Ya-Ling Huang’s research while affiliated with National Taiwan University Hospital and other places

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Publications (9)


Figure 4-Bland-Atman plots visualizing the differences between the automatic sleep staging system (ASSS) and expert scoring.
Automatic Sleep Staging in Patients With Obstructive Sleep Apnea Using Single-Channel Frontal EEG
  • Article
  • Full-text available

October 2019

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18 Reads

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12 Citations

Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine

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Yi-Hao Huang

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Po-Chen Lin

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Tzi-Dar Chiueh

Study objectives: Reliable sleep staging is difficult to obtain from home sleep testing for diagnosis of obstructive sleep apnea (OSA), especially when it is self-applied. Hence, the current study aimed to develop a single frontal electroencephalography-based automatic sleep staging system (ASSS). Methods: The ASSS system was developed on a clinical dataset, with a high percentage of participants with OSA. The F4-M1 signal extracted from 62 participants (62.9% having OSA) was used to build a four-stage classifier. Performance of the ASSS was tested in a holdout set of 58 patients (60.3% having OSA) with epoch-by-epoch and whole-night agreement for sleep staging compared with expert scoring of polysomnography. Results: Mean all-stage percentage agreement was 75.52% (95% confidence interval, 72.90 to 78.13) (kappa 0.62; 95% confidence interval, 0.58 to 0.65), with mean percentage agreement for wake, light sleep, deep sleep (DS), and rapid eye movement of 78.04%, 70.97%, 83.65%, and 75.00%, respectively. The whole-night agreement was good-excellent (intraclass correlation coefficient, 0.74 to 0.88) for sleep onset latency, wake after sleep onset, total sleep time, and sleep efficiency. Compared to the non-OSA subset, the OSA subset had lower agreement for DS. Conclusions: Our results indicate that a single-channel F4-M1 based ASSS was sufficient for sleep staging in a population with a high percentage of participants with OSA.

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The (A) residual apnea-hypopnea index (AHI), (B) residual oxygen desaturation index (ODI), and (C) residual percentage of total sleep time with SpO2 <90% (%TST-SpO2 <90%) before and under treatments with PAP, MAD, and CT in 14 patients. PAP, continuous positive airway pressure; MAD, mandibular advancement device; CT, combination therapy. Each dot represents a measurement of an individual patient. The p values were analyzed by Tukey’s correction: # p < 0.05 and ### p < 0.005 compared with pretreatment values; * p < 0.05, ** p < 0.01, and *** p < 0.005 compared with PAP therapy; § p < 0.05 and §§§ p < 0.005 compared with MAD therapy.
Correction: Combining MAD and CPAP as an effective strategy for treating patients with severe sleep apnea intolerant to high-pressure PAP and unresponsive to MAD

April 2018

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66 Reads

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3 Citations

[This corrects the article DOI: 10.1371/journal.pone.0187032.].



Combining MAD and CPAP as an effective strategy for treating patients with severe sleep apnea intolerant to high-pressure PAP and unresponsive to MAD

October 2017

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901 Reads

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36 Citations

Introduction This study aimed to determine the effect of combining positive airway pressure (PAP) therapy and mandibular advancement device (MAD) in patients with severe obstructive sleep apnea (OSA) who were pressure intolerant for PAP and were unresponsive to MAD. Methods This retrospective study reviewed the medical records of severe OSA patients with apnea-hypopnea index (AHI) ≥ 30/hr who were diagnosed between October 1, 2008 and June 30, 2014. Patients were initially treated with 2 weeks of PAP, and those who were intolerant to high-pressure PAP (≥15 cm H2O) were switched to 12 weeks of MAD, which is a monobloc designed at 75% of maximum protrusion. Patients who had high residual AHI (≥15/hr) on MAD underwent 12 weeks of combination therapy (CT) with MAD and CPAP and were enrolled in the present study. Enrolled subjects who completed the 12-week CT were followed-up until June 30, 2016. Results A total of 14 male patients were included. All three treatments effectively reduced AHI, oxygen desaturation index (ODI), and total sleep time with SpO2 <90% (% TST-SpO2<90%) compared to pretreatment values. The residual AHI and ODI on CT was lower than that on MAD or PAP. The residual % TST-SpO2<90% was lower than that on MAD and similar to that on PAP. The therapeutic pressure on CT was on average 9.2 cm H2O lower than that on PAP. For the 11 patients who completed CT, only CT reduced ESS compared to pretreatment value. No treatment had significant impact on % slow wave sleep or overnight change of blood pressure. For patients who completed CT, the average usage was 5.9±1.7 hr/night at 12th week and 6.4±1.5 hr/night at a median follow-up of 36.5-months. Conclusions Combining MAD and CPAP showed additive effects on reducing AHI and ODI, and lowered the therapeutic pressures.





Citations (3)


... Another automatic algorithm for F4-M1 derivation utilizing a combination of feature extraction based on spectral analysis and a decision tree based on neural network reported kappa of 0.62 and percent agreement of 75.5% for the four categories (with N1 and N2 merged into light sleep) in the investigation group comprising 60% of participants with OSA. 30 In recent years further significant improvement in the accuracy of sleep staging algorithms was achieved with application of Deep Learning (DL) models and software tools. 31 DL to development of single EEG channel sleep staging algorithms, typically using multilayer convolutional neural networks (CNN) 34,35,38,40,42 or different implementations of recurrent neural networks (RNN) 32,37 or combinations of CNN and RNN. ...

Reference:

Performance Investigation of Somfit Sleep Staging Algorithm
Automatic Sleep Staging in Patients With Obstructive Sleep Apnea Using Single-Channel Frontal EEG

Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine

... Long term side effects of MAD therapy are dental and skeletal changes, which are progressive over time [82]. It stands to reason that combination therapy of CPAP and MAD may also be considered as the CPAP might be more comfortable at lower therapeutic pressures resulting in improved sleep metrics [83]. ...

Correction: Combining MAD and CPAP as an effective strategy for treating patients with severe sleep apnea intolerant to high-pressure PAP and unresponsive to MAD

... For example, the combination of positional therapy and OAT is more efficacious than either positional therapy or OAT alone [116]. The combination of CPAP therapy with oral appliances can treat OSA when OAT alone is ineffective, while reducing CPAP requirement (~9 cm H 2 O less with combined OAT and CPAP therapy than on CPAP therapy alone) [117]. Therefore, combination therapy may be a good option for those who are pressure intolerant. ...

Combining MAD and CPAP as an effective strategy for treating patients with severe sleep apnea intolerant to high-pressure PAP and unresponsive to MAD