Characterising the motion and cardiorespiratory interaction of preterm infants can improve the classification of their sleep state

Dandan Zhang, Zheng Peng, Shaoxiong Sun, Carola van Pul, Caifeng Shan, Jeroen Dudink, Peter Andriessen, Ronald M. Aarts, Xi Long (Corresponding author)

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Aim: This study aimed to classify quiet sleep, active sleep and wake states in preterm infants by analysing cardiorespiratory signals obtained from routine patient monitors. Methods: We studied eight preterm infants, with an average postmenstrual age of 32.3 ± 2.4 weeks, in a neonatal intensive care unit in the Netherlands. Electrocardiography and chest impedance respiratory signals were recorded. After filtering and R-peak detection, cardiorespiratory features and motion and cardiorespiratory interaction features were extracted, based on previous research. An extremely randomised trees algorithm was used for classification and performance was evaluated using leave-one-patient-out cross-validation and Cohen's kappa coefficient. Results: A sleep expert annotated 4731 30-second epochs (39.4 h) and active sleep, quiet sleep and wake accounted for 73.3%, 12.6% and 14.1% respectively. Using all features, and the extremely randomised trees algorithm, the binary discrimination between active and quiet sleep was better than between other states. Incorporating motion and cardiorespiratory interaction features improved the classification of all sleep states (kappa 0.38 ± 0.09) than analyses without these features (kappa 0.31 ± 0.11). Conclusion: Cardiorespiratory interactions contributed to detecting quiet sleep and motion features contributed to detecting wake states. This combination improved the automated classifications of sleep states.

Original languageEnglish
Pages (from-to)1236-1245
Number of pages10
JournalActa Paediatrica
Issue number6
Early online date19 Mar 2024
Publication statusPublished - Jun 2024


FundersFunder number
China Scholarship Council201806170049


    • automated classification
    • cardiorespiratory signal
    • motion
    • preterm infant
    • sleep


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