Unsupervised domain transfer: Overcoming signal degradation in sleep monitoring by increasing scoring realism

Objective: Investigate whether hypnogram 'realism' can be used to guide an unsupervised method for handling arbitrary types of signal degradation in mobile sleep monitoring. Approach: Combining a pretrained, state-of-the-art 'u-sleep' model with a 'discriminator' network, we align features from a target domain with a feature space learned during pretraining. To test the approach, we distort the source domain with realistic signal degradations, to see how well the method can adapt to different types of degradation. We compare the performance of the resulting model with best-case models designed in a supervised manner for each type of transfer. Main Results: Depending on the type of distortion, we find that the unsupervised approach can increase Cohen's kappa with as little as 0.03 and up to 0.29, and that for all transfers, the method does not decrease performance. However, the approach never quite reaches the estimated theoretical optimal performance, and when tested on a real-life domain mismatch between two sleep studies, the benefit was insignificant. Significance: 'Discriminator-guided fine tuning' is an interesting approach to handling signal degradation for 'in the wild' sleep monitoring, with some promise. In particular, what it says about sleep data in general is interesting. However, more development will be necessary before using it 'in production'.

Fully-automated sleep staging: multicenter validation of a generalizable deep neural network for Parkinson's disease and isolated REM sleep behavior disorder

Isolated REM sleep behavior disorder (iRBD) is a key prodromal marker of Parkinson's disease (PD), and video-polysomnography (vPSG) remains the diagnostic gold standard. However, manual sleep staging is particularly challenging in neurodegenerative diseases due to EEG abnormalities and fragmented sleep, making PSG assessments a bottleneck for deploying new RBD screening technologies at scale. We adapted U-Sleep, a deep neural network, for generalizable sleep staging in PD and iRBD. A pretrained U-Sleep model, based on a large, multisite non-neurodegenerative dataset (PUB; 19,236 PSGs across 12 sites), was fine-tuned on research datasets from two centers (Lundbeck Foundation Parkinson's Disease Research Center (PACE) and the Cologne-Bonn Cohort (CBC); 112 PD, 138 iRBD, 89 age-matched controls. The resulting model was evaluated on an independent dataset from the Danish Center for Sleep Medicine (DCSM; 81 PD, 36 iRBD, 87 sleep-clinic controls). A subset of PSGs with low agreement between the human rater and the model (Cohen's $κ$ < 0.6) was re-scored by a second blinded human rater to identify sources of disagreement. Finally, we applied confidence-based thresholds to optimize REM sleep staging. The pretrained model achieved mean $κ$ = 0.81 in PUB, but $κ$ = 0.66 when applied directly to PACE/CBC. By fine-tuning the model, we developed a generalized model with $κ$ = 0.74 on PACE/CBC (p < 0.001 vs. the pretrained model). In DCSM, mean and median $κ$ increased from 0.60 to 0.64 (p < 0.001) and 0.64 to 0.69 (p < 0.001), respectively. In the interrater study, PSGs with low agreement between the model and the initial scorer showed similarly low agreement between human scorers. Applying a confidence threshold increased the proportion of correctly identified REM sleep epochs from 85% to 95.5%, while preserving sufficient (> 5 min) REM sleep for 95% of subjects.