Decreased sample entropy during sleep-to-wake transition in sleep apnea patients

Objective. This study aimed to prove that there is a sudden change in the human physiology system when switching from one sleep stage to another and physical threshold-based sample entropy (SampEn) is able to capture this transition in an RR interval time series from patients with disorders such as sleep apnea.Approach. Physical threshold-based SampEn was used to analyze different sleep-stage RR segments from sleep apnea subjects in the St. Vincents University Hospital/University College Dublin Sleep Apnea Database, and SampEn differences were compared between two consecutive sleep stages. Additionally, other standard heart rate variability (HRV) measures were also analyzed to make comparisons.Main results. The findings suggested that the sleep-to-wake transitions presented a SampEn decrease significantly larger than intra-sleep ones (P < 0.01), which outperformed other standard HRV measures. Moreover, significant entropy differences between sleep and subsequent wakefulness appeared when the previous sleep stage was either S1 (P < 0.05), S2 (P < 0.01) or S4 (P < 0.05).Significance. The results demonstrated that physical threshold-based SampEn has the capability of depicting physiological changes in the cardiovascular system during the sleep-to-wake transition in sleep apnea patients and it is more reliable than the other analyzed HRV measures. This noninvasive HRV measure is a potential tool for further evaluation of sleep physiological time series.