Abstract
Sleep is a key phenomenon to both understanding, diagnosing and treatment of many illnesses, as well as for studying health and well being in general. Today, the only widely accepted method for clinically monitoring sleep is the polysomnography (PSG), which is, however, both expensive to perform and influences the sleep. This has led to investigations into light weight electroencephalography (EEG) alternatives. However, there has been a substantial performance gap between proposed alternatives and PSG. Here we show results from an extensive study of 80 full night recordings of healthy participants wearing both PSG equipment and ear-EEG. We obtain automatic sleep scoring with an accuracy close to that achieved by manual scoring of scalp EEG (the current gold standard), using only ear-EEG as input, attaining an average Cohen’s kappa of 0.73. In addition, this high performance is present for all 20 subjects. Finally, 19/20 subjects found that the ear-EEG had little to no negative effect on their sleep, and subjects were generally able to apply the equipment without supervision. This finding marks a turning point on the road to clinical long term sleep monitoring: the question should no longer be whether ear-EEG could ever be used for clinical home sleep monitoring, but rather when it will be.
Highlights
Sleep monitoring, meaning the recording and subsequent analysis of physiological signals during sleep, is important in the study and diagnosis of a long list of diseases[1]
Important examples are idiopathic hypersomnia and circadian rhythm sleep-wake disorders, but studies such as Ciano et al 2017 and Ye et al 2018 demonstrate the value of longitudinal sleep monitoring in more general care as well as research[2,3]
We show a performance of the automatic classifier at a level very close to the gold standard of manually scored PSGs14
Summary
Sleep monitoring, meaning the recording and subsequent analysis of physiological signals during sleep, is important in the study and diagnosis of a long list of diseases[1]. Of special interest in this endeavor is the method of ear-EEG4, in which recording electrodes are placed in or around the ears This placement is useful because the area is largely hairless and relatively hidden (meaning the possibility of good signals and a low-profile device). Mikkelsen et al 2018 and Nakamura et al 2019 performed 15 and 22 full-night recordings using ear-EEG and full PSG, finding increases in performance, but still a significant gap between device and PSG performances[10,11]. All these studies used wet electrodes, which can be difficult for subjects to apply themselves. What is new is that we perform multiple repeated recordings on the same subject, to investigate the relative strengths of both broad and narrow training sets
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