JOURNAL ARTICLE

Neural network analysis of nocturnal SpO 2 signal enables easy screening of sleep apnea in patients with acute cerebrovascular disease

Akseli Leino, Sami Nikkonen, Samu Kainulainen, Henri Korkalainen, Juha Töyräs, Sami Myllymaa, Timo Leppänen, Salla Ylä-Herttuala, Susanna Westeren-Punnonen, Anu Muraja-Murro, Pekka Jäkälä, Esa Mervaala, Katja Myllymaa
Sleep Medicine 2020 December 31, 79: 71-78
33482455
Current diagnostics of sleep apnea relies on the time-consuming manual analysis of complex sleep registrations, which is impractical for routine screening in hospitalized patients with a high probability for sleep apnea, e.g. those experiencing acute stroke or transient ischemic attacks (TIA). To overcome this shortcoming, we aimed to develop a convolutional neural network (CNN) capable of estimating the severity of sleep apnea in acute stroke and TIA patients based solely on the nocturnal oxygen saturation (SpO2 ) signal. The CNN was trained with SpO2 signals derived from 1379 home sleep apnea tests (HSAT) of suspected sleep apnea patients and tested with SpO2 signals of 77 acute ischemic stroke or TIA patients. The CNN's performance was tested by comparing the estimated respiratory event index (REI) and oxygen desaturation index (ODI) with manually obtained values. Median estimation errors for REI and ODI in patients with stroke or TIA were 1.45 events/hour and 0.61 events/hour, respectively. Furthermore, based on estimated REI and ODI, 77.9% and 88.3% of these patients were classified into the correct sleep apnea severity categories. The sensitivity and specificity to identify sleep apnea (REI > 5 events/hour) were 91.8% and 78.6%, respectively. Moderate-to-severe sleep apnea was detected (REI > 15 events/hour) with sensitivity of 92.3% and specificity of 96.1%. The CNN analysis of the SpO2 signal has great potential as a simple screening tool for sleep apnea. This novel automatic method accurately detects sleep apnea in acute cerebrovascular disease patients and facilitates their referral for a differential diagnostic HSAT or polysomnography evaluation.

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