{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T14:45:00Z","timestamp":1777128300720,"version":"3.51.4"},"reference-count":38,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T00:00:00Z","timestamp":1725235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Eindhoven MedTech Innovation Center"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Overnight sleep staging is an important part of the diagnosis of various sleep disorders. Polysomnography is the gold standard for sleep staging, but less-obtrusive sensing modalities are of emerging interest. Here, we developed and validated an algorithm to perform \u201cproxy\u201d sleep staging using cardiac and respiratory signals derived from a chest-worn accelerometer. We collected data in two sleep centers, using a chest-worn accelerometer in combination with full PSG. A total of 323 participants were analyzed, aged 13\u201383 years, with BMI 18\u201347 kg\/m2. We derived cardiac and respiratory features from the accelerometer and then applied a previously developed method for automatic cardio-respiratory sleep staging. We compared the estimated sleep stages against those derived from PSG and determined performance. Epoch-by-epoch agreement with four-class scoring (Wake, REM, N1+N2, N3) reached a Cohen\u2019s kappa coefficient of agreement of 0.68 and an accuracy of 80.8%. For Wake vs. Sleep classification, an accuracy of 93.3% was obtained, with a sensitivity of 78.7% and a specificity of 96.6%. We showed that cardiorespiratory signals obtained from a chest-worn accelerometer can be used to estimate sleep stages among a population that is diverse in age, BMI, and prevalence of sleep disorders. This opens up the path towards various clinical applications in sleep medicine.<\/jats:p>","DOI":"10.3390\/s24175717","type":"journal-article","created":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T12:54:42Z","timestamp":1725281682000},"page":"5717","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Overnight Sleep Staging Using Chest-Worn Accelerometry"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8018-6807","authenticated-orcid":false,"given":"Fons","family":"Schipper","sequence":"first","affiliation":[{"name":"Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands"},{"name":"Philips Sleep and Respiratory Care, 5656 AE Eindhoven, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9955-5780","authenticated-orcid":false,"given":"Angela","family":"Grassi","sequence":"additional","affiliation":[{"name":"Philips Sleep and Respiratory Care, 5656 AE Eindhoven, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0603-5709","authenticated-orcid":false,"given":"Marco","family":"Ross","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands"},{"name":"The Siesta Group, 1210 Vienna, Austria"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8191-1866","authenticated-orcid":false,"given":"Andreas","family":"Cerny","sequence":"additional","affiliation":[{"name":"FH Technikum Wien, 1200 Wien, Austria"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3869-6678","authenticated-orcid":false,"given":"Peter","family":"Anderer","sequence":"additional","affiliation":[{"name":"The Siesta Group, 1210 Vienna, Austria"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2069-4105","authenticated-orcid":false,"given":"Lieke","family":"Hermans","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5486-9663","authenticated-orcid":false,"given":"Fokke","family":"van Meulen","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands"},{"name":"Center for Sleep Medicine Kempenhaeghe, 5591 VE Heeze, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2745-6967","authenticated-orcid":false,"given":"Mickey","family":"Leentjens","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery OLVG West, 1061 AE Amsterdam, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7435-6204","authenticated-orcid":false,"given":"Emily","family":"Schoustra","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery OLVG West, 1061 AE Amsterdam, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7964-3225","authenticated-orcid":false,"given":"Pien","family":"Bosschieter","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands"},{"name":"Center for Sleep Medicine Kempenhaeghe, 5591 VE Heeze, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2845-0495","authenticated-orcid":false,"given":"Ruud J. G.","family":"van Sloun","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6445-9836","authenticated-orcid":false,"given":"Sebastiaan","family":"Overeem","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands"},{"name":"Center for Sleep Medicine Kempenhaeghe, 5591 VE Heeze, The Netherlands"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2932-6402","authenticated-orcid":false,"given":"Pedro","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands"},{"name":"Philips Sleep and Respiratory Care, 5656 AE Eindhoven, The Netherlands"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,2]]},"reference":[{"key":"ref_1","unstructured":"Troester, M.M., Quan, S.F., Berry, R.B., Plante, D.T., Abreu, A.R., Alzoubaidi, M., Bandyopadhyay, A., Delrosso, L., Ebben, M., and Kwon, Y. (2023). The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, American Academy of Sleep Medicine. [3rd ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"551","DOI":"10.5664\/jcsm.6540","article-title":"Potential Underestimation of Sleep Apnea Severity by At-Home Kits: Rescoring In-Laboratory Polysomnography Without Sleep Staging","volume":"13","author":"Bianchi","year":"2017","journal-title":"J. Clin. Sleep Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1055\/a-1826-7603","article-title":"Insomnie-Screening mit dem Home Sleep Test","volume":"41","author":"Hofmann","year":"2022","journal-title":"Nervenheilkunde"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"T\u0103utan, A.-M., Rossi, A.C., de Francisco, R., and Ionescu, B. (2020, January 20\u201324). Automatic Sleep Stage Detection: A Study on the Influence of Various PSG Input Signals. Proceedings of the 2020 42nd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC), Montreal, QC, Canada.","DOI":"10.1109\/EMBC44109.2020.9175628"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.smrv.2011.02.005","article-title":"Heart rate variability, sleep and sleep disorders","volume":"16","author":"Stein","year":"2012","journal-title":"Sleep Med. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S48","DOI":"10.1038\/sj.npp.1300146","article-title":"Dynamics of Heart Rate and Sleep Stages in Normals and Patients with Sleep Apnea","volume":"28","author":"Penzel","year":"2003","journal-title":"Neuropsychopharmacology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/S0921-884X(96)96070-1","article-title":"Heart rate variability: Sleep stage, time of night, and arousal influences","volume":"102","author":"Bonnet","year":"1997","journal-title":"Electroencephalogr. Clin. Neurophysiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.bspc.2014.08.001","article-title":"Analyzing respiratory effort amplitude for automated sleep stage classification","volume":"14","author":"Long","year":"2014","journal-title":"Biomed. Signal Process. Control"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2027","DOI":"10.1088\/0967-3334\/36\/10\/2027","article-title":"Sleep stage classification with ECG and respiratory effort","volume":"36","author":"Fonseca","year":"2015","journal-title":"Physiol. Meas."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e12949","DOI":"10.14814\/phy2.12949","article-title":"Respiratory rate variability in sleeping adults without obstructive sleep apnea","volume":"4","author":"Gutierrez","year":"2016","journal-title":"Physiol. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"101611","DOI":"10.1016\/j.smrv.2022.101611","article-title":"Representations of temporal sleep dynamics: Review and synthesis of the literature","volume":"63","author":"Hermans","year":"2022","journal-title":"Sleep Med. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1007\/s11325-021-02435-8","article-title":"Automatic sleep staging by cardiorespiratory signals: A systematic review","volume":"26","author":"Ebrahimi","year":"2022","journal-title":"Sleep Breath."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.5664\/jcsm.9192","article-title":"Estimating sleep stages using cardiorespiratory signals: Validation of a novel algorithm across a wide range of sleep-disordered breathing severity","volume":"17","author":"Bakker","year":"2021","journal-title":"J. Clin. Sleep Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Imtiaz, S.A. (2021). A Systematic Review of Sensing Technologies for Wearable Sleep Staging. Sensors, 21.","DOI":"10.3390\/s21051562"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1249\/MSS.0000000000001947","article-title":"Wearable Sleep Technology in Clinical and Research Settings","volume":"51","author":"Cellini","year":"2019","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"zsz254","DOI":"10.1093\/sleep\/zsz254","article-title":"Wearable Technologies for Developing Sleep and Circadian Biomarkers: A Summary of Workshop Discussions","volume":"43","author":"Depner","year":"2019","journal-title":"Sleep"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"885","DOI":"10.2147\/NSS.S306808","article-title":"It is All in the Wrist: Wearable Sleep Staging in a Clinical Population versus Reference Polysomnography","volume":"13","author":"Wulterkens","year":"2021","journal-title":"Nat. Sci. Sleep"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1016\/j.jacc.2020.01.046","article-title":"Wearable Devices for Ambulatory Cardiac Monitoring","volume":"75","author":"Sana","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"947","DOI":"10.5664\/jcsm.7868","article-title":"NightBalance Sleep Position Treatment Device Versus Auto-Adjusting Positive Airway Pressure for Treatment of Positional Obstructive Sleep Apnea","volume":"15","author":"Berry","year":"2019","journal-title":"J. Clin. Sleep Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"045004","DOI":"10.1088\/1361-6579\/abf01f","article-title":"Estimation of respiratory rate and effort from a chest-worn accelerometer using constrained and recursive principal component analysis","volume":"42","author":"Schipper","year":"2021","journal-title":"Physiol. Meas."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"035009","DOI":"10.1088\/1361-6579\/ad2f5e","article-title":"Maximum a posteriori detection of heartbeats from a chest-worn accelerometer","volume":"45","author":"Schipper","year":"2024","journal-title":"Physiol. Meas."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e030996","DOI":"10.1136\/bmjopen-2019-030996","article-title":"Protocol of the SOMNIA project: An observational study to create a neurophysiological database for advanced clinical sleep monitoring","volume":"9","author":"Krijn","year":"2019","journal-title":"BMJ Open"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1007\/s13239-011-0065-3","article-title":"An Efficient R-peak Detection Based on New Nonlinear Transformation and First-Order Gaussian Differentiator","volume":"2","author":"Kathirvel","year":"2011","journal-title":"Cardiovasc. Eng. Technol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.5665\/sleep.5046","article-title":"Computer-Assisted Automated Scoring of Polysomnograms Using the Somnolyzer System","volume":"38","author":"Punjabi","year":"2015","journal-title":"Sleep"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"zsac154","DOI":"10.1093\/sleep\/zsac154","article-title":"Scoring sleep with artificial intelligence enables quantification of sleep stage ambiguity: Hypnodensity based on multiple expert scorers and auto-scoring","volume":"46","author":"Bakker","year":"2023","journal-title":"Sleep"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/978-3-031-06413-5_7","article-title":"Automated Scoring of Sleep and Associated Events","volume":"Volume 1384","author":"Penzel","year":"2022","journal-title":"Advances in the Diagnosis and Treatment of Sleep Apnea"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Schipper, F., van Sloun, R.J.G., Grassi, A., Overeem, S., and Fonseca, P. (2023). A deep-learning approach to assess respiratory effort with a chest-worn accelerometer during sleep. Biomed. Signal Process. Control, 83.","DOI":"10.1016\/j.bspc.2023.104726"},{"key":"ref_28","unstructured":"Sateia, M.J. (2023). International Classification of Sleep Disorders, American Academy of Sleep Medicine. [3rd ed.]. Text Revision (ICSD-3-TR)."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","article-title":"Interrater reliability: The kappa statistic","volume":"22","author":"McHugh","year":"2012","journal-title":"Biochem. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"193","DOI":"10.5664\/jcsm.9538","article-title":"Interrater reliability of sleep stage scoring: A meta-analysis","volume":"18","author":"Lee","year":"2022","journal-title":"J. Clin. Sleep Med."},{"key":"ref_31","unstructured":"Celmer, L. (2024, May 31). AASM Announces First Recipient of Autoscoring Software Certification. American Academy of Sleep Medicine\u2014Association for Sleep Clinicians and Researchers. Available online: https:\/\/aasm.org\/american-academy-of-sleep-medicine-announces-first-recipient-of-autoscoring-software-certification\/."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.2147\/NSS.S373107","article-title":"Actigraphy-Based Sleep Detection: Validation with Polysomnography and Comparison of Performance for Nighttime and Daytime Sleep During Simulated Shift Work","volume":"14","author":"Gao","year":"2022","journal-title":"Nat. Sci. Sleep"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1109\/TITB.2010.2044797","article-title":"Sleep Staging Based on Signals Acquired through Bed Sensor","volume":"14","author":"Kortelainen","year":"2010","journal-title":"IEEE Trans. Inf. Technol. Biomed."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Migliorini, M., Bianchi, A.M., Nistic\u00f2, D., Kortelainen, J., Arce-Santana, E., Cerutti, S., and O Mendez, M. (September, January 31). Automatic sleep staging based on ballistocardiographic signals recorded through bed sensors. Proceedings of the 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Buenos Aires, Argentina.","DOI":"10.1109\/IEMBS.2010.5627217"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2022\/4509612","article-title":"Sleep Staging Using Noncontact-Measured Vital Signs","volume":"2022","author":"Wang","year":"2022","journal-title":"J. Health Eng."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Yi, R., Enayati, M., Keller, J.M., Popescu, M., and Skubic, M. (2019, January 19\u201322). Non-Invasive In-Home Sleep Stage Classification Using a Ballistocardiography Bed Sensor. Proceedings of the 2019 IEEE EMBS International Conference on Biomedical & Health Informatics (BHI), Chicago, IL, USA.","DOI":"10.1109\/BHI.2019.8834535"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Voss, A., Schroeder, R., Heitmann, A., Peters, A., and Perz, S. (2015). Short-term heart rate variability\u2014Influence of gender and age in healthy subjects. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0118308"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Moula, A.I., Parrini, I., Tetta, C., Luc\u00e0, F., Parise, G., Rao, C.M., Mauro, E., Parise, O., Matteucci, F., and Gulizia, M.M. (2022). Obstructive Sleep Apnea and Atrial Fibrillation. J. Clin. Med., 11.","DOI":"10.3390\/jcm11051242"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/17\/5717\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:47:29Z","timestamp":1760111249000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/17\/5717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,2]]},"references-count":38,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["s24175717"],"URL":"https:\/\/doi.org\/10.3390\/s24175717","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,2]]}}}