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Predicting subjective sleepiness during auditory cognitive testing using voice signaling analysis.

Tue T Te^1,2,3, Mary Regina Boland⁴, Sara Ghadimi²

¹Department of Medicine, David Geffen School of Medicine at University of California, 10833 Le Conte Ave, Los Angeles, CA 90095 USA.

Sleep Science and Practice

|July 4, 2025

Summary

Objective voice markers can passively detect sleepiness. Longer verbal reaction times (VRT) in older adults correlated with increased self-reported sleepiness, validating voice analysis for sleepiness detection.

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Area of Science:

Gerontology
Sleep Medicine
Speech-Language Pathology

Background:

Assessing sleepiness objectively in older adults, particularly those with insomnia and benzodiazepine-receptor-agonist (BZRA) use, is challenging.
Current methods often require active participation or are not suitable for passive, out-of-office monitoring.

Purpose of the Study:

To investigate the feasibility of using passive voice data, specifically verbal reaction time (VRT), as an objective marker for detecting sleepiness.
To correlate VRT with subjective sleepiness ratings in middle-aged and older adults undergoing cognitive assessments.

Main Methods:

Recruited adults aged 55+ from a BZRA deprescribing trial for out-of-office cognitive testing via mobile apps.
Assessed working/episodic memory using Verbal Paired Associates (VPA) tests with recorded verbal responses and ecological momentary assessments (EMA) for sleepiness.
Analyzed the association between VRT and EMA sleepiness using generalized additive models and employed stratified k-fold cross-validation/random forest (SKCV/RF) for sleepiness classification.

Main Results:

Analysis of 1,513 observations from 16 patients revealed a positive association between longer VRT and increased EMA-assessed sleepiness (p≤0.05).
VRT was operationalized as the time from recording start to the first speech epoch.
The SKCV/RF model achieved a mean F1-score of 0.80 ± 0.08, indicating good classification performance.

Conclusions:

Voice data, specifically VRT, can serve as a passive, objective marker for detecting sleepiness in older adults during cognitive testing.
This approach offers a non-intrusive method for monitoring sleepiness in real-world, out-of-office settings.