Skip to main content
Log in

Probabilistic neural network approach for the detection of SAHS from overnight pulse oximetry

  • Original Article
  • Published:
Medical & Biological Engineering & Computing Aims and scope Submit manuscript

Abstract

Diagnosis of sleep apnea hypopnoea syndrome (SAHS) depends on the apnea–hypopnea index determined by the standard in-laboratory overnight polysomnography (PSG). PSG is a costly, labor intensive and, at times, inaccessible approach. Because of the high demand, the need for timely diagnosis and the associated costs, novel methods for SAHS detection are required. In this study, a novel multivariate system is proposed for SAHS detection from the analysis of overnight blood oxygen saturation (SpO2). 115 subjects with SAHS suspicion were studied. A starting set of 17 time domain, stochastic, frequency-domain and nonlinear features were initially computed from SpO2 recordings. Sequential forward feature selection and a probabilistic neural network with leave-one-out cross-validation were applied. Oxygen desaturations below a 4 % threshold within 30 s (ODI430), restorations of 4 % within 10 s (RES4), median value (Sat50), SD1 Poincaré descriptor and the relative power in the 0.013–0.067 Hz frequency band (PSD15/75) formed the optimum features subset. 92.4 % sensitivity and 95.9 % specificity were achieved. Results significantly outperformed the univariate and multivariate approaches reported in literature. The outcome is a simple cost-effective tool that could be used as an alternative or supplementary method in a domiciliary approach to early diagnosis of SAHS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. AlGhanim N, Comondore VR, Fleetham J, Marra CA, Ayas NT (2008) The economic impact of obstructive sleep apnea. Lung 186(1):7–12

    Article  PubMed  Google Scholar 

  2. Álvarez D, Hornero R, Abásolo D, del Campo F, Zamarrón C (2006) Nonlinear characteristics of blood oxygen saturation from nocturnal oximetry for obstructive sleep apnoea detection. Physiol Meas 27(4):399–412

    Article  PubMed  Google Scholar 

  3. Álvarez D, Hornero R, Marcos JV, del Campo F (2010) Multivariate analysis of blood oxygen saturation recordings in obstructive sleep apnea diagnosis. IEEE Trans Biomed Eng 57:2816–2824

    Article  PubMed  Google Scholar 

  4. American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22(5):667–689

    Google Scholar 

  5. Bagai K (2010) Obstructive sleep apnea, stroke, and cardiovascular diseases. Neurologist 16(6):329–339

    Article  PubMed  Google Scholar 

  6. Bakker JP, Malhotra A, Patel SR (2012) Essentials of sleep medicine. In: Badr MS (ed) Obstructive sleep apnea: epidemiology of sleep apnea. Springer, Berlin, pp 91–114

    Google Scholar 

  7. Chiner E, Signes-Costa J, Arriero JM, Marco J, Fuentes I, Sergado A (1999) Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies? Thorax 54:968–971

    Article  PubMed  CAS  Google Scholar 

  8. Del Campo F, Hornero R, Zamarron C, Abasolo DE, Alvarez D (2006) Oxygen saturation regularity analysis in the diagnosis of obstructive sleep apnea. Artif Intell Med 37(2):111–118

    Article  PubMed  Google Scholar 

  9. Dutta K, Prakash N, Kaushik S (2010) Probabilistic neural network approach to the classification of demonstrative pronouns for indirect anaphora in Hindi. Expert Syst Appl 37(8):5607–5613

    Article  Google Scholar 

  10. Fawcett T (2006) An introduction to ROC analysis. Pattern Recogn Lett 27(8):861–874

    Article  Google Scholar 

  11. Finkel K, Searleman A, Tymkew H, Finkel KJ, Searleman AC, Tymkew H, Tanaka CY, Saager L, Safer-Zadeh E, Bottros M, Selvidge JA, Jacobsohn E, Pulley D, Duntley S, Becker C, Avidan MS (2009) Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med 10(7):753–758

    Article  PubMed  Google Scholar 

  12. Flemons WW, Littner MR, Rowley JA, Gay P, Anderson WM, Hudgel DW, McEvoy RD, Loube DI (2003) Home diagnosis of sleep apnea: a systematic review of the literature. An evidence review cosponsored by the American Academy of Sleep Medicine, the American College of Chest Physicians, and the American Thoracic Society. Chest 124(4):1543–1579

    Article  PubMed  Google Scholar 

  13. Gross N, Friedmann J, Kunze C, Stork W, Morillo DS, Jimenez AL, Foix LFC (2011) Increasing reliability and information content of pulse oximetric SAHS screening algorithms. In: BIOSIGNALS—Proceedings of the International Conference on Bio-Inspired Systems and Signal Processing, pp 438–445

  14. Herer B, Roche N, Carton M, Roig C, Poujol V, Huchon G (1999) Value of clinical, functional, and oximetric data for the prediction of obstructive sleep apnea in obese patients. Chest 116:1537–1544

    Article  PubMed  CAS  Google Scholar 

  15. Hornero R, Álvarez D, Abásolo D, del Campo F, Zamarrón C (2007) Utility of approximate entropy from overnight pulse oximetry data in the diagnosis of the obstructive sleep apnea syndrome. IEEE Trans Biomed Eng 54(1):107–113

    Article  PubMed  Google Scholar 

  16. Hua CC, Yu CC (2007) Smoothed periodogram of oxyhemoglobin saturation by pulse oximetry in sleep apnea syndrome. Chest 131:750–757

    Article  PubMed  Google Scholar 

  17. Kapur V, Blough D, Sandblom R, Hert R, de Maine JB, Sullivan SD, Psaty BM (1999) The medical cost of undiagnosed sleep apnea. Sleep 22(6):749–755

    PubMed  CAS  Google Scholar 

  18. Levy P, Pépin JL, Deschaux-Blanc C, Paramelle B, Brambilla C (1996) Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome. Chest 109:395–399

    Article  PubMed  CAS  Google Scholar 

  19. Magalang U, Dmochowski J, Veeramachaneni S, Draw A, Mador M, El-Solh A, Grant B (2003) Prediction of the apnea–hypopnea prediction of the apnea–hypopnea index from overnight pulse oximetry index. Chest 124(5):1694–1701

    Article  PubMed  Google Scholar 

  20. Marcos JV, Hornero R, Álvarez D, del Campo F, Zamarrón C (2009) Assessment of four statistical pattern recognition techniques to assist in obstructive sleep apnoea diagnosis from nocturnal oximetry. Med Eng Phys 31:971–978

    Article  PubMed  Google Scholar 

  21. Marcos JV, Hornero R, Álvarez D, del Campo F, Aboy M (2010) Automated detection of obstructive sleep apnoea syndrome from oxygen saturation recordings using linear discriminant analysis. Med Biol Eng Comput 48:895–902

    Article  PubMed  Google Scholar 

  22. Mayer G, Fietze I, Fischer J, Penzel T, Riemann D, Rodenbeck A, Sitter H, Teschler H, Becker HF, Ficker J, Geisler P, Happe S, Hornyak M, Kotterba S, Orth M, Podszus T, Raschke F, Randerath W, Rühle KH, Stiasny-Kolster K, Walther B, Wiater A (2009) S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen. Somnologie 13:4–160

    Article  Google Scholar 

  23. Morillo DS, Rojas JL, Crespo LF, León 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(4):405–420

    Article  PubMed  Google Scholar 

  24. Morillo DS, Gross N, León A, Crespo LF (2012) Automated frequency domain analysis of oxygen saturation as a screening tool for SAHS. Med Eng Phys 34(7):946–953

    Article  PubMed  Google Scholar 

  25. Netzer N, Eliasson AH, Netzer C, Kristo DA (2001) Overnight pulse oximetry for sleep-disordered breathing in adults. Chest 120:625–633

    Article  PubMed  CAS  Google Scholar 

  26. Parzen E (1962) On estimation of a probability density-function and mode. Ann Math Statist 33(3):1065–1076

    Article  Google Scholar 

  27. Rauscher H, Popp W, Zwick H (1991) Computerized detection of respiratory events during sleep from rapid increases in oxyhemoglobin saturation. Lung 169(6):335–342

    Article  PubMed  CAS  Google Scholar 

  28. Rechtschaffen A, Kales A (eds) (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. US Department of Health, Education, and Welfare Public Health Service-NIH/NIND, Washington, DC

  29. Rusch TL, Sankar R, Scharf JE (1996) Signal processing methods for pulse oximetry. Comput Biol Med 26(2):143–159

    Article  PubMed  CAS  Google Scholar 

  30. Specht DF (1990) Probabilistic neural networks and the polynomial adaline as complementary techniques for classification. IEEE Trans Neural Netw 1(1):111–121

    Article  PubMed  CAS  Google Scholar 

  31. Sunwoo BY, Pack AI, Gurubhagavatula I (2011) Diagnostic approaches to sleep-disordered breathing in the era of portable monitoring and biomarkers. Clin Pulm Med 18(4):192–200

    Article  Google Scholar 

  32. Wolpert DH (1992) Stacked generalization. Neural Netw 5:241–259

    Article  Google Scholar 

  33. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235

    Article  PubMed  CAS  Google Scholar 

  34. Young T, Evans L, Finn L, Palta M (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20:705–706

    PubMed  CAS  Google Scholar 

  35. Zamarron C, Romero PV, Rodriguez JR, Gude F (1999) Oximetry spectral analysis in the diagnosis of obstructive sleep apnoea. Clin Sci 97(4):467–473

    Article  PubMed  CAS  Google Scholar 

  36. Zweig MH, Campbell G (1993) Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 39(4):561–577

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study would not have been possible without the cooperation of University Hospital Puerta del Mar of Cádiz. In particular, we are indebted to Dr. Antonio León who afforded us the authorization, data collection and backup we needed.

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniel Sánchez Morillo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morillo, D.S., Gross, N. Probabilistic neural network approach for the detection of SAHS from overnight pulse oximetry. Med Biol Eng Comput 51, 305–315 (2013). https://doi.org/10.1007/s11517-012-0995-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11517-012-0995-4

Keywords

Navigation