Sleep Stage Classification During CPAP Therapy from CPAP-Airflow and Wearable Fingertip Signals

Background: Continuous Positive Airway Pressure (CPAP) therapy is the standard treatment for obstructive sleep apnea–hypopnea syndrome (OSAHS), and photoplethysmography (PPG) sensors are commonly used in wearable devices for home sleep apnea testing. The recorded airflow and PPG signals from both sensors capture rich physiological patterns. We hypothesize that by combining information from these signals, we can efficiently estimate sleep dynamics of patients receiving CPAP treatment. Methods: The airflow signals were obtained from CPAP titration devices, denoted as CPAP-airflow, while the PPG signals were collected using the PranaQ TipTraQ (TTQ001), a fingertip-worn wearable device. We separately trained one-dimensional convolutional neural networks for CPAP-airflow and PPG signals and fused their outputs through probabilistic ensembling to predict sleep stages. The ensemble method is a late-fusion soft-voting scheme that computes a linearly weighted combination of synchronized softmax probability vectors from the modality-specific models. Results: For three-stage classification (Wake, REM, NREM), the PPG-based and CPAP-airflow-based models achieved overall Cohen’s kappa scores of 0.511 and 0.452, respectively, while the ensembled model improved the overall kappa to 0.587. The F1-score for the REM stage improved to 0.706 using the ensemble method, compared to 0.685 and 0.532 achieved by the individual models, respectively. In the four-stage classification (Wake, REM, Light, Deep) task, a deep sleep sensitivity of 0.596 was attained through the application of probabilistic ensembling. Conclusions: A fusion scheme of complementary information from the CPAP and PPG enhances the accuracy of sleep stage detection and hence enables more precise sleep monitoring, especially with an improved REM identification. Clinical implications include applying the proposed algorithm to improve in-home auto-CPAP titration by capturing REM-related respiratory instability and avoiding under-titration in REM-dominant OSAHS, better reflecting the patient’s true nocturnal respiratory needs.