title: Recurrence analysis of the EEG during sleep accurately identifies subjects with mental health symptoms.
abstract: Analysis of brain recurrence (ABR) is a novel computational method that uses two variables for sleep depth and two for sleep fragmentation to quantify temporal changes in non-random brain electrical activity. We postulated that ABR of the sleep-staged EEG could identify an EEG signature specific for the presence of mental health symptoms. Using the Mental Health Inventory Questionnaire (MHI-5) as ground truth, psychological distress was assessed in a study cohort obtained from the Sleep Heart Health Study. Subjects with MHI-5 <50 (N=34) were matched for sex, BMI, age, and race with 34 subjects who had MHI-5 scores >50. Sixteen ABR markers derived from the EEG were analyzed using linear discriminant analysis to identify marker combinations that reliably classified individual subjects. A biomarker function computed from 12 of the markers accurately classified the subjects based on their MHI-5 scores (AUROC=82%). Use of additional markers did not improve classification accuracy. Subgroup analysis (20 highest and 20 lowest MHI-5 scores) improved classification accuracy (AUROC=89%). Biomarker values for individual subjects were significantly correlated with MHI-5 score (r=0.36, 0.54 for N=68, 40, respectively). ABR of EEGs obtained during sleep successfully classified subjects with regard to the severity of mental health symptoms, indicating that mood systems were reflected in brain electrical activity.
authors.affiliation: Division of Sleep Medicine, Department of Neurology, LSU Health Sciences Center, Shreveport, LA, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: McCarty
authors.affiliation: Department of Pulmonary & Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD, USA.
authors.forename: Naresh M
authors.initials: NM
authors.lastname: Punjabi
authors.affiliation: Division of Sleep Medicine, Department of Neurology, LSU Health Sciences Center, Shreveport, LA, USA.
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Kim
authors.affiliation: School of Allied Health Professions, LSU Health Sciences Center, Shreveport, LA, USA.
authors.forename: Clifton
authors.initials: C
authors.lastname: Frilot
authors.affiliation: Division of Sleep Medicine, Department of Neurology, LSU Health Sciences Center, Shreveport, LA, USA. Electronic address: andrewamarino@gmail.com.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Marino
mesh_terms: D015415:Biomarkers; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis*; D008875:Middle Aged; D012893:Sleep Wake Disorders / Q000503:physiopathology*
chemical_list: D015415:Biomarkers
keywords: AUROC; Biomarker; Brain recurrence; Electroencephalography; MHI-5; Mental disorders