Employing Neural Network Methods to Label Sleep EEG Micro-Arousals in Obstructive Sleep Apnea Syndrome

Document Type : Methodology Report


1 Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.

2 Sleep Disorders Laboratory, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

3 Sleep Disorders Unit, American Hospital, Koc Foundation, Istanbul, Turkey.



Well-designed studies are essential to screen suspected cases of Obstructive Sleep Apnea Syndrome (OSAS) using the widely-referenced questionnaires and then to confirm the diagnosis by means of full Polysomnography (PSG), and finally to assess various variables of treatment efficacy and safety. Defining the severity index of OSAS based on the Apnea-Hypopnea Index (AHI), sleep marco- and micro-structural features (i.e. hypnogram and cyclic alternating patterns or CAPs), and neurocognitive functions would help better explain the treatment outcome. Using the neural network models on sleep data in OSAS sufferers is potentially expected to help the above goals. Determination of neurocognitive impairments in OSAS subjects in relation with disease severity indices and subsequent changes in microstructural changes (i.e. CAPs) in sleep Electroencephalography (EEG), would therefore be useful in defining individualized care and cognitive rehabilitation plans. The present methodology paper has attempted to address the above hypothesis in a clinical population from a hospital-based sleep disorders laboratory.


  1. Baldi I, Gulati A, Lorenzoni G, Natarajan K, Ballali S, Kameswaran M, et al. Public health implications of obstructive sleep apnea burden. Indian Journal of Pediatrics. 2014; 81(1):55-62. [DOI:10.1007/s12098-014-1539-8] [PMID]
  2. Young T, Palta M, Dempsey J, Peppard PE, Nieto FJ, Hla KM. Burden of sleep apnea: Rationale, design, and major findings of the Wisconsin Sleep Cohort study. World Medical Association. 2009; 108(5):246-9. [PMID] [PMCID]
  3. Madbouly EM, Nadeem R, Nida M, Molnar J, Aggarwal S, Loomba R. The role of severity of obstructive sleep apnea measured by apnea-hypopnea index in predicting compliance with pressure therapy: A meta-analysis. American Journal of Therapeutics. 2014; 21(4):260-4. [DOI:10.1097/MJT.0b013e318249a09d] [PMID]
  4. Hsieh SW, Lai CL, Liu CK, Hsieh CF, Hsu CY. Obstructive sleep apnea linked to wake-up strokes. Journal of Neurology. 2012; 259(7):1433-9. [DOI:10.1007/s00415-011-6370-9] [PMID]
  5. Torabi-Nami M, Mehrabi S, Borhani-Haghighi A, Derman S. Withstanding the obstructive sleep apnea syndrome at the expense of arousal instability, altered cerebral autoregulation and neurocognitive decline. Journal of Integrative Neuroscience. 2015; 14(2):169-93. [DOI:10.1142/S0219635215500144] [PMID]
  6. Gelir E, Basaran C, Bayrak S, Yagcioglu S, Budak MT, Firat H, et al. Electrophysiological assessment of the effects of obstructive sleep apnea on cognition. PLoS One. 2014; 9(2):e90647. [DOI:10.1371/journal.pone.0090647] [PMID] [PMCID]
  7. Beebe DW, Groesz L, Wells C, Nichols A, McGee K. The neuropsychological effects of obstructive sleep apnea: A meta-analysis of norm-referenced and case-controlled data. Sleep. 2003; 26(3):298-307. [DOI:10.1093/sleep/26.3.298] [PMID]
  8. Canessa N, Castronovo V, Cappa SF, Aloia MS, Marelli S, Falini A, et al. Obstructive sleep apnea: Brain structural changes and neurocognitive function before and after treatment. American Journal of Respiratory and Critical Care Medicine. 2011; 183(10):1419-26. [DOI:10.1164/rccm.201005-0693OC] [PMID]
  9. Karimzadeh F, Nami M, Boostani R. Sleep microstructure dynamics and neurocognitive performance in obstructive sleep apnea syndrome patients. Journal of Integrative Neuroscience. 2017; 16(2):127-42. [DOI:10.3233/JIN-170004] [PMID]
  10. Milioli G, Bosi M, Grassi A, Riccardi S, Terzano MG, Cortelli P, et al. Can sleep microstructure improve diagnosis of OSAS? Integrative information from CAP parameters. Archives Italiennes de Biologie. 2015; 153(2-3):194-203. [PMID]
  11. Smerieri A, Parrino L, Agosti M, Ferri R, Terzano MG. Cyclic alternating pattern sequences and non-cyclic alternating pattern periods in human sleep. Clinical Neurophysiology. 2007; 118(10):2305-13. [DOI:10.1016/j.clinph.2007.07.001] [PMID]
  12. Thomas RJ, Terzano MG, Parrino L, Weiss JW. Obstructive sleep-disordered breathing with a dominant cyclic alternating pattern: A recognizable polysomnographic variant with practical clinical implications. Sleep. 2004; 27(2):229-34. [DOI:10.1093/sleep/27.2.229] [PMID]
  13. Terzano MG, Parrino L, Boselli M, Spaggiari MC, Di Giovanni G. Polysomnographic analysis of arousal responses in obstructive sleep apnea syndrome by means of the cyclic alternating pattern. Journal of Clinical Neurophysiology. 1996; 13(2):145-55. [DOI:10.1097/00004691-199603000-00005] [PMID]