SelANet: decision-assisting selective sleep apnea detection based on confidence score

• Published in: BMC medical informatics and decision making Vol. 23; no. 1; pp. 1 - 12
• Main Authors: Bark, Beomjun, Nam, Borum, Kim, In Young
• Format: Journal Article
• Language: English
• Published: London BioMed Central 21.09.2023; BioMed Central Ltd; Springer Nature B.V; BMC
• Subjects: Algorithms; Analysis; Apnea; Artificial intelligence; Artificial neural networks; Automation; Care and treatment; Classification; Counterfactual Prediction Models in Medicine; Decision assisting; Deep learning; Diagnosis; EKG; Electrocardiogram; Electrocardiography; Evaluation; Expected values; Feature extraction; Health Informatics; Information Systems and Communication Service; Long short-term memory; Management of Computing and Information Systems; Measurement methods; Medical tests; Medicine; Medicine & Public Health; Neural networks; Optimization; Oxygen content; Oxygen saturation; Performance evaluation; Predictions; Respiration; Selective prediction; Signal quality; Sleep apnea; Sleep apnea syndrome; Sleep apnea syndromes; Sleep disorders; Time series; Uncertainty; Wearable devices; Wearable technology; South Korea; Sleep apnea syndrome; Decision assisting; Selective prediction; Artificial intelligence; Wearable devices
• ISSN: 1472-6947; 1472-6947
• DOI: 10.1186/s12911-023-02292-3

Background One of the most common sleep disorders is sleep apnea syndrome. To diagnose sleep apnea syndrome, polysomnography is typically used, but it has limitations in terms of labor, cost, and time. Therefore, studies have been conducted to develop automated detection algorithms using limited biological signals that can be more easily diagnosed. However, the lack of information from limited signals can result in uncertainty from artificial intelligence judgments. Therefore, we performed selective prediction by using estimated respiratory signals from electrocardiogram and oxygen saturation signals based on confidence scores to classify only those sleep apnea occurrence samples with high confidence. In addition, for samples with high uncertainty, this algorithm rejected them, providing a second opinion to the clinician. Method Our developed model utilized polysomnography data from 994 subjects obtained from Massachusetts General Hospital. We performed feature extraction from the latent vector using the autoencoder. Then, one dimensional convolutional neural network—long short-term memory (1D CNN-LSTM) was designed and trained to measure confidence scores for input, with an additional selection function. We set a confidence score threshold called the target coverage and performed optimization only on samples with confidence scores higher than the target coverage. As a result, we demonstrated that the empirical coverage trained in the model converged to the target coverage. Result To confirm whether the model has been optimized according to the objectives, the coverage violation was used to measure the difference between the target coverage and the empirical coverage. As a result, the value of coverage violation was found to be an average of 0.067. Based on the model, we evaluated the classification performance of sleep apnea and confirmed that it achieved 90.26% accuracy, 91.29% sensitivity, and 89.21% specificity. This represents an improvement of approximately 7.03% in all metrics compared to the performance achieved without using a selective prediction. Conclusion This algorithm based on selective prediction utilizes confidence measurement method to minimize the problem caused by limited biological information. Based on this approach, this algorithm is applicable to wearable devices despite low signal quality and can be used as a simple detection method that determine the need for polysomnography or complement it.