Nocturnal Awakening and Sleep Efficiency Estimation Using Unobtrusively Measured Ballistocardiogram

Fragmented sleep due to frequent awakenings represents a major cause of impaired daytime performance and adverse health outcomes. Currently, the gold standard for studying and assessing sleep fragmentation is polysomnography (PSG). Here, we propose an alternative method for real-time detection of nocturnal awakening via ballistocardiography using an unobtrusive polyvinylidene fluoride (PVDF) film sensor on a bed mattress. From ballistocardiogram, heart rate and body movement information were extracted to develop an algorithm for classifying sleeping and awakening epochs. In total, ten normal subjects (mean age 38.7 +/- 14.6 years) and ten patients with obstructive sleep apnea (OSA) (mean age 44.2 +/- 16.5 years) of varying symptom severity participated in this study. Our study detected awakening epochs with an average sensitivity of 85.3% and 85.2%, specificity of 98.4% and 97.7%, accuracy of 97.4% and 96.5%, and Cohen's kappa coefficient of 0.83 and 0.81 for normal subjects and OSA patients, respectively. Also, sleep efficiency was estimated using detected awakening epochs and then compared with PSG results. Mean absolute errors in sleep efficiency were 1.08% and 1.44% for normal subjects and OSA patients, respectively. The results presented here indicate that our suggested method could be reliably applied to real-time nocturnal awakening detection and sleep efficiency estimation. Furthermore, our method may ultimately be an effective tool for long-term, home monitoring of sleep-wake behavior.