A Systematic Review of Sensing Technologies for Wearable Sleep Staging

111

Consumer-grade sleep trackers represent a promising tool for large scale studies and health management. However, the potential and limitations of these devices remain less well quantified. Addressing this issue, we aim at providing a comprehensive analysis of the impact of accelerometer, autonomic nervous system (ANS)-mediated peripheral signals, and circadian features for sleep stage detection on a large dataset. Four hundred and forty nights from 106 individuals, for a total of 3444 h of combined polysomnography (PSG) and physiological data from a wearable ring, were acquired. Features were extracted to investigate the relative impact of different data streams on 2-stage (sleep and wake) and 4-stage classification accuracy (light NREM sleep, deep NREM sleep, REM sleep, and wake). Machine learning models were evaluated using a 5-fold cross-validation and a standardized framework for sleep stage classification assessment. Accuracy for 2-stage detection (sleep, wake) was 94% for a simple accelerometer-based model and 96% for a full model that included ANS-derived and circadian features. Accuracy for 4-stage detection was 57% for the accelerometer-based model and 79% when including ANS-derived and circadian features. Combining the compact form factor of a finger ring, multidimensional biometric sensory streams, and machine learning, high accuracy wake-sleep detection and sleep staging can be accomplished.

Section: Discussionmentioning

confidence: 99%

The Promise of Sleep: A Multi-Sensor Approach for Accurate Sleep Stage Detection Using the Oura Ring

Altini

Kinnunen²

2021

111

“…Similar findings exist surrounding physiology in terms of HR, HRV, and RR [ 96 , 97 ]. However, few researchers will be comfortable utilizing sleep staging classifications reported from these devices, as most devices consistently exhibit error rates over 30% [ 91 , 98 ]. While the question of ‘how accurate is accurate enough?’ will never be answered simply, this question does pose significant context for whether commercial multi-modal devices may be appropriate for use in research [ 99 ].…”

Section: Remaining Challenges For Accurate Sleep Monitoringmentioning

confidence: 99%

Deconstructing Commercial Wearable Technology: Contributions toward Accurate and Free-Living Monitoring of Sleep

Rentz

Ulman

Galster

2021

Despite prolific demands and sales, commercial sleep assessment is primarily limited by the inability to “measure” sleep itself; rather, secondary physiological signals are captured, combined, and subsequently classified as sleep or a specific sleep state. Using markedly different approaches compared with gold-standard polysomnography, wearable companies purporting to measure sleep have rapidly developed during recent decades. These devices are advertised to monitor sleep via sensors such as accelerometers, electrocardiography, photoplethysmography, and temperature, alone or in combination, to estimate sleep stage based upon physiological patterns. However, without regulatory oversight, this market has historically manufactured products of poor accuracy, and rarely with third-party validation. Specifically, these devices vary in their capacities to capture a signal of interest, process the signal, perform physiological calculations, and ultimately classify a state (sleep vs. wake) or sleep stage during a given time domain. Device performance depends largely on success in all the aforementioned requirements. Thus, this review provides context surrounding the complex hardware and software developed by wearable device companies in their attempts to estimate sleep-related phenomena, and outlines considerations and contributing factors for overall device success.

“…Agreement for sleep stage classification was 74% (κ = 0.61). Other small series have also reported interesting results, with accuracies between 72% and 90% [61]. Recently, technical improvements of in-ear EEG were obtained by Kaveh et al with the development of the first wireless, dry multielectrode in-ear EEG [62].…”

Section: Discussionmentioning

confidence: 93%

Photoplethysmography in Normal and Pathological Sleep

Vulcan

André

Bruyneel

2021

This article presents an overview of the advancements that have been made in the use of photoplethysmography (PPG) for unobtrusive sleep studies. PPG is included in the quickly evolving and very popular landscape of wearables but has specific interesting properties, particularly the ability to capture the modulation of the autonomic nervous system during sleep. Recent advances have been made in PPG signal acquisition and processing, including coupling it with accelerometry in order to construct hypnograms in normal and pathologic sleep and also to detect sleep-disordered breathing (SDB). The limitations of PPG (e.g., oxymetry signal failure, motion artefacts, signal processing) are reviewed as well as technical solutions to overcome these issues. The potential medical applications of PPG are numerous, including home-based detection of SDB (for triage purposes), and long-term monitoring of insomnia, circadian rhythm sleep disorders (to assess treatment effects), and treated SDB (to ensure disease control). New contact sensor combinations to improve future wearables seem promising, particularly tools that allow for the assessment of brain activity. In this way, in-ear EEG combined with PPG and actigraphy could be an interesting focus for future research.