Identification of Comorbidities in Obstructive Sleep Apnea Using Diverse Data and a One-Dimensional Convolutional...

Recent advances in deep learning (DL) have enabled the integration of diverse biomedical data for disease prediction and risk stratification. Building on this progress, the overall objective of this study was to develop and evaluate a multimodal DL framework for robust multi-label classification (MLC) of major comorbidities in patients with obstructive sleep apnea (OSA) using physiological time series signals and clinical data. This study proposes a robust framework for multi-label classification (MLC) of comorbidities in patients with OSA using diverse physiological and clinical data sources. We conducted a retrospective observational study including a convenience sample of 144 patients referred for overnight polysomnography at the Sleep Medicine Center (SleepLab Split), University Hospital Centre Split (KBC Split), Split, Croatia. Patients were selected based on predefined inclusion criteria and data availability. A one-dimensional Convolutional Neural Network (1D-CNN) was developed to process and fuse time series signals, oxygen saturation (SpO2), derived SpO2 features, and nasal airflow (FP0), with demographic and physiological parameters, enabling the identification of key comorbidities such as arterial hypertension, diabetes mellitus, and asthma/COPD. The instruments included polysomnography-derived signals (SpO₂ and FP0 airflow) and structured demographic/physiological parameters. Signals were preprocessed and used as inputs to the proposed fusion model. The proposed model was trained and fine-tuned using the Optuna hyperparameter optimization framework, addressing class imbalance through weighted loss adjustments. Its performance was comprehensively assessed using multi-label evaluation metrics, including macro/micro F1-score, AUC-ROC, AUC-PR, subset and partial accuracy, Hamming loss, and multi-label confusion matrix (MLCM). The study protocol was approved by the Ethics Committee of the School of Medicine, University of Split (Approval No. 003-08/23-03/0015, Date: 17 October 2023). The 1D-CNN achieved superior predictive performance compared to traditional machine learning (ML) classifiers with macro AUC-ROC = 0.731 and AUC-PR = 0.750. The model demonstrated consistent behavior across age, gender, and BMI groups, indicating strong generalization and minimal demographic bias. In conclusion, the results confirm that SpO2 and airflow signals inherently encode comorbidity-specific physiological patterns, enabling efficient and scalable screening of OSA-related comorbidities without the need for full polysomnography. Although the study is limited by data set size, it provides a methodological basis for the application of multi-label DL models in clinical decision support systems. Future research should focus on the expansion of multi-center datasets, thereby improving model interpretability and potential clinical adoption.