Comparison analysis between standard polysomnographic data and in-ear-EEG signals: A preliminary study

Study Objectives: Polysomnography (PSG) currently serves as the benchmark for evaluating sleep disorders. Its discomfort, impracticality for home-use, and introduction of bias in sleep quality assessment necessitate the exploration of less invasive, cost-effective, and portable alternatives. One promising contender is the in-ear-EEG sensor, which offers advantages in terms of comfort, fixed electrode positions, resistance to electromagnetic interference, and user-friendliness. This study aims to establish a methodology to assess the similarity between the in-ear-EEG signal and standard PSG. Methods: We assess the agreement between the PSG and in-ear-EEG derived hypnograms. We extract features in the time- and frequency- domain from PSG and in-ear-EEG 30-second epochs. We only consider the epochs where the PSG-scorers and the in-ear-EEG-scorers were in agreement. We introduce a methodology to quantify the similarity between PSG derivations and the single-channel in-ear-EEG. The approach relies on a comparison of distributions of selected features -- extracted for each sleep stage and subject on both PSG and the in-ear-EEG signals -- via a Jensen-Shannon Divergence Feature-based Similarity Index (JSD-FSI). Results: We found a high intra-scorer variability, mainly due to the uncertainty the scorers had in evaluating the in-ear-EEG signals. We show that the similarity between PSG and in-ear-EEG signals is high (JSD-FSI: 0.61 +/- 0.06 in awake, 0.60 +/- 0.07 in NREM and 0.51 +/- 0.08 in REM), and in line with the similarity values computed independently on standard PSG-channel-combinations. Conclusions: In-ear-EEG is a valuable solution for home-based sleep monitoring, however further studies with a larger and more heterogeneous dataset are needed.

Bridging AI and Clinical Practice: Integrating Automated Sleep Scoring Algorithm with Uncertainty-Guided Physician Review

Purpose: This study aims to enhance the clinical use of automated sleep-scoring algorithms by incorporating an uncertainty estimation approach to efficiently assist clinicians in the manual review of predicted hypnograms, a necessity due to the notable inter-scorer variability inherent in polysomnography (PSG) databases. Our efforts target the extent of review required to achieve predefined agreement levels, examining both in-domain and out-of-domain data, and considering subjects diagnoses. Patients and methods: Total of 19578 PSGs from 13 open-access databases were used to train U-Sleep, a state-of-the-art sleep-scoring algorithm. We leveraged a comprehensive clinical database of additional 8832 PSGs, covering a full spectrum of ages and sleep-disorders, to refine the U-Sleep, and to evaluate different uncertainty-quantification approaches, including our novel confidence network. The ID data consisted of PSGs scored by over 50 physicians, and the two OOD sets comprised recordings each scored by a unique senior physician. Results: U-Sleep demonstrated robust performance, with Cohen's kappa (K) at 76.2% on ID and 73.8-78.8% on OOD data. The confidence network excelled at identifying uncertain predictions, achieving AUROC scores of 85.7% on ID and 82.5-85.6% on OOD data. Independently of sleep-disorder status, statistical evaluations revealed significant differences in confidence scores between aligning vs discording predictions, and significant correlations of confidence scores with classification performance metrics. To achieve K of at least 90% with physician intervention, examining less than 29.0% of uncertain epochs was required, substantially reducing physicians workload, and facilitating near-perfect agreement.