Automated Sleep Staging in Epilepsy Using Deep Learning on Standard Electroencephalogram and Wearable Data

Automated sleep staging on wearable data could improve our understanding and management of epilepsy. This study evaluated sleep scoring by a deep learning model on 223 night-sleep recordings from 50 patients measured in the hospital with an electroencephalogram (EEG) and a wearable device. The model scored the sleep stage of every 30-s epoch on the EEG and wearable data, and we compared the output with a clinical expert on 20 nights, each for a different patient. The Bland-Altman analysis examined differences in the automated staging in both modalities, and using mixed-effect models, we explored sleep differences between patients with and without seizures. Overall, we found moderate accuracy and Cohen's kappa on the model scoring of standard EEG (0.73 and 0.59) and the wearable (0.61 and 0.43) versus the clinical expert. F1 scores also varied between patients and the modalities. The sensitivity varied by sleep stage and was very low for stage N1. Moreover, sleep staging on the wearable data underestimated the duration of most sleep macrostructure parameters except N2. On the other hand, patients with seizures during the hospital admission slept more each night (6.37, 95% confidence interval [CI] 5.86-7.87) compared with patients without seizures (5.68, 95% CI 5.24-6.13), p = 0.001, but also spent more time in stage N2. In conclusion, wearable EEG and accelerometry could monitor sleep in patients with epilepsy, and our approach can help automate the analysis. However, further steps are essential to improve the model performance before clinical implementation. Trial Registration: The SeizeIT2 trial was registered in clinicaltrials.gov, NCT04284072.