Gutiérrez-Tobal Gonzalo C, Álvarez Daniel, Vaquerizo-Villar Fernando, Crespo Andrea, Kheirandish-Gozal Leila, Gozal David, Del Campo Félix, Hornero Roberto
Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain.
Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, (CIBER-BBN), Madrid, Spain.
Appl Soft Comput. 2021 Nov;111. doi: 10.1016/j.asoc.2021.107827. Epub 2021 Aug 25.
Overnight pulse oximetry has shown usefulness to simplify obstructive sleep apnea (OSA) diagnosis when combined with machine-learning approaches. However, the development and evaluation of a single model with ability to reach high diagnostic performance in both community-based non-referral and clinical referral cohorts are still pending. Since ensemble-learning algorithms are known for their generalization ability, we propose a least-squares boosting (LSBoost) model aimed at estimating the apnea-hypopnea index (AHI), as the correlate clinical measure of disease severity. A thorough characterization of 8,762 nocturnal blood-oxygen saturation signals (SpO) obtained at home was conducted to extract the oximetric information subsequently used in the training, validation, and test stages. The estimated AHI derived from our model achieved high diagnostic ability in both referral and non-referral cohorts reaching intra-class correlation coefficients within 0.889-0.924, and Cohen's within 0.478-0.663 when considering the four OSA severity categories. These resulted in accuracies ranging 87.2%-96.6%, 81.1%-87.6%, and 91.6%-94.6% when assessing the three typical AHI severity thresholds, 5 events/hour (e/h), 15 e/h, and 30 e/h, respectively. Our model also revealed the importance of the SpO predictors, thereby minimizing the 'black box' perception traditionally attributed to the machine-learning approaches. Furthermore, a decision curve analysis emphasized the clinical usefulness of our proposal. Therefore, we conclude that the LSBoost-based model can foster development of clinically applicable and cost saving protocols for detection of patients attending primary care services, or to avoid full polysomnography in specialized sleep facilities, thus demonstrating the diagnostic usefulness of SpO signals obtained at home.
夜间脉搏血氧饱和度测定法与机器学习方法相结合时,已显示出有助于简化阻塞性睡眠呼吸暂停(OSA)的诊断。然而,开发和评估一个能够在基于社区的非转诊队列和临床转诊队列中均达到高诊断性能的单一模型仍有待完成。由于集成学习算法以其泛化能力而闻名,我们提出了一种最小二乘增强(LSBoost)模型,旨在估计呼吸暂停低通气指数(AHI),作为疾病严重程度的相关临床指标。我们对在家中获得的8762个夜间血氧饱和度信号(SpO)进行了全面表征,以提取随后用于训练、验证和测试阶段的血氧测定信息。从我们的模型得出的估计AHI在转诊和非转诊队列中均具有较高的诊断能力,在考虑四个OSA严重程度类别时,组内相关系数在0.889 - 0.924之间,科恩系数在0.478 - 0.663之间。在评估三个典型的AHI严重程度阈值,即5次/小时(e/h)、15 e/h和30 e/h时,准确率分别为87.2% - 96.6%、81.1% - 87.6%和91.6% - 94.6%。我们的模型还揭示了SpO预测因子的重要性,从而将传统上归因于机器学习方法的“黑箱”观念降至最低。此外,决策曲线分析强调了我们提议的临床实用性。因此,我们得出结论,基于LSBoost的模型可以促进针对基层医疗服务患者检测的临床适用且节省成本的方案的开发,或避免在专业睡眠机构进行全面的多导睡眠图检查,从而证明在家中获得的SpO信号的诊断有用性。