Skip to main content
Erschienen in: Sleep and Breathing 1/2019

18.07.2018 | Sleep Breathing Physiology and Disorders • Original Article

Noncontact identification of sleep-disturbed breathing from smartphone-recorded sounds validated by polysomnography

verfasst von: Sanjiv Narayan, Priyanka Shivdare, Tharun Niranjan, Kathryn Williams, Jon Freudman, Ruchir Sehra

Erschienen in: Sleep and Breathing | Ausgabe 1/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Diagnosis of obstructive sleep apnea by the gold-standard of polysomnography (PSG), or by home sleep testing (HST), requires numerous physical connections to the patient which may restrict use of these tools for early screening. We hypothesized that normal and disturbed breathing may be detected by a consumer smartphone without physical connections to the patient using novel algorithms to analyze ambient sound.

Methods

We studied 91 patients undergoing clinically indicated PSG. Phase I: In a derivation cohort (n = 32), we placed an unmodified Samsung Galaxy S5 without external microphone near the bed to record ambient sounds. We analyzed 12,352 discrete breath/non-breath sounds (386/patient), from which we developed algorithms to remove noise, and detect breaths as envelopes of spectral peaks. Phase II: In a distinct validation cohort (n = 59), we tested the ability of acoustic algorithms to detect AHI < 15 vs AHI > 15 on PSG.

Results

Smartphone-recorded sound analyses detected the presence, absence, and types of breath sound. Phase I: In the derivation cohort, spectral analysis identified breaths and apneas with a c-statistic of 0.91, and loud obstruction sounds with c-statistic of 0.95 on receiver operating characteristic analyses, relative to adjudicated events. Phase II: In the validation cohort, automated acoustic analysis provided a c-statistic of 0.87 compared to whole-night PSG.

Conclusions

Ambient sounds recorded from a smartphone during sleep can identify apnea and abnormal breathing verified on PSG. Future studies should determine if this approach may facilitate early screening of SDB to identify at-risk patients for definitive diagnosis and therapy.

Clinical trials

Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014CrossRefPubMedPubMedCentral Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Doff MH, Hoekema A, Wijkstra PJ, van der Hoeven JH, Huddleston Slater JJ, de Bont LG, Stegenga B (2013) Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up. Sleep 36:1289–1296CrossRefPubMedPubMedCentral Doff MH, Hoekema A, Wijkstra PJ, van der Hoeven JH, Huddleston Slater JJ, de Bont LG, Stegenga B (2013) Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up. Sleep 36:1289–1296CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Hoekema A, Stegenga B, Wijkstra PJ, van der Hoeven JH, Meinesz AF, de Bont LG (2008) Obstructive sleep apnea therapy. J Dent Res 87:882–887CrossRefPubMed Hoekema A, Stegenga B, Wijkstra PJ, van der Hoeven JH, Meinesz AF, de Bont LG (2008) Obstructive sleep apnea therapy. J Dent Res 87:882–887CrossRefPubMed
4.
Zurück zum Zitat de Ruiter MHT, Apperloo RC, Milstein DMJ, de Lange J (2017) Assessment of obstructive sleep apnoea treatment success or failure after maxillomandibular advancement. Int J Oral Maxillofac Surg de Ruiter MHT, Apperloo RC, Milstein DMJ, de Lange J (2017) Assessment of obstructive sleep apnoea treatment success or failure after maxillomandibular advancement. Int J Oral Maxillofac Surg
5.
Zurück zum Zitat Cross NE, Harrison CM, Yee BJ, Grunstein RR, Wong KK, HC B, Marshall NS (2016) Management of snoring and sleep apnea in Australian primary care: the BEACH study (2000-2014). J Clin Sleep Med: JCSM : Off Publ Am Acad Sleep Med 12:1167–1173 Cross NE, Harrison CM, Yee BJ, Grunstein RR, Wong KK, HC B, Marshall NS (2016) Management of snoring and sleep apnea in Australian primary care: the BEACH study (2000-2014). J Clin Sleep Med: JCSM : Off Publ Am Acad Sleep Med 12:1167–1173
7.
Zurück zum Zitat Chang KM (2009) Portable obstructive sleep apnea screening system using overnight ECG and a PDA-based wireless transmission system. Telemed J E Health 15:353–361CrossRefPubMed Chang KM (2009) Portable obstructive sleep apnea screening system using overnight ECG and a PDA-based wireless transmission system. Telemed J E Health 15:353–361CrossRefPubMed
8.
Zurück zum Zitat Nakano H, Hirayama K, Sadamitsu Y, Toshimitsu A, Fujita H, Shin S, Tanigawa T (2014) Monitoring sound to quantify snoring and sleep apnea severity using a smartphone: proof of concept. J Clin Sleep Med: JCSM: Off Publ Am Acad Sleep Med. 10:73–78 Nakano H, Hirayama K, Sadamitsu Y, Toshimitsu A, Fujita H, Shin S, Tanigawa T (2014) Monitoring sound to quantify snoring and sleep apnea severity using a smartphone: proof of concept. J Clin Sleep Med: JCSM: Off Publ Am Acad Sleep Med. 10:73–78
9.
Zurück zum Zitat Alshaer H, Fernie GR, Maki E, Bradley TD (2013) Validation of an automated algorithm for detecting apneas and hypopneas by acoustic analysis of breath sounds. Sleep Med 14:562–571CrossRefPubMed Alshaer H, Fernie GR, Maki E, Bradley TD (2013) Validation of an automated algorithm for detecting apneas and hypopneas by acoustic analysis of breath sounds. Sleep Med 14:562–571CrossRefPubMed
10.
Zurück zum Zitat Herzog M, Plossl S, Glien A, Herzog B, Rohrmeier C, Kuhnel T, Plontke S, Kellner P (2015) Evaluation of acoustic characteristics of snoring sounds obtained during drug-induced sleep endoscopy. Sleep Breath 19:1011–1019CrossRefPubMed Herzog M, Plossl S, Glien A, Herzog B, Rohrmeier C, Kuhnel T, Plontke S, Kellner P (2015) Evaluation of acoustic characteristics of snoring sounds obtained during drug-induced sleep endoscopy. Sleep Breath 19:1011–1019CrossRefPubMed
11.
Zurück zum Zitat Swarnkar V, Abeyratne UR, Hukins C, Duce B (2009) A state transition-based method for quantifying EEG sleep fragmentation. Medical & biological engineering & computing 47:1053–1061CrossRef Swarnkar V, Abeyratne UR, Hukins C, Duce B (2009) A state transition-based method for quantifying EEG sleep fragmentation. Medical & biological engineering & computing 47:1053–1061CrossRef
12.
Zurück zum Zitat Amatoury J, Ali A, Younes M, Jordan AS, Wellman A, Eckert DJ (2016) Arousal intensity is a distinct pathophysiological trait in obstructive sleep apnea. Sleep 39:2091–2100CrossRefPubMedPubMedCentral Amatoury J, Ali A, Younes M, Jordan AS, Wellman A, Eckert DJ (2016) Arousal intensity is a distinct pathophysiological trait in obstructive sleep apnea. Sleep 39:2091–2100CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Garde A, Dehkordi P, Karlen W, Wensley D, Ansermino JM, Dumont GA (2014) Development of a screening tool for sleep disordered breathing in children using the phone Oximeter. PLoS One 9:e112959CrossRefPubMedPubMedCentral Garde A, Dehkordi P, Karlen W, Wensley D, Ansermino JM, Dumont GA (2014) Development of a screening tool for sleep disordered breathing in children using the phone Oximeter. PLoS One 9:e112959CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Force USPST, Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW Jr, Garcia FA, Herzstein J, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Phillips WR, Phipps MG, Pignone MP, Silverstein M, Tseng CW (2017) Screening for obstructive sleep apnea in adults: US preventive services task force recommendation statement. JAMA 317:407–414CrossRef Force USPST, Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW Jr, Garcia FA, Herzstein J, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Phillips WR, Phipps MG, Pignone MP, Silverstein M, Tseng CW (2017) Screening for obstructive sleep apnea in adults: US preventive services task force recommendation statement. JAMA 317:407–414CrossRef
15.
Zurück zum Zitat Bailes S, Fichten CS, Rizzo D, Baltzan M, Grad R, Pavilanis A, Creti L, Amsel R, Libman E (2017) The challenge of identifying family medicine patients with obstructive sleep apnea: addressing the question of gender inequality. Fam Pract 34:467–472CrossRefPubMed Bailes S, Fichten CS, Rizzo D, Baltzan M, Grad R, Pavilanis A, Creti L, Amsel R, Libman E (2017) The challenge of identifying family medicine patients with obstructive sleep apnea: addressing the question of gender inequality. Fam Pract 34:467–472CrossRefPubMed
16.
Zurück zum Zitat Smith HA, Smith ML (2017) The role of dentists and primary care physicians in the care of patients with sleep-related breathing disorders. Front Public Health 5:137CrossRefPubMedPubMedCentral Smith HA, Smith ML (2017) The role of dentists and primary care physicians in the care of patients with sleep-related breathing disorders. Front Public Health 5:137CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Chiu HY, Chen PY, Chuang LP, Chen NH, Tu YK, Hsieh YJ, Wang YC, Guilleminault C (2017) Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev 36:57–70CrossRefPubMed Chiu HY, Chen PY, Chuang LP, Chen NH, Tu YK, Hsieh YJ, Wang YC, Guilleminault C (2017) Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev 36:57–70CrossRefPubMed
18.
Zurück zum Zitat Freedman N (2015) COUNTERPOINT: does laboratory polysomnography yield better outcomes than home sleep testing? No. Chest 148:308–310CrossRefPubMed Freedman N (2015) COUNTERPOINT: does laboratory polysomnography yield better outcomes than home sleep testing? No. Chest 148:308–310CrossRefPubMed
19.
Zurück zum Zitat Pack AIPOINT (2015) Does laboratory polysomnography yield better outcomes than home sleep testing? Yes. Chest 148:306–308CrossRefPubMed Pack AIPOINT (2015) Does laboratory polysomnography yield better outcomes than home sleep testing? Yes. Chest 148:306–308CrossRefPubMed
20.
Zurück zum Zitat Younes M, Raneri J and Hanly P.(2016) Staging sleep in polysomnograms: analysis of inter-scorer variability. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Younes M, Raneri J and Hanly P.(2016) Staging sleep in polysomnograms: analysis of inter-scorer variability. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
21.
Zurück zum Zitat Ho V, Crainiceanu CM, Punjabi NM, Redline S, Gottlieb DJ (2015) Calibration model for apnea-hypopnea indices: impact of alternative criteria for hypopneas. Sleep 38:1887–1892CrossRefPubMedPubMedCentral Ho V, Crainiceanu CM, Punjabi NM, Redline S, Gottlieb DJ (2015) Calibration model for apnea-hypopnea indices: impact of alternative criteria for hypopneas. Sleep 38:1887–1892CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat McManus DD, Lee J, Maitas O, Esa N, Pidikiti R, Carlucci A, Harrington J, Mick E (2013) Chon KH. A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation. Heart Rhythm : Off J Heart Rhythm Soc 10:315–319CrossRef McManus DD, Lee J, Maitas O, Esa N, Pidikiti R, Carlucci A, Harrington J, Mick E (2013) Chon KH. A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation. Heart Rhythm : Off J Heart Rhythm Soc 10:315–319CrossRef
23.
Zurück zum Zitat Couderc JP, Kyal S, Mestha LK, Xu B, Peterson DR, Xia X, Hall B (2015) Detection of atrial fibrillation using contactless facial video monitoring. Heart Rhythm : Off J Heart Rhythm Soc 12:195–201CrossRef Couderc JP, Kyal S, Mestha LK, Xu B, Peterson DR, Xia X, Hall B (2015) Detection of atrial fibrillation using contactless facial video monitoring. Heart Rhythm : Off J Heart Rhythm Soc 12:195–201CrossRef
24.
Zurück zum Zitat Al-Mardini M, Aloul F, Sagahyroon A, Al-Husseini L (2014) Classifying obstructive sleep apnea using smartphones. J Biomed Inform 52:251–259CrossRefPubMed Al-Mardini M, Aloul F, Sagahyroon A, Al-Husseini L (2014) Classifying obstructive sleep apnea using smartphones. J Biomed Inform 52:251–259CrossRefPubMed
25.
Zurück zum Zitat Shcherbina A and Ashley EA. (2017) Accuracy in wrist-worn, sensor-based measurements J Pers Med ;7:in press Shcherbina A and Ashley EA. (2017) Accuracy in wrist-worn, sensor-based measurements J Pers Med ;7:in press
26.
Zurück zum Zitat Koo SK, Kwon SB, Kim YJ, Moon JI, Kim YJ and Jung SH. (2016) Acoustic analysis of snoring sounds recorded with a smartphone according to obstruction site in OSAS patients. Eur Arch Otorhinolaryngol Koo SK, Kwon SB, Kim YJ, Moon JI, Kim YJ and Jung SH. (2016) Acoustic analysis of snoring sounds recorded with a smartphone according to obstruction site in OSAS patients. Eur Arch Otorhinolaryngol
27.
Zurück zum Zitat Dafna E, Tarasiuk A, Zigel Y (2013) OSA severity assessment based on sleep breathing analysis using ambient microphone. Conference proceedings : Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Annual Conference 2013:2044–2047 Dafna E, Tarasiuk A, Zigel Y (2013) OSA severity assessment based on sleep breathing analysis using ambient microphone. Conference proceedings : Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Annual Conference 2013:2044–2047
28.
Zurück zum Zitat Diaz JA, Arancibia JM, Bassi A, Vivaldi EA (2014) Envelope analysis of the airflow signal to improve polysomnographic assessment of sleep disordered breathing. Sleep 37:199–208CrossRefPubMedPubMedCentral Diaz JA, Arancibia JM, Bassi A, Vivaldi EA (2014) Envelope analysis of the airflow signal to improve polysomnographic assessment of sleep disordered breathing. Sleep 37:199–208CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Morillo DS, Rojas JL, Crespo LF, Leon A, Gross N (2009) Poincare analysis of an overnight arterial oxygen saturation signal applied to the diagnosis of sleep apnea hypopnea syndrome. Physiol Meas 30:405–420CrossRefPubMed Morillo DS, Rojas JL, Crespo LF, Leon A, Gross N (2009) Poincare analysis of an overnight arterial oxygen saturation signal applied to the diagnosis of sleep apnea hypopnea syndrome. Physiol Meas 30:405–420CrossRefPubMed
30.
Zurück zum Zitat Park JU, Lee HK, Lee J, Urtnasan E, Kim H, Lee KJ (2015) Automatic classification of apnea/hypopnea events through sleep/wake states and severity of SDB from a pulse oximeter. Physiol Meas 36:2009–2025CrossRefPubMed Park JU, Lee HK, Lee J, Urtnasan E, Kim H, Lee KJ (2015) Automatic classification of apnea/hypopnea events through sleep/wake states and severity of SDB from a pulse oximeter. Physiol Meas 36:2009–2025CrossRefPubMed
31.
Zurück zum Zitat Ben-Israel N, Tarasiuk A, Zigel Y (2010) Nocturnal sound analysis for the diagnosis of obstructive sleep apnea. Conference proceedings : Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Annual Conference. 2010:6146–6149 Ben-Israel N, Tarasiuk A, Zigel Y (2010) Nocturnal sound analysis for the diagnosis of obstructive sleep apnea. Conference proceedings : Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Annual Conference. 2010:6146–6149
32.
Zurück zum Zitat Sprenger R, Martins LAC, Dos Santos JCB, de Menezes CC, Venezian GC, Degan VV (2017) A retrospective cephalometric study on upper airway spaces in different facial types. Prog Orthod 18:25CrossRefPubMedPubMedCentral Sprenger R, Martins LAC, Dos Santos JCB, de Menezes CC, Venezian GC, Degan VV (2017) A retrospective cephalometric study on upper airway spaces in different facial types. Prog Orthod 18:25CrossRefPubMedPubMedCentral
Metadaten
Titel
Noncontact identification of sleep-disturbed breathing from smartphone-recorded sounds validated by polysomnography
verfasst von
Sanjiv Narayan
Priyanka Shivdare
Tharun Niranjan
Kathryn Williams
Jon Freudman
Ruchir Sehra
Publikationsdatum
18.07.2018
Verlag
Springer International Publishing
Erschienen in
Sleep and Breathing / Ausgabe 1/2019
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-018-1695-6

Weitere Artikel der Ausgabe 1/2019

Sleep and Breathing 1/2019 Zur Ausgabe

Sleep Breathing Physiology and Disorders • Original Article

Cough hypersensitivity in patients with obstructive sleep apnea hypopnea syndrome

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.