{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:24:47Z","timestamp":1760747087326,"version":"build-2065373602"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL158952"],"award-info":[{"award-number":["R01HL158952"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-025-20282-5","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T14:36:26Z","timestamp":1760711786000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improved non-invasive detection of sleep stages when combining skin sympathetic nerve activity and heart rate variability analysis with AI"],"prefix":"10.1038","volume":"15","author":[{"given":"Md.","family":"Aktaruzzaman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4235-3838","authenticated-orcid":false,"suffix":"IV","given":"Thomas H.","family":"Everett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"20282_CR1","doi-asserted-by":"publisher","first-page":"133","DOI":"10.5664\/jcsm.26815","volume":"3","author":"MH Bonnet","year":"2007","unstructured":"Bonnet, M. H. et al. The scoring of arousal in sleep: Reliability, validity, and alternatives. J. Clin. Sleep Med. 3, 133\u2013145 (2007).","journal-title":"J. Clin. Sleep Med."},{"key":"20282_CR2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0009442","volume":"5","author":"J Yordanova","year":"2010","unstructured":"Yordanova, J., Kolev, V., Wagner, U. & Verleger, R. Differential associations of early- and late-night sleep with functional brain states promoting insight to abstract task regularity. PLoS ONE 5, e9442. https:\/\/doi.org\/10.1371\/journal.pone.0009442 (2010).","journal-title":"PLoS ONE"},{"key":"20282_CR3","doi-asserted-by":"publisher","first-page":"10130","DOI":"10.1073\/pnas.0900271106","volume":"106","author":"DJ Cai","year":"2009","unstructured":"Cai, D. J., Mednick, S. A., Harrison, E. M., Kanady, J. C. & Mednick, S. C. REM, not incubation, improves creativity by priming associative networks. Proc. Natl. Acad. Sci. USA 106, 10130\u201310134. https:\/\/doi.org\/10.1073\/pnas.0900271106 (2009).","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"20282_CR4","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1097\/HCO.0000000000000324","volume":"31","author":"MA Grandner","year":"2016","unstructured":"Grandner, M. A. et al. Sleep: Important considerations for the prevention of cardiovascular disease. Curr. Opin. Cardiol. 31, 551\u2013565. https:\/\/doi.org\/10.1097\/HCO.0000000000000324 (2016).","journal-title":"Curr. Opin. Cardiol."},{"issue":"Suppl 1","key":"20282_CR5","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1111\/obr.12499","volume":"18","author":"MP St-Onge","year":"2017","unstructured":"St-Onge, M. P. Sleep-obesity relation: Underlying mechanisms and consequences for treatment. Obes. Rev. 18(Suppl 1), 34\u201339. https:\/\/doi.org\/10.1111\/obr.12499 (2017).","journal-title":"Obes. Rev."},{"key":"20282_CR6","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.jsmc.2022.02.009","volume":"17","author":"RK Malhotra","year":"2022","unstructured":"Malhotra, R. K. Neurodegenerative disorders and sleep. Sleep Med. Clin. 17, 307\u2013314. https:\/\/doi.org\/10.1016\/j.jsmc.2022.02.009 (2022).","journal-title":"Sleep Med. Clin."},{"key":"20282_CR7","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/s11325-002-0085-1","volume":"6","author":"JL Hossain","year":"2002","unstructured":"Hossain, J. L. & Shapiro, C. M. The prevalence, cost implications, and management of sleep disorders: an overview. Sleep Breath 6, 85\u2013102. https:\/\/doi.org\/10.1007\/s11325-002-0085-1 (2002).","journal-title":"Sleep Breath"},{"key":"20282_CR8","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1007\/s11517-015-1249-z","volume":"53","author":"M Aktaruzzaman","year":"2015","unstructured":"Aktaruzzaman, M. et al. The addition of entropy-based regularity parameters improves sleep stage classification based on heart rate variability. Med. Biol. Eng. Comput. 53, 415\u2013425. https:\/\/doi.org\/10.1007\/s11517-015-1249-z (2015).","journal-title":"Med. Biol. Eng. Comput."},{"key":"20282_CR9","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1109\/TBME.2007.900558","volume":"55","author":"A Lewicke","year":"2008","unstructured":"Lewicke, A. et al. Sleep versus wake classification from heart rate variability using computational intelligence: Consideration of rejection in classification models. IEEE Trans. Biomed. Eng. 55, 108\u2013118. https:\/\/doi.org\/10.1109\/TBME.2007.900558 (2008).","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"20282_CR10","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6579\/aaf339","volume":"39","author":"Q Li","year":"2018","unstructured":"Li, Q. et al. Deep learning in the cross-time frequency domain for sleep staging from a single-lead electrocardiogram. Physiol. Meas. 39, 124005. https:\/\/doi.org\/10.1088\/1361-6579\/aaf339 (2018).","journal-title":"Physiol. Meas."},{"key":"20282_CR11","doi-asserted-by":"publisher","first-page":"14149","DOI":"10.1038\/s41598-019-49703-y","volume":"9","author":"M Radha","year":"2019","unstructured":"Radha, M. et al. Sleep stage classification from heart-rate variability using long short-term memory neural networks. Sci. Rep. 9, 14149. https:\/\/doi.org\/10.1038\/s41598-019-49703-y (2019).","journal-title":"Sci. Rep."},{"key":"20282_CR12","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/0013-4694(73)90041-2","volume":"34","author":"AJ Welch","year":"1973","unstructured":"Welch, A. J. & Richardson, P. C. Computer sleep stage classification using heart rate data. Electroencephalogr. Clin. Neurophysiol. 34, 145\u2013152. https:\/\/doi.org\/10.1016\/0013-4694(73)90041-2 (1973).","journal-title":"Electroencephalogr. Clin. Neurophysiol."},{"key":"20282_CR13","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.compbiomed.2017.08.006","volume":"89","author":"M Aktaruzzaman","year":"2017","unstructured":"Aktaruzzaman, M. et al. Performance comparison between wrist and chest actigraphy in combination with heart rate variability for sleep classification. Comput. Biol. Med. 89, 212\u2013221. https:\/\/doi.org\/10.1016\/j.compbiomed.2017.08.006 (2017).","journal-title":"Comput. Biol. Med."},{"key":"20282_CR14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0285703","volume":"18","author":"TA Song","year":"2023","unstructured":"Song, T. A. et al. AI-Driven sleep staging from actigraphy and heart rate. PLoS ONE 18, e0285703. https:\/\/doi.org\/10.1371\/journal.pone.0285703 (2023).","journal-title":"PLoS ONE"},{"issue":"Pt 3","key":"20282_CR15","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.1093\/brain\/114.3.1281","volume":"114","author":"M Hornyak","year":"1991","unstructured":"Hornyak, M., Cejnar, M., Elam, M., Matousek, M. & Wallin, B. G. Sympathetic muscle nerve activity during sleep in man. Brain 114(Pt 3), 1281\u20131295. https:\/\/doi.org\/10.1093\/brain\/114.3.1281 (1991).","journal-title":"Brain"},{"key":"20282_CR16","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.hrthm.2016.09.019","volume":"14","author":"A Doytchinova","year":"2017","unstructured":"Doytchinova, A. et al. Simultaneous noninvasive recording of skin sympathetic nerve activity and electrocardiogram. Heart Rhythm 14, 25\u201333. https:\/\/doi.org\/10.1016\/j.hrthm.2016.09.019 (2017).","journal-title":"Heart Rhythm"},{"key":"20282_CR17","doi-asserted-by":"publisher","first-page":"1936","DOI":"10.1016\/j.hrthm.2020.06.018","volume":"17","author":"W He","year":"2020","unstructured":"He, W. et al. Skin sympathetic nerve activity in patients with obstructive sleep apnea. Heart Rhythm 17, 1936\u20131943. https:\/\/doi.org\/10.1016\/j.hrthm.2020.06.018 (2020).","journal-title":"Heart Rhythm"},{"key":"20282_CR18","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.hrthm.2021.09.018","volume":"19","author":"G Meng","year":"2022","unstructured":"Meng, G. et al. Successful continuous positive airway pressure treatment reduces skin sympathetic nerve activity in patients with obstructive sleep apnea. Heart Rhythm 19, 127\u2013136. https:\/\/doi.org\/10.1016\/j.hrthm.2021.09.018 (2022).","journal-title":"Heart Rhythm"},{"key":"20282_CR19","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.jbi.2015.06.003","volume":"56","author":"BM Silva","year":"2015","unstructured":"Silva, B. M., Rodrigues, J. J., de la Torre Diez, I., Lopez-Coronado, M. & Saleem, K. Mobile-health: A review of current state in 2015. J. Biomed. Inform. 56, 265\u2013272. https:\/\/doi.org\/10.1016\/j.jbi.2015.06.003 (2015).","journal-title":"J. Biomed. Inform."},{"key":"20282_CR20","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2024.108679","volume":"179","author":"K Kazemi","year":"2024","unstructured":"Kazemi, K. et al. Improved sleep stage predictions by deep learning of photoplethysmogram and respiration patterns. Comput. Biol. Med. 179, 108679. https:\/\/doi.org\/10.1016\/j.compbiomed.2024.108679 (2024).","journal-title":"Comput. Biol. Med."},{"key":"20282_CR21","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2022.106100","volume":"150","author":"S Xu","year":"2022","unstructured":"Xu, S. et al. A review of automated sleep disorder detection. Comput. Biol. Med. 150, 106100. https:\/\/doi.org\/10.1016\/j.compbiomed.2022.106100 (2022).","journal-title":"Comput. Biol. Med."},{"key":"20282_CR22","doi-asserted-by":"publisher","first-page":"2893","DOI":"10.1109\/TNSRE.2024.3438610","volume":"32","author":"J Pradeepkumar","year":"2024","unstructured":"Pradeepkumar, J. et al. Toward interpretable sleep stage classification using cross-modal transformers. IEEE Trans. Neural Syst. Rehabil. Eng. 32, 2893\u20132904. https:\/\/doi.org\/10.1109\/TNSRE.2024.3438610 (2024).","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"20282_CR23","doi-asserted-by":"publisher","unstructured":"Everett, T. H. t., Doytchinova, A., Cha, Y. M. & Chen, P. S. Recording sympathetic nerve activity from the skin. Trends Cardiovasc. Med. 27, 463\u2013472 (2017). https:\/\/doi.org\/10.1016\/j.tcm.2017.05.003","DOI":"10.1016\/j.tcm.2017.05.003"},{"key":"20282_CR24","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6579\/aad5a9","volume":"39","author":"J Malik","year":"2018","unstructured":"Malik, J., Lo, Y. L. & Wu, H. T. Sleep-wake classification via quantifying heart rate variability by convolutional neural network. Physiol. Meas. 39, 085004. https:\/\/doi.org\/10.1088\/1361-6579\/aad5a9 (2018).","journal-title":"Physiol. Meas."},{"key":"20282_CR25","doi-asserted-by":"publisher","first-page":"2711","DOI":"10.1109\/TBME.2017.2664105","volume":"64","author":"G Manis","year":"2017","unstructured":"Manis, G., Aktaruzzaman, M. & Sassi, R. Bubble entropy: An entropy almost free of parameters. IEEE Trans. Biomed. Eng. 64, 2711\u20132718. https:\/\/doi.org\/10.1109\/TBME.2017.2664105 (2017).","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"20282_CR26","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1177\/001316446002000104","volume":"20","author":"J Cohen","year":"1960","unstructured":"Cohen, J. A coefficient of agreement for nominal scales. Educ. Psychol. Measur. 20, 37\u201346 (1960).","journal-title":"Educ. Psychol. Measur."},{"key":"20282_CR27","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1056\/NEJM199302043280502","volume":"328","author":"VK Somers","year":"1993","unstructured":"Somers, V. K., Dyken, M. E., Mark, A. L. & Abboud, F. M. Sympathetic-nerve activity during sleep in normal subjects. N. Engl. J. Med. 328, 303\u2013307. https:\/\/doi.org\/10.1056\/NEJM199302043280502 (1993).","journal-title":"N. Engl. J. Med."},{"key":"20282_CR28","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/j.sleep.2024.05.033","volume":"119","author":"FB Silva","year":"2024","unstructured":"Silva, F. B. et al. Sleep staging algorithm based on smartwatch sensors for healthy and sleep apnea populations. Sleep Med. 119, 535\u2013548 (2024).","journal-title":"Sleep Med."},{"key":"20282_CR29","doi-asserted-by":"publisher","first-page":"zsaf091","DOI":"10.1093\/sleep\/zsaf091","volume":"48","author":"D Krauss","year":"2025","unstructured":"Krauss, D. et al. Incorporating respiratory signals for machine learning-based multimodal sleep stage classification: A large-scale benchmark study with actigraphy and heart rate variability. Sleep 48, zsaf091. https:\/\/doi.org\/10.1093\/sleep\/zsaf091 (2025).","journal-title":"Sleep"},{"key":"20282_CR30","doi-asserted-by":"publisher","first-page":"17730","DOI":"10.1038\/s41598-023-45020-7","volume":"13","author":"S Morokuma","year":"2023","unstructured":"Morokuma, S. et al. Deep learning-based sleep stage classification with cardiorespiratory and body movement activities in individuals with suspected sleep disorders. Sci. Rep. 13, 17730. https:\/\/doi.org\/10.1038\/s41598-023-45020-7 (2023).","journal-title":"Sci. Rep."},{"key":"20282_CR31","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1016\/j.hrthm.2019.10.008","volume":"17","author":"A Kumar","year":"2020","unstructured":"Kumar, A. et al. Skin sympathetic nerve activity as a biomarker for syncopal episodes during a tilt table test. Heart Rhythm 17, 804\u2013812. https:\/\/doi.org\/10.1016\/j.hrthm.2019.10.008 (2020).","journal-title":"Heart Rhythm"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-20282-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-20282-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-20282-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T14:36:26Z","timestamp":1760711786000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-20282-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,17]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["20282"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-20282-5","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,17]]},"assertion":[{"value":"2 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"36342"}}