论文标题
数字生物标志物和人工智能,用于大量诊断的人口纤颤样本,呼吸障碍风险
Digital biomarkers and artificial intelligence for mass diagnosis of atrial fibrillation in a population sample at risk of sleep disordered breathing
论文作者
论文摘要
心房颤动(AF)是最普遍的心律不齐,与中风风险增加了五倍。许多患有AF的人未被发现。这些人通常是无症状的。关于是否建议对AF进行大规模筛查,存在持续的辩论。但是,对特定的处于危险组进行筛查(例如涉嫌睡眠呼吸呼吸的个体)有动力,在这种情况下,已经证明了AF和阻塞性睡眠呼吸暂停(OSA)之间的重要关联。我们引入了一种利用数字生物标志物以及人工智能(AI)的最新进展的新方法,以进行大规模AF诊断。我们证明了这种方法在大量人群样本中的价值,呼吸障碍的风险。四个数据库,总计n = 3,088例,P = 26,913小时的ECG原始数据。其中三个数据库(n = 125,p = 2,513)用于训练机器学习模型,以识别从节拍到beat间隔时间序列的AF事件。 Sleep Heart Health研究数据库(SHHS1,n = 2,963,p = 24,400)的访问1由隔夜多聚会(PSG)录音组成,并被视为测试集。在SHHS1中,专家检查确定了70名具有突出AF节奏的患者。 SHHS1上的模型预测显示,在分类有或没有突出AF的个体时,SHHS1的整体SE = 0.97,SP = 0.99,NPV = 0.99,PPV = 0.67。对于患有呼吸暂停的呼吸暂停指数(AHI)> 15对AHI <15的个体,PPV是非内部(P = 0.03)。在22%的正确识别的AF节律病例中,未在SHHS1中记录为AF的22%。可以自动从隔夜的单个通道ECG记录中自动诊断出具有突出AF的个体,其准确性不受OSA的影响。从一夜之间的心电图记录中检测AF检测表明,未诊断的AF很大一部分,可能会增强OSA的表型。
Atrial fibrillation (AF) is the most prevalent arrhythmia and is associated with a five-fold increase in stroke risk. Many individuals with AF go undetected. These individuals are often asymptomatic. There are ongoing debates on whether mass screening for AF is to be recommended. However, there is incentive in performing screening for specific at risk groups such as individuals suspected of sleep-disordered breathing where an important association between AF and obstructive sleep apnea (OSA) has been demonstrated. We introduce a new methodology leveraging digital biomarkers and recent advances in artificial intelligence (AI) for the purpose of mass AF diagnosis. We demonstrate the value of such methodology in a large population sample at risk of sleep disordered breathing. Four databases, totaling n=3,088 patients and p=26,913 hours of ECG raw data were used. Three of the databases (n=125, p=2,513) were used for training a machine learning model in recognizing AF events from beat-to-beat interval time series. The visit 1 of the sleep heart health study database (SHHS1, n=2,963, p=24,400) consists of overnight polysomnographic (PSG) recordings, and was considered as the test set. In SHHS1, expert inspection identified a total of 70 patients with a prominent AF rhythm. Model prediction on the SHHS1 showed an overall Se=0.97,Sp=0.99,NPV=0.99,PPV=0.67 in classifying individuals with or without prominent AF. PPV was non-inferior (p=0.03) for individuals with an apnea-hypopnea index (AHI) > 15 versus AHI < 15. Over 22% of correctly identified prominent AF rhythm cases were not documented as AF in the SHHS1. Individuals with prominent AF can be automatically diagnosed from an overnight single channel ECG recording, with an accuracy unaffected by the presence of OSA. AF detection from overnight ECG recording revealed a large proportion of undiagnosed AF and may enhance the phenotyping of OSA.