Deep Learning for Pediatric Sleep Staging From Photoplethysmography: A Transfer Learning Approach From Adults to Children

Background: Sleep staging is critical for diagnosing sleep disorders. Traditional methods in clinical settings involve time-intensive scoring procedures. Recent advancements in data-driven algorithms using photoplethysmogram (PPG) time series have shown promise in automating sleep staging in adults. However, for children, algorithm development is hindered by the limited availability of datasets, with the Childhood Adenotonsillectomy Trial (CHAT) being the only substantial source, comprising recordings from children aged 5-10. This limitation constrains the evaluation of algorithmic generalization performance. Methods: We employed a deep learning model for sleep staging from PPG, initially trained using a large dataset of adult sleep recordings, and fine-tuned it on 80% of the CHAT dataset (CHAT-train) for the task of three-class sleep staging (wake, REM, non-REM). The resulting algorithm performance was compared to the same model architecture but trained from scratch on CHAT-train (benchmark). The algorithms are evaluated on the local test set, denoted CHAT-test, as well as on a newly introduced independent dataset. Results: Our deep learning algorithm achieved a Cohen's Kappa of 0.88 on CHAT-test (versus 0.65), and demonstrated generalization capabilities with a Kappa of 0.72 on the external Ichilov dataset for children above 5 years old (versus 0.64) and 0.64 for those below 5 (versus 0.53). Significance: This research establishes a new state-of-the-art performance for the task of sleep staging in children using raw PPG. The findings underscore the value of transfer learning from the adults to children domain. However, the reduced performance in children under 5 suggests the need for further research and additional datasets covering a broader pediatric age range to fully address generalization limitations.