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Volume 15 No. 10
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Accepted Papers

Scientific Investigations

Automatic Sleep Staging in Patients With Obstructive Sleep Apnea Using Single-Channel Frontal EEG

Pei-Lin Lee, MD1,2,3; Yi-Hao Huang, MS4; Po-Chen Lin, MS4; Yu-An Chiao, MS4; Jen-Wen Hou, BS4; Hsiang-Wen Liu, MD2; Ya-Ling Huang, MS2; Yu-Ting Liu, PhD5; Tzi-Dar Chiueh, PhD4,6
1Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan; 2Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 3Center for Electronics Technology Integration, National Taiwan University; 4Graduate Institute of Electronics Engineering, National Taiwan University, Taipei, Taiwan; 5MediaTek Inc., Hsinchu, Taiwan; 6Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan

Study Objectives:

Reliable sleep staging is difficult to obtain from home sleep testing for diagnosis of obstructive sleep apnea (OSA), especially when it is self-applied. Hence, the current study aimed to develop a single frontal electroencephalography-based automatic sleep staging system (ASSS).


The ASSS system was developed on a clinical dataset, with a high percentage of participants with OSA. The F4-M1 signal extracted from 62 participants (62.9% having OSA) was used to build a four-stage classifier. Performance of the ASSS was tested in a holdout set of 58 patients (60.3% having OSA) with epoch-by-epoch and whole-night agreement for sleep staging compared with expert scoring of polysomnography.


Mean all-stage percentage agreement was 75.52% (95% confidence interval, 72.90 to 78.13) (kappa 0.62; 95% confidence interval, 0.58 to 0.65), with mean percentage agreement for wake, light sleep, deep sleep (DS), and rapid eye movement of 78.04%, 70.97%, 83.65%, and 75.00%, respectively. The whole-night agreement was good-excellent (intraclass correlation coefficient, 0.74 to 0.88) for sleep onset latency, wake after sleep onset, total sleep time, and sleep efficiency. Compared to the non-OSA subset, the OSA subset had lower agreement for DS.


Our results indicate that a single-channel F4-M1 based ASSS was sufficient for sleep staging in a population with a high percentage of participants with OSA.


Lee P-L, Huang Y-H, Lin P-C, Chiao Y-A, Hou J-W, Liu H-W, Huang Y-L, Liu Y-T, Chiueh T-D. Automatic sleep staging in patients with obstructive sleep apnea using single-channel frontal EEG. J Clin Sleep Med. 2019;15(10):1411–1420.

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