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A Computerized Algorithm for Arousal Detection in Healthy Adults and Patients With Parkinson Disease

Sorensen, Gertrud L.*,†,‡; Jennum, Poul†,‡; Kempfner, Jacob*,†,‡; Zoetmulder, Marielle†,‡,§; Sorensen, Helge B.D.*

Journal of Clinical Neurophysiology: February 2012 - Volume 29 - Issue 1 - p 58–64
doi: 10.1097/WNP.0b013e318246b74e
Original Research

Summary Arousals occur from all sleep stages and can be identified as abrupt electroencephalogram (EEG) and electromyogram (EMG) changes. Manual scoring of arousals is time consuming with low interscore agreement. The aim of this study was to design an arousal detection algorithm capable of detecting arousals from non–rapid eye movement (REM) and REM sleep, independent of the subject's age and disease. The proposed algorithm uses features from EEG, EMG, and the manual sleep stage scoring as input to a feed-forward artificial neural network (ANN). The performance of the algorithm has been assessed using polysomnographic (PSG) recordings from a total of 24 subjects. Eight of the subjects were diagnosed with Parkinson disease (PD) and the rest (16) were healthy adults in various ages. The performance of the algorithm was validated in 3 settings: testing on the 8 patients with PD using the leave-one-out method, testing on the 16 healthy adults using the leave-one-out method, and finally testing on all 24 subjects using a 4-fold crossvalidation. For these 3 validations, the sensitivities were 89.8%, 90.3%, and 89.4%, and the positive predictive values (PPVs) were 88.8%, 89.4%, and 86.1%. These results are high compared with those of previously presented arousal detection algorithms and especially compared with the high interscore variability of manual scorings.

*Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark

Danish Center for Sleep Medicine, Glostrup University Hospital, Glostrup, Denmark

Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark

§Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.

Address correspondence and reprint requests to Gertrud Laura Sorensen, Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup University Hospital, DK-2600 Glostrup, Denmark, e-mail:; Poul Jennum, Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup University Hospital, 2600 Glostrup, Denmark, e-mail:; Helge B. D. Sorensen, Technical University of Denmark Ørsteds Plads, Building 349, room 112, 2800 Kgs. Lyngby, Denmark, e-mail:

Copyright © 2012 American Clinical Neurophysiology Society