# Data–Driven Multimodal Sleep Apnea Events Detection

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## Abstract

A novel multimodal and bio–inspired approach to biomedical signal processing and classification is presented in the paper. This approach allows for an automatic semantic labeling (interpretation) of sleep apnea events based the proposed data–driven biomedical signal processing and classification. The presented signal processing and classification methods have been already successfully applied to real–time unimodal brainwaves (EEG only) decoding in brain–computer interfaces developed by the author. In the current project the very encouraging results are obtained using multimodal biomedical (brainwaves and peripheral physiological) signals in a unified processing approach allowing for the automatic semantic data description. The results thus support a hypothesis of the data–driven and bio–inspired signal processing approach validity for medical data semantic interpretation based on the sleep apnea events machine–learning–related classification.

### Keywords

EEG Sleep apnea semantic interpretation Data–driven biomedical data processing Bio–inspired data processing Semantic biomedical data interpretation## Introduction

In recent years new technologies and bio–inspired approaches for medical data analysis and subsequent semantic interpretation (qualitative analysis) are gaining a research momentum [10, 15]. The automatic semantic interpretation of biomedical datasets allows for home–based medical symptoms interpretations and preliminary diagnosis before a subsequent clinical evaluation. In the current study an extension of the previously developed by the author method [19] to the multimodal physiological signals such as: EEG, ECG, EOG, EMG, oro–nasal airflow, ribcage and abdomen movements, oxygen saturation (pulse–oximetery), acoustic snoring, and body position is proposed in an unified approach leading to successful automatic classification (semantic interpretation) of sleep apnea events. The employed synchrosqueezing transform (SST) method [2, 3, 4, 9, 19] for the multimodal physiological signals outperforms the classical time-frequency analysis techniques of the non–linear and non–stationary signals [16, 17, 18] such as multimodal sleep physiological datasets. This not only allows for examination of the spectral contents of each signal as well as the interdependence between the multimodal data streams, but also complies with what clinical experts use in their visual judgments of EEG and body peripheral physiological signals used in sleep studies. For clinically, as well as home–user oriented sleep support applications, the plug & play operation is nowadays considered as a minimum requirement for any consumer devices. In the classification step, thanks to information geometry approach it is possible to define a metric enjoying the sought adaptive (data–driven) properties. The information geometry is a field of information theory where the probability distributions are taken as point of a Riemannian manifold [6]. This field has been popularized by S. Amari [5].

We present successful application of adaptive sleep apnea events classification approach leading to the semantic data interpretation, which employs the above mentioned data–driven filtering and information geometry–based classification techniques. The paper from now on is organized as follows. In the next section methods used in the paper are introduced and explained. Discussion of results follows. Finally conclusions with future research directions summarize the paper.

## Methods

bipolar EEG derivations

*C*3 −*A*2 and*C*4 −*A*1;bipolar EOG of left and right eyes;

submentas EMG;

ECG of a modified lead

*V*2the oro–nasal airflow using a thermistor;

the ribcage and abdomen movements;

the oxygen saturation from a finger pulse–oximeter;

the snoring from a tracheal microphone;

the body position.

- 1.
obstructive hypopnea;

- 2.
central hypopnea;

- 3.
mixed hypopnea;

- 4.
obstructive apnea;

- 5.
central apnea;

- 6.
mixed apnea;

- 7.
periodic breathing;

- 8.
possible apnea or hypopnea;

- 9.
normal sleep.

*%*.

### Synchrosquezing transform processing of multimodal biomedical signals

An empirical mode decomposition (EMD) class of algorithms is a technique that decomposes a given univariate [11] or multivariate [16] signal into its building block functions. Those functions are the superposition of a limited number of extracted (sifted from the original signal) components. The EMD–based techniques have been already applied successfully to artifacts removal from EEG [12, 13, 14, 17, 19]. Unfortunately the original EMD algorithm due to its iterative decomposition nature is difficult to apply for online EEG processing due to its computational complexity [19]. A recently proposed solution for this problem is the synchrosqueezing transform (SST) method proposed by [9]. The SST method is a combination of wavelet analysis and reallocation methods [2, 3, 4, 19].

*i*of a multimodal sleep signal

*s*(

*t*) (EEG, ECG, EOG, EMG, oro–nasal airflow, ribcage and abdomen movements, oxygen saturation, acoustic snoring, and body position), its classical wavelet transform

*W*

_{s, i}(

*a*,

*t*) is obtained as [19],

*a*sets the scale and

*ψ*(

*u*) is the chosen wavelet function (Morlet wavelet in this project). The wavelet transform fortunately is an information preserving operation, so the original signal is reconstructed as,

*D*

_{ψ}determined as \(D_{\psi } = {\int }_{0}^{\infty } |{\Psi }(\xi )|\frac {d\xi }{\xi }\) with Ψ(

*ξ*) denoting a Fourier transform of the wavelet function used in the original decomposition (1). In usual signal processing cases, both the time and frequency take the discrete values. Time

*t*

_{k}=

*k*

*δ*

*t*=

*k*/

*f*

_{s}where

*f*

_{s}is the sampling frequency of the original, multimodal sleep recording in this case, signal. The recently proposed SST method by [9] allows for providing a time–frequency representation with more precise oscillatory frequency tracking and time resolutions at the same time leading to more accurate signal decompositions [19]. The above mentioned concept is based an identification of the frequencies

*f*(

*a*,

*t*) for which the phase of the wavelet coefficient grows for each scale and time, at the first processing step [9]:

*π*converts frequency between circular and normal units. Determination of the

*f*(

*a*,

*t*) from the analyzed signal leads identification of

*f*

_{i}frequency bins as \([f_{i}^{-},f_{i}^{+}].\) The SST decomposition is calculated next as

*a*

_{j}are the distances between the adjacent scales. The constant

*C*

_{ψ}representing the amplitude is defined as,

### Riemannian geometry feature extraction for multimodal biomedical signals

*N*sensors captured at discrete time sample

*t*and let \(\mathbf {S}_{k}\in \mathbb {\mathbb {}R}^{NK}\) be a single event record comprised of

*K*samples belonging to a sleep event

*k*∈ {1,…,

*K*}. The single record data shall be always assumed having a zero mean as result of the data–driven filtering procedures (effectively band–limited spectral decompositions) discussed in Section “Synchrosquezing transform processing of multimodal biomedical signals”. Thus, the sleep record sample covariance matrix of a given trial

**S**

_{k}belonging to a class

*z*is given by

**S**

_{i}, of which the covariance matrix

**C**

_{i}is computed, to one of the

*K*classes. From the collected previously training records a geometric mean covariance matrix

**M**

_{i}representing each one of the

*K*classes is computed. The covariance matrices are symmetric and positive definite, which implies that they can be diagonalized by rotation. They have also all positive eigenvalues. In order to measure a distance of the new sleep data record to the above mentioned class means an appropriate metric shall be employed. We propose to utilize a Riemannian geometry framework [5, 6]. On the Riemannian manifold each of the symmetric positive definite matrices is represented by a point. In such a space case a geodesic between two points

*C*

_{1}and

*C*

_{2}is a curve passing the two points having a minimum length. Additionally, such connecting curve is unique for a given metric. The length of the geodesic connecting two points is equal to a distance between them. The Riemannian distance between two covariance matrices

*C*

_{1}and

*C*

_{2}is computed as follows [6],

*w*

_{1},…,

*w*

_{n}the eigenvalues of \(C_{1}^{-1}C_{2}\), respectively. The geometric mean of

*m*covariance matrices using the above defined Riemannian distance (8) is computed as follows [7]

*t*∈ [0:1] being a scalar. It is worth to note, that the geometric mean of two points is equal to the geodesic in the middle at Γ(

*C*

_{1},

*C*

_{2},0.5).

### Sleep apnea classification approaches

A very natural for Riemmanian geometry–based features generic classification algorithm, as proposed in [8], shall be based on fining a minimum distance of the newly arriving sleep data record from the mean covariance matrices, representing the desired classes *K*, using the proposed framework. A minimum distance to mean (MDM) classifier [8] meets the above criterium and it has been chosen in this project. This very generic approach is applied in four distance evaluation metric methods taking into account arithmetic; Riemannian; a mixture of Riemanian for mean covariance and geodesic for subsequent distance from mean calculation; and finally for geodesic only distances. The MDM classifier is also compared with a *K*−means unsupervised [6, 22]; tangent space linear discriminant analysis (LDA) [6, 22]; and tangent space linear support vector machine (SVM) [6, 23] methods.

## Results

As a result of data–driven filtering and classification methods, discussed in Sections “Synchrosquezing transform processing of multimodal biomedical signals” and “Riemannian geometry feature extraction for multimodal biomedical signals”, very encouraging results of automatic sleep apnea detection resulted. The task was to automatically classify the events into one of nine classes comprising of six apnea cases, possible (uncertain) occurrences and normal (non–obstructive) periods. The proposed minimum distance to mean classifier application within the Riemannian geometry approach was tested in leave–one–out setting. The obtained results of 25 subject datasets from St. Vincent’s University Hospital / University College Dublin Sleep Apnea Database [1] are summarized in Fig. 1.

*%*accuracies were also at a high number for the Riemmanian distance cases as reported in Fig. 1.

## Conclusions

This study demonstrated automatic apnea classification results from 25 subjects suffering from various levels of sleep problems. The study confirmed also the validity of the data–driven based and frequency domain filtering in SST space. It allowed for successful classification (semantic interpretation) of the six apnea classes, possible (uncertain) occurrences, periodic breathing and normal (non–obstructive) periods.

The results presented offer a step forward in the development of novel and very much expected to improve life of sleep obstructive condition suffering patients using brainwave decoding neurotechnology applications. Since the results obtained from the tested sleep database did not yield maximum possible accuracies, the current methods would obviously still need improvements and modifications. These needs determine the major lines of study for future research. However, even in its current form, the proposed automatic apnea detections method can be regarded as a practical solution for sleep obstruction suffering patients.

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