Application of Deep Learning to Improve Sleep Scoring of Wrist Actigraphy.

Background: Estimation of sleep parameters by wrist actigraphy is highly dependent on performance of the interpretative algorithm (IA) that converts movement data into sleep/wake scores. Research questions: (1) Does the actigraphy mode of operation -Proportional Integrating Measure (PIM) or Zero Crossing Mode (ZCM), responsive respectively to intensity and frequency of movements- impact sleep scoring; and (2) Can a better performing sleep scoring IA be developed by a deep learning approach combining PIM/ZCM data. Study design and Methods: ZCM and PIM plus electroencephalographic (EEG) data of 40 healthy adults (17 female, mean age: 26.7 years) were obtained from a single in-home nighttime sleep study. Effect of mode of operation was first evaluated by applying several classic deep learning models to PIM only, ZCM only, and combined ZCM/PIM data. After, a novel deep learning model was developed incorporating combined ZCM/PIM data, and its performance was compared with existing Cole-Kripke, rescored ColeKripke, Sadeh, and UCSD lAs. Results: Relative to the EEG reference, ZCM/PIM combined mode produced higher agreement of scoring sleep/wake epochs than only ZCM or PIM modes. The proposed novel deep learning model showed 87.7% accuracy (0.2-1% higher than the other IAs), 94.1% sensitivity (0.7-4.3% lower than the other IAs), 64.0% specificity (9.9-21.5% higher than the other IAs), and 59.9% Kappa agreement (similar to 6.9-11.6% higher than other IAs) in detecting sleep epochs. The proposed deep learning model did not differ significantly from the reference EEG in estimating sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE). Amount of bias and minimum detectable change in estimating SOL, WASO, TST and SE by the deep learning model was smaller than other four IAs. Interpretation: The proposed novel deep learning algorithm simultaneously incorporating ZCM/PIM mode data performs significantly better in assessing sleep than existing conventional IAs. (C) 2020 Elsevier B.V. All rights reserved.