title: Sleep/wake estimation using only anterior tibialis electromyography data.
abstract: BACKGROUND
  In sleep efficiency monitoring system, actigraphy is the simplest and most commonly used device. However, low specificity to wakefulness of actigraphy was revealed in previous studies. In this study, we assumed that sleep/wake estimation using actigraphy and electromyography (EMG) signals would show different patterns. Furthermore, each EMG pattern in two states (sleep, wake during sleep) was analysed. Finally, we proposed two types of method for the estimation of sleep/wake patterns using only EMG signals from anterior tibialis muscles and the results were compared with PSG data.
  
  
  METHODS
  Seven healthy subjects and five patients (2 obstructive sleep apnea, 3 periodic limb movement disorder) participated in this study. Night time polysomnography (PSG) recordings were conducted, and electrooculogram, EMG, electroencephalogram, electrocardiogram, and respiration data were collected. Time domain analysis and frequency domain analysis were applied to estimate the sleep/wake patterns. Each method was based on changes in amplitude or spectrum (total power) of anterior tibialis electromyography signals during the transition from the sleep state to the wake state. To obtain the results, leave-one-out-cross-validation technique was adopted.
  
  
  RESULTS
  Total sleep time of the each group was about 8 hours. For healthy subjects, the mean epoch-by-epoch results between time domain analysis and PSG data were 99%, 71%, 80% and 0.64 (sensitivity, specificity, accuracy and kappa value), respectively. For frequency domain analysis, the corresponding values were 99%, 73%, 81% and 0.67, respectively. Absolute and relative differences between sleep efficiency index from PSG and our methods were 0.8 and 0.8% (for frequency domain analysis). In patients with sleep-related disorder, our proposed methods revealed the substantial agreement (kappa > 0.61) for OSA patients and moderate or fair agreement for PLMD patients.
  
  
  CONCLUSIONS
  The results of our proposed methods were comparable to those of PSG. The time and frequency domain analyses showed the similar sleep/wake estimation performance.
authors.affiliation: Interdisciplinary program of Bioengineering, Seoul National University, Seoul, Republic of Korea.
authors.forename: SuHwan
authors.initials: S
authors.lastname: Hwang
authors.forename: GihSung
authors.initials: G
authors.lastname: Chung
authors.forename: JeongSu
authors.initials: J
authors.lastname: Lee
authors.forename: JaeHyuk
authors.initials: J
authors.lastname: Shin
authors.forename: So-Jin
authors.initials: SJ
authors.lastname: Lee
authors.forename: Do-Un
authors.initials: DU
authors.lastname: Jeong
authors.forename: KwangSuk
authors.initials: K
authors.lastname: Park
mesh_terms: D056044:Actigraphy; D000328:Adult; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D007866:Leg; D008297:Male; D009132:Muscles / Q000502:physiology*; D020189:Nocturnal Myoclonus Syndrome / Q000503:physiopathology; D015203:Reproducibility of Results; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology; D013997:Time Factors; D014851:Wakefulness / Q000502:physiology*