Abstract

ObjectiveTo develop a non-invasive and clinically practical method for a long-term monitoring of infant sleep cycling in the intensive care unit.MethodsForty three infant polysomnography recordings were performed at 1–18 weeks of age, including a piezo element bed mattress sensor to record respiratory and gross-body movements. The hypnogram scored from polysomnography signals was used as the ground truth in training sleep classifiers based on 20,022 epochs of movement and/or electrocardiography signals. Three classifier designs were evaluated in the detection of deep sleep (N3 state): support vector machine (SVM), Long Short-Term Memory neural network, and convolutional neural network (CNN).ResultsDeep sleep was accurately identified from other states with all classifier variants. The SVM classifier based on a combination of movement and electrocardiography features had the highest performance (AUC 97.6%). A SVM classifier based on only movement features had comparable accuracy (AUC 95.0%). The feature-independent CNN resulted in roughly comparable accuracy (AUC 93.3%).ConclusionAutomated non-invasive tracking of sleep state cycling is technically feasible using measurements from a piezo element situated under a bed mattress.SignificanceAn open source infant deep sleep detector of this kind allows quantitative, continuous bedside assessment of infant’s sleep cycling.

Highlights

  • Recent studies on sleep quality in the intensive care units have prompted interest in early sleep monitoring due to its association with general well-being and distress (van den Hoogen et al, 2017; Werth et al, 2017a)

  • The support vector machine (SVM) classifier based on a combination of movement and electrocardiography features had the highest performance (AUC 97.6%)

  • A SVM classifier based on only movement features had comparable accuracy (AUC 95.0%)

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Summary

Introduction

Recent studies on sleep quality in the intensive care units have prompted interest in early sleep monitoring due to its association with general well-being and distress (van den Hoogen et al, 2017; Werth et al, 2017a). For long-term studies, infant sleep behavior is assessed with sleep diaries and questionnaires (Sadeh, 2004; Paavonen et al, 2019). Recent work has used wrist- or ankle-worn actigraphy (Sadeh, 2011; Paavonen et al, 2019) to provide rough assessments of sleep-wake cycles. All of these methods have significant limitations. The use of PSG is hampered by its relative obtrusiveness and is laborintensive in both recording and analysis, questionnaires have only limited accuracy and reliability, while actigraphy is challenged in infants due to many factors that confound interpretation (Sokoloff et al, 2020)

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