Sleep apnea classification algorithm development using a machine-learning framework and bag-of-features derived from electrocardiogram spectrograms

Background: Heart rate variability (HRV) and electrocardiogram (ECG)-derived respiration (EDR) have been used to detect sleep apnea (SA) for decades. The present study proposes an SA-detection algorithm using a machine-learning framework and bag-of-features (BoF) derived from an ECG spectrogram. Methods: This study was verified using overnight ECG recordings from 83 subjects with an average apnea–hypopnea index (AHI) 29.63 (/h) derived from the Physionet Apnea-ECG and National Cheng Kung University Hospital Sleep Center database. The study used signal preprocessing to filter noise and artifacts, ECG time–frequency transformation using continuous wavelet transform (CWT), BoF feature generation, machine-learning classification using support vector machine (SVM), ensemble learning (EL), k-nearest neighbor (KNN) classification, and cross-validation. The time length of the spectrogram was set as 10 and 60 s to examine the required minimum spectrogram window time length to achieve satisfactory accuracy. Specific frequency bands of 0.1–50, 8–50, 0.8–10, and 0–0.8 Hz were also extracted to generate the BoF to determine the band frequency best suited for SA detection. Results: The five-fold cross-validation accuracy using the BoF derived from the ECG spectrogram with 10 and 60 s time windows were 90.5% and 91.4% for the 0.1–50 Hz and 8–50 Hz frequency bands, respectively. Conclusion: An SA-detection algorithm utilizing BoF and a machine-learning framework was successfully developed in this study with satisfactory classification accuracy and high temporal resolution.