Learning individual autonomic representations of sleep stages to improve photoplethysmography based sleep monitoring

• Published in: Physiological measurement
• Main Authors: van der Aar, Jaap, van Gilst, Merel Marietje, van den Ende, Daan, Overeem, Sebastiaan, Peri, Elisabetta, Fonseca, Pedro
• Format: Journal Article
• Language: English
• Published: England 29.08.2025
• Subjects: interindividual; personalization; transfer learning; wearable; hypnodensity; sleep staging
• ISSN: 0967-3334; 1361-6579
• DOI: 10.1088/1361-6579/ae0119

Objective: Wrist-worn photoplethysmography (PPG) enables scalable, long-term unobtrusive sleep monitoring through the expression of sympathetic and parasympathetic activity in heart rate variability. However, interindividual differences in the sympatho-vagal balance may inherently limited general PPG-based sleep staging models. This study investigates whether learning individual autonomic representations through model personalization can improve PPG based automated sleep staging performance.- Approach: Concurrent wrist-worn PPG and wearable electroencephalography (EEG) were collected during home monitoring for up to seven nights in a heterogeneous sleep-disordered population (n=59). Personalization was performed through finetuning (i.e., partial retraining) a general PPG-based model by coupling the subject-specific PPG data with the wearable EEG stage classifications. Performance of the general and personalized models were compared on PPG acquired during a gold-standard clinical polysomnography, testing their agreement on 4-stage classification (W/N1+N2/N3/REM) with the manual scoring. Main Result: Overall performance increased in 82.5% of the subjects, with significantly improved performance reached when personalizing the model on three or more training nights. Performance increased with personalization on additional training nights for each stage: wake (β=.005, p<.001), N1+N2 (β=.003, p<.001), N3 (β=.004, p<.001), and REM (β=.005, p<.001). Effects were strongest for younger individuals (β=.009, p<.001) and patients with insomnia (β=.011, p<.001). Personalization greatly impacted the derived sleep macrostructural sleep parameters, with considerable improvement in N3 sleep classification, and in capturing REM fragmentation. Significance: Personalization can overcome one-size-fits-all limitations of a general model and should be considered for PPG-based sleep staging when an altered autonomic modulation is expected that deviates from the general model's global representation.