title: Reviewing the connection between speech and obstructive sleep apnea.
abstract: BACKGROUND
  Sleep apnea (OSA) is a common sleep disorder characterized by recurring breathing pauses during sleep caused by a blockage of the upper airway (UA). The altered UA structure or function in OSA speakers has led to hypothesize the automatic analysis of speech for OSA assessment. In this paper we critically review several approaches using speech analysis and machine learning techniques for OSA detection, and discuss the limitations that can arise when using machine learning techniques for diagnostic applications.
  
  
  METHODS
  A large speech database including 426 male Spanish speakers suspected to suffer OSA and derived to a sleep disorders unit was used to study the clinical validity of several proposals using machine learning techniques to predict the apnea-hypopnea index (AHI) or classify individuals according to their OSA severity. AHI describes the severity of patients' condition. We first evaluate AHI prediction using state-of-the-art speaker recognition technologies: speech spectral information is modelled using supervectors or i-vectors techniques, and AHI is predicted through support vector regression (SVR). Using the same database we then critically review several OSA classification approaches previously proposed. The influence and possible interference of other clinical variables or characteristics available for our OSA population: age, height, weight, body mass index, and cervical perimeter, are also studied.
  
  
  RESULTS
  The poor results obtained when estimating AHI using supervectors or i-vectors followed by SVR contrast with the positive results reported by previous research. This fact prompted us to a careful review of these approaches, also testing some reported results over our database. Several methodological limitations and deficiencies were detected that may have led to overoptimistic results.
  
  
  CONCLUSIONS
  The methodological deficiencies observed after critically reviewing previous research can be relevant examples of potential pitfalls when using machine learning techniques for diagnostic applications. We have found two common limitations that can explain the likelihood of false discovery in previous research: (1) the use of prediction models derived from sources, such as speech, which are also correlated with other patient characteristics (age, height, sex,…) that act as confounding factors; and (2) overfitting of feature selection and validation methods when working with a high number of variables compared to the number of cases. We hope this study could not only be a useful example of relevant issues when using machine learning for medical diagnosis, but it will also help in guiding further research on the connection between speech and OSA.
authors.affiliation: GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, Madrid, Spain. fernando@gaps.ssr.upm.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: Espinoza-Cuadros
authors.affiliation: GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, Madrid, Spain. ruben@gaps.ssr.upm.es.
authors.forename: Rubén
authors.initials: R
authors.lastname: Fernández-Pozo
authors.affiliation: ATVS Biometric Recognition Group, Universidad Autónoma de Madrid, Madrid, Spain. doroteo.torre@uam.es.
authors.forename: Doroteo T
authors.initials: DT
authors.lastname: Toledano
authors.affiliation: Respiratory Department, Sleep Unit Hospital Quirón Málaga, Málaga, Spain. jose44@separ.es.
authors.forename: José D
authors.initials: JD
authors.lastname: Alcázar-Ramírez
authors.affiliation: GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, Madrid, Spain. eduardo.lopez@upm.es.
authors.forename: Eduardo
authors.initials: E
authors.lastname: López-Gonzalo
authors.affiliation: GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, Madrid, Spain. luisalfonso.hernandez@upm.es.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Hernández-Gómez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003936:Diagnosis, Computer-Assisted; D005260:Female; D006801:Humans; D000069550:Machine Learning; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology*; D013060:Speech; D055815:Young Adult