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Heliyon. 2019 Oct 2;5(10):e02529. doi: 10.1016/j.heliyon.2019.e02529. eCollection 2019 Oct.

Sleep-wake stages classification using heart rate signals from pulse oximetry.

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Lab. de Señales y Dinámicas no Lineales, Facultad de Ingeniería, Universidad Nacional de Entre Ríos (UNER), Argentina.
Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
Instituto de Investigación y Desarrollo en Bioingeniería y Bioinformática, UNER, CONICET, Argentina.
Instituto de Investigacion en Señales, Sistemas e Inteligencia Computacional, Universidad Nacional del Litoral, CONICET, Argentina.


The most important index of obstructive sleep apnea/hypopnea syndrome (OSAHS) is the apnea/hyponea index (AHI). The AHI is the number of apnea/hypopnea events per hour of sleep. Algorithms for the screening of OSAHS from pulse oximetry estimate an approximation to AHI counting the desaturation events without consider the sleep stage of the patient. This paper presents an automatic system to determine if a patient is awake or asleep using heart rate (HR) signals provided by pulse oximetry. In this study, 70 features are estimated using entropy and complexity measures, frequency domain and time-scale domain methods, and classical statistics. The dimension of feature space is reduced from 70 to 40 using three different schemes based on forward feature selection with support vector machine and feature importance with random forest. The algorithms were designed, trained and tested with 5000 patients from the Sleep Heart Health Study database. In the test stage, 10-fold cross validation method was applied obtaining performances up to 85.2% accuracy, 88.3% specificity, 79.0% sensitivity, 67.0% positive predictive value, and 91.3% negative predictive value. The results are encouraging, showing the possibility of using HR signals obtained from the same oximeter to determine the sleep stage of the patient, and thus potentially improving the estimation of AHI based on only pulse oximetry.


Automatic sleep staging; Biomedical engineering; Computer science; Heart rate; Pulse oximetry; Sleep apnea

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