Semi-Supervised Learning for Low-Cost Personalized Obstructive Sleep Apnea Detection Using Unsupervised Deep Learning and Single-Lead Electrocardiogram

OBJECTIVE: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that can lead to a wide range of health issues if left untreated. This study aims to address the lack of research on personalized models for single-lead electrocardiogram (ECG)-based OSA detection, by proposing an automatic semi-supervised algorithm for automated low-cost personalization fine-tuning. METHODS: We utilize a convolutional neural network (CNN)-based auto-encoder (AE) with a modified training objective to detect anomalous region of OSA. An indicator based on model outputs is utilized as a benchmark measure to assign pseudo-labels with confidence to each sample. Finally, we perform validation of the semi-supervised algorithm on the same database and cross-database scenarios. RESULTS: By introducing semi-supervised personalization, the accuracy, AUC, and mean absolute error (MAE) of the general model (GM) of 35 subjects from the same database are improved from 86.3%, 0.915, and 5.178 to 90.3%, 0.948, and 2.593. Simultaneously, in the validation of 25 subjects from a cross-database, the accuracy, AUC, and MAE of the GM are enhanced from 75.6%, 0.800, and 9.149 to 84.3%, 0.881, and 3.509. CONCLUSION: The improved version of AE demonstrates excellent adaptability in identifying abnormal features in OSA, employing a data-driven approach to assign pseudo-labels for unknown data automatically. Additionally, leveraging the pseudo-labels through a semi-supervised fine-tuning strategy provides a solution to overcome the limitation of clinical annotations, facilitating low-cost implementation of personalized models. SIGNIFICANCE: The semi-supervised approach proposed in this article provides a high-performance and annotation-free solution for personalized adjustment of automatic OSA detection.