Abstract
Purpose
To explore the feasibility of automatic detection based on air flow and blood oxygen in patients with sleep disordered breathing.
Methods
This study proposes a new automated detection method for sleep disordered breathing based on overnight airflow and blood oxygen saturation (SaO2). In this regard, local range (LR) of the airflow was adopted to detect apnea events and the SaO2 sudden drops were used to help determine hypopnea events. Pearson correlation index was used to evaluate the relationship between the two automated methods (this study vs. Remlogic software) and the manual reports. Error and mean absolute error (MAE) were used to assess the two automated methods.
Results
For all patients, the apnea–hypopnea index (AHI), apnea index (AI) and hypopnea index (HI) for our automated scoring and manual reports were highly correlated (the Pearson correlation index were 0.996, 0.995 and 0.928, respectively, P < 0.001). However, HI for Remlogic automated scoring and clinical manual reports was poorly correlated (r = 0.316, P < 0.001). Compared with the manual reports, mean absolute error of AHI, AI and HI between the two automated methods (this study vs. Remlogic software) were statistically significant (P < 0.0001). Furthermore, among the three subgroups (group 1, AHI < 15/h, group 2, 15/h ≤ AHI < 30/h and group 3, AHI ≥ 30/h), the mean error and MAE of AHI between the two automated methods were also statistically significant (P < 0.01).
Conclusions
Generally, good agreements were shown between our automated detection and clinical reports. This procedure is robust and effective, which would significantly shorten the analysis time.
This is a preview of subscription content, access via your institution.



References
- 1.
Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, Nunez CM, Patel SR, Penzel T, Pépin JL, Peppard PE, Sinha S, Tufik S, Valentine K, Malhotra A (2019) Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 7(8):687–698
- 2.
Baboli M, Singh A, Soll B, Boric-Lubecke O, Lubecke V (2015) Good night: sleep monitoring using a physiological radar monitoring system integrated with a polysomnography system. IEEE Microwave Mag 16(6):34–41
- 3.
Kapur VK, Auckley DH, Chowdhuri S et al (2017) clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an american academy of sleep medicine clinical practice guideline. J Clin Sleep Med 13(3):479–504
- 4.
Zamarrón C, Romero PV, Gude F, Amaro A, Rodriguez JR (2001) Screening of obstructive sleep apnoea: heart rate spectral analysis of nocturnal pulse oximetric recording. Resp Med 95(9):759–765
- 5.
Oeverland B, Skatvedt O, Kværner KJ, Akre H (2002) Pulseoximetry: sufficient to diagnose severe sleep apnea. Sleep Med 3(2):133–138
- 6.
Nazeran H, Almas A, Behbehani K, Burk J, Lucas E (2001) A fuzzy inference system for detection of obstructive sleep apnea. EMBS’01: 23rd Annu. Int. Conf. of IEEE Engineering in Medicine and Biology Society, Istanbul, pp 1645–1648
- 7.
Morsy AA, Al-Ashmouny KM (2006) Sleep apnea detection using an adaptive fuzzy logic based screening system. EMBS’05: 27th Annu. Int. Conf. of IEEE Engineering in Medicine and Biology Society, Shanghai, pp 6124–6127
- 8.
Ben-Israel N, Tarasiuk A, Zigel Y (1305C) Obstructive apnea hypopnea index estimation by analysis of nocturnal snoring signals in adults. Sleep 35(9):1299–1305C
- 9.
Travieso CM, Alonso JB, del Pozo M, Ticay JR, Castellanos-Dominguez G (2014) Building a Cepstrum-HMM kernel for apnea identification. Neurocomputing 132:159–165
- 10.
Song C, Liu K, Zhang X, Chen L, Xian X (2016) An obstructive sleep apnea detection approach using a discriminative hidden Markov model from ECG signals. IEEE Trans Biomed Eng 63(7):1532–1542
- 11.
Kaimakamis E, Tsara V, Bratsas C, Sichletidis L, Karvounis C, Maglaveras N (2016) Evaluation of a decision support system for obstructive sleep apnea with nonlinear analysis of respiratory signals. PLoS ONE 11(3):e0150163
- 12.
Huang W, Guo B, Shen Y, Tang X (2017) A novel method to precisely detect apnea and hypopnea events by airflow and oximetry signals. Comput Biol Med 88:32–40
- 13.
de Chazal P, Heneghan C, Sheridan E, Reilly R, Nolan P, O’Malley M (2003) Automated processing of the single-lead electrocardiogram for the detection of obstructive sleep apnoea. IEEE Trans Biomed Eng 50(6):686–696
- 14.
Cabrero-Canosa M, Hernández-Pereira E, Moret-Bonillo V (2004) Intelligent diagnosis of sleep apnea syndrome. IEEE Eng Med Biol Mag 23(2):72–81
- 15.
del Campo F, Hornero R, Zamarrón C, Abasolo DE, Álvarez D (2006) Oxygen saturation regularity analysis in the diagnosis of obstructive sleep apnea. Artif Intell Med 37(2):111–118
- 16.
Park DY, Kim HJ, Kim CH, Kim YS, Choi JH, Hong SY, Jung JJ, Lee KI, Lee HS (2015) Reliability and validity testing of automated scoring in obstructive sleep apnea diagnosis with the Embletta X100. Laryngoscope 125(2):493–497
- 17.
Ciołek M, Niedźwiecki M, Sieklicki S, Drozdowski J, Siebert J (2015) automated detection of sleep apnea and hypopnea events based on robust airflow envelope tracking in the presence of breathing artifacts. IEEE J Biomed Health Inform 19(2):418–429. https://doi.org/10.1109/JBHI.2014.2325997
- 18.
Tian JY, Liu JQ (2005) Apnea detection based on time delay neural network. EMBS’05: 27th Annu. Int. Conf. of IEEE Engineering in Medicine and Biology Society, Shanghai, pp 2571–2574
- 19.
Álvarez D, Gutiérrez GC, Marcos JV, del Campo F, Hornero R (2010a) Spectral analysis of single channel airflow and oxygen saturation recordings in obstructive sleep apnea detection. 32nd Annu. Int. Conf. of IEEE Engineering in Medicine and Biology Society, Buenos Aires pp 847–850. https://doi.org/10.1109/IEMBS.2010.5626861
- 20.
Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep Medicine (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619
- 21.
Gutiérrez-Tobal GC, Hornero R, Álvarez D, Marcos JV, del Campo F (2012) Linear and nonlinear analysis of airflow recordings to help in sleep apnoea-hypopnoea syndrome diagnosis. Physiol Meas 33(7):1261–1275
- 22.
Ciołek M, Niedźwiecki M, Sieklicki S, Drozdowski J, Siebert J (2015) Automated detection of sleep apnea and hypopnea events based on robust airflow envelope tracking in the presence of breathing artifacts. IEEE J Biomed Health Inform 19(2):418–429
- 23.
Punjabi NM, Shifa N, Dorffner G, Patil S, Pien G, Aurora RN (2015) Computer-assisted automated scoring of polysomnograms using the somnolyzer system. Sleep 38(10):1555–1566. https://doi.org/10.5665/sleep.5046
- 24.
Gutiérrez-Tobal GC, Hornero R, Álvarez D, Marcos JV, del Campo F (2012) Linear and nonlinear analysis of airflow recordings to help in sleep apnoea–hypopnoea syndrome diagnosis. Physiol Meas 33(7):1261–1275
- 25.
Gutiérrez-Tobal GC, Álvarez D, Marcos JV, del Campo F, Hornero R (2013) Pattern recognition in airflow recordings to assist in the sleep apnoea–hypopnoea syndrome diagnosis. Med Biol Eng Comput 51(12):1367–1380
- 26.
Gutiérrez-Tobal GC, Álvarez D, del Campo F, Hornero R (2016) Utility of AdaBoost to detect sleep apnea-hypopnea syndrome from single-channel airflow. IEEE Trans Biomed Eng 63(3):636–646
- 27.
Selvaraj N, Narasimhan R (2013) Detection of sleep apnea on a per-second basis using respiratory signals. EMBS’13: 35th Annu. Int. Conf. of IEEE Engineering in Medicine and Biology Society, Osaka, pp 2124–2127
- 28.
Marcos JV, Hornero R, Nabney IT, Álvarez D, Del Campo F (2011) Analysis of nocturnal oxygen saturation recordings using kernel entropy to assist in sleep apnea-hypopnea diagnosis. EMBS’11: 33rd Annu. Int. Conf. of IEEE Engineering in Medicine and Biology Society, Boston, pp1745–1748
- 29.
Marcos JV, Hornero R, Álvarez D, Del Campo F, Zamarrón C (2009) A classification algorithm based on spectral features from nocturnal oximetry and support vector machines to assist in the diagnosis of obstructive sleep apnea. EMBS’09: 31st Annu. Int. Conf. of IEEE Engineering in Medicine and Biology Society, Minneapolis, pp 5547–5550
- 30.
Marcos JV, Hornero R, Álvarez D, del Campo F, López M, Zamarrón C (2008) Radial basis function classifiers to help in the diagnosis of the obstructive sleep apnoea syndrome from nocturnal Oximetry. Med Biol Eng Comput 46(4):323–332
- 31.
Rolón RE, Larrateguy LD, Di Persia LE, Spies RD, Rufiner HL (2017) Discriminative methods based on sparse representations of pulse oximetry signals for sleep apnea–hypopnea detection. Biomed Signal Proces Control 33:358–367
- 32.
Otero A, Félix P, Barro S, Zamarrón C (2012) A structural knowledge-based proposal for the identification and characterization of apnoea episodes. Appl Soft Comput 12:516–526
Funding
This work was funded by the Science and Technology Commission of Shanghai Municipality of China (Grant no 17411962000) and also supported by the Health and Family Planning Commission of Shanghai Municipality of China (Grant no 2019SY059).
Author information
Affiliations
Contributions
All authors contributed to the study conception and design. JH and LR contribute equally to this paper. Material preparation, data collection and analysis were performed by JH, LR, LC, ZJ, TZ and HW. The first draft of the manuscript was written by JH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Conceptualization: JH, LR and LC; Methodology: LR and LC; Formal analysis and investigation: JH and ZJ; Writing-original draft preparation: JH and LR; Writing-review and editing: HW; Funding acquisition: HW; Resources: HW; Supervision: TZ.
Corresponding author
Ethics declarations
Conflict of interest
None of the above-mentioned authors has a conflict of interest regarding this publication.
Ethics approval
Our study was performed in accordance with Declaration of Helsinki and its amendments. The Ethics Committee of Shanghai Fudan University Affiliated Eye and ENT Hospital has confirmed that no ethical approval is required. All the procedures being performed were part of the routine care.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on sleep apnea syndrome. Guest Editors: Manuele Casale, Rinaldi Vittorio.
Rights and permissions
About this article
Cite this article
Huang, J., Ren, L., Chen, L. et al. Application of automatic detection based on overnight airflow and blood oxygen in patients with sleep disordered breathing. Eur Arch Otorhinolaryngol 278, 873–881 (2021). https://doi.org/10.1007/s00405-020-06008-5
Received:
Accepted:
Published:
Issue Date:
Keywords
- Sleep apnea–hypopnea syndrome
- Airflow record
- Automated detection
- Blood oxygen