

463 N1 REM Continue with the last score

464 N2 REM

465 REM REM

466 REM REM

467 REM REM

468 REM REM Apnea/hypopnea detected

REM K complex/Sleep Spindle detected

470 N2

471 N1 REM SEM detected

Apnea/hypopnea detec

N2 REM K complex/Sleep Spindle detected Apnea/hypopnea detected

472 REM

473 REM

474 REM REM

475 REM REM

. .

REM

488 REM

489 REM REM

REM

491 REM

492 REM REM

Wake K complex / Sleep Spindle detected

495 N2

496 N2 Wake Continue with the last score Apnea/hypopnea detec

N1 Continue with the last score

497 N2

499 N2 N2

500 N2 N2

501 N2 N2

502 N2 N2

. . .

686 N2 N2

687 N2 N2

688 N2 N2 689 N2 N2

(76)

75

692 Wake REM Blink detected

693 Wake REM Continue with the last score

694 Wake REM Continue with the last score

695 N1 REM SEM detected

697 REM REM 698 REM REM 699 REM REM 700 REM REM 701 REM REM 702 REM REM 703 REM REM Apnea/hypopnea detected 704 REM REM 705 REM REM 706 REM REM 707 REM REM 708 REM REM 709 REM REM 710 REM REM 711 REM REM 712 REM REM

K complex / Sleep Spindle detected

713 N2 REM

719 Wake Wake

720 Wake Wake

721 Wake Wake

722 Wake Wake

723 Wake N1

726 N1 N1 727 N1 N1 728 N2 N2

.

. . . . . . . . Waking Wake Wake 1071 1072 Wake Wake 1073 Wake Wake 1074 Wake Wake 1075 Wake Wake 1076 Wake Wake 1077 Wake Wake 1078 Wake Wake 1079 Wake Wake

(77)

76

1080 Wake Wake 1081 Wake Wake 1082 Wake Wake 1083 Wake Wake 1084 Wake Wake

Different scores: 259 and 23.89 Percent

---

Scorer Visual Score Sleep Parameters

393

376 Total Sleep Time (mins)

Sleep Onset 32 31 Sleep Waking 910 909 Sleep Efficiency 89.52 85.54 Respiratory disorders 49.09 Apnea/hypopnea Sensitivity Apnea/hypopnea Specificity 91.55

Apnea/hypopnea Accuracy 89.39

(78)

(79)