Sleep Apnea and Hypopnea Events Detection Based on Airflow Signals
Using LSTM Network
Wenming Yang, Jiamin Fan, Xingjun Wang and Qingmin Liao
Abstract— Sleep Apnea-Hypopnea Syndrome (SAHS) is a
sleep-related breathing disorder which involves the reduction
in breathing airway when patiens sleep. However, a large
proportion of patients are usually undiagnosed and untreated
which may lead to the risk of life. In this paper, we propose an
automatic SAHS event detection method based on Long Short-
Term Memory (LSTM) network via nasal airway pressure
and temperature signals from clinical polysomnography (PSG)
dataset. Focusing on time location of the events, we firstly
segment the two channels of signals into a series of sequences
by feature extraction. Secondly, a LSTM network is established
and these sequences are subsequently fed into this LSTM
network for SAHS event classification. The experimental results
on both our clinical PSG dataset and public MIT-BIH PSG
database show that our method is promising in terms of recall.
I. I NTRODUCTION
Sleep disorder is a common breath syndrome that has
affected numerous people in the world nowadays. Sleep
Apnea-Hypopnea Syndrome (SAHS) is a most common and
dangerous sleep-related breathing disorder. It is diagnosed
when the reduction in breathing airway appears in a certain
number of times during sleeping. Studies have shown that
SAHS occurs in both men and women whose age range from
30 to 60 years or older [1]. A large proportion of the patients
are undiagnosed and untreated as only a small number of
people are aware of these symptoms. The symptom remains
untreated and undiagnosed may generally cuase heart and
brain disease and has a risk to patients’ life [2-3]. In terms
of SAHS diagnosis, the most reliable method is to analysis
patients’ polysomnography (PSG) which is also the most
widely used method.
Multiple algorithms have been proposed to detect ob-
structive sleep apnea (OSA) based on different types of
signals or combined approaches [4]. Multiple statistical
pattern recognition techniques, logistic regression,k-nearest
neighbor, were analyzed based on pulse oximetry [5-6].
Another common approach for detecting sleep disorders is
to analyze electrocardiogram (ECG). In these kinds of meth-
ods, ECG signals are firstly separated into different forms,
which will be further analyzed for classification. Multiple
classifiers, linear discriminant analysis (LDA), support vector
machine,as for example [7-10]. Respiration signals is one
of the most direct signals of sleep disorders and was used
*This work is supported by the National Key Research and Development
Program of China (No. 2017YFC0112500).
Wenming Yang (yangelwm@163.com), Jiamin Fan (fanjm1994@1-
63.com), Xingjun Wang (wangxj@tsinghua.edu.cn) and Qingmin Liao
(liaoqm@tsinghua.edu.cn) are with Shenzhen Key Lab. of Information
Sci&Tech, Department of Electronic Engineering /Graduate School at
Shenzhen, Tsinghua University, China.
978-1-5386-1311-5/19/$31.00 ©2019 IEEE
in many studies. Hilbert-Huang transform was adopted to
the respiration pressure signal by Caseiro et al. for respira-
tion syndromes [11]. Recent studies concentrate on using
networks like convolutional neural networks to diagnose
respiration syndromes [12-16]. Sounds occurred when people
breathe is also directly related to these syndromes, for what
sound signals are also studied for the relationship between
sleep syndromes. Recorded respiratory sounds were used
to extract spectrum features and classified utilized K-means
clustering algorithm and machine learning [17]. Voice activ-
ity detection was employed to distinguish airflow signals into
silence and sleep disorder syndromes by Almazaydeh et al.
[18]. Combinations of multiple signals are also presented to
diagnose sleep respiration syndromes. By analyzing airway
and other signals, Xie and Min [19] presented an algorithm
for sleeping apnea and hypopnea syndromes. A method
combining oxygen saturations and RR series features based
on oximetry and ECG was proposed. These features are then
selected for classification via linear discriminant analysis by
Ravelo-Garcia et al. [20]. Also, a number of approaches are
proposed to reduce the computation complexity and time cost
of processing procedure [21].
In this paper, we develop a method to detect SAHS
events by using candidate segmentation and LSTM clas-
sification. Two respiration channels from PSG recordings,
nasal pressure and nasal temperature, are analyzed. These
nasal signals are first segmented by frequency feature and
energy ratio extracted respectively from two signals. And
then the candidate segments with longer time signal in both
two channels are sent into the classifier, LSTM, to analyze
the characteristic of three different classes. We focus on
comparatively exact time location of the breathing events
during sleep. Both sleep apnea syndrome and sleep hypopnea
syndrome are considered.
II. R ELATED W ORK
Recurrent neural network (RNN) is now a widely used
network on pattern recognition. Typical RNN learning algo-
rithms perform well on mapping real-valued input sequences
into output sequences. Long Short-Term Memory network,
which is a novel derivative from RNN, performs better than
RNNs when the input sequence is too long[22].
The special character of an LSTM network is the memory
block. The memory cells and gating units help the net-
work store and abandon information from sequences long
time ago. The parameters of the gating system all can be
learned when the network works. These cells help decide
the information stored from previous sequence and when
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it is helpful so that it can be used [22]. LSTM performs
well when the amount of input data is too large and the
previous information is important for the current situation.
In our SAHS tasks, the length of the signals can be hold by
the cells enough and the network can work well.
Compared to traditional RNNs, LSTM networks have
better performance on long continues-valued sequence and
work more efficiently. Considering the characteristic of the
relation between the respiration events and nasal signals,
LSTM is of great advantage on the study.

III. M ETHODS
The framework of the proposed algorithm is demonstrated
in Figure 1. It can be divided into two main parts: potential
events detection and classification. The candidate SAHA
events are first detected by manually chosen features. Then
the two signals are segmented by the location of the detected
events into segments with different length. These segments
are finally sent into LSTM network for classification.

A. Experimental Setup
We establish a clinical PSG database consisting of two
oronasal airflow signals from PSG signals of 130 adult
patients. All these records are of breathing events of vari-
ous occurrence frequency during one night. The sampling
frequency of all acquired signals is 100Hz. The PSG signals
are recorded by devices of polysomnography conducted by
cooperated hospitals. The labels of the apnea and hypopnea
symptoms are confirmed by clinical experts for diagnosing
relating symptoms. While the whole dataset contains other
signals, which have also been studied to diagnose SAHS, our
study extract the two simultaneous nasal breathing signals,
nasal pressure and nasal temperature signals.
B. Respiration Signals Pre-processing
Respiration siganls are the most related siganls of sleep
syndrome. They are used both on clinical stuies and en-
gineering for sleep syndrome analysis. The clinical PSG
signals often take various kinds of noises. Therefore, the
PSG signals are first filtered with a low pass Butterworth
filter. When breathing apnea occurs, the signals will be flat
and with no change. For those signals with poor quality ,we
use a band pass filter to remove the disturbing information
.Finally, the filtered signals are normalized to avoid subject-
dependent variations.
On account of the fact that SAHS events will not occur
when the patient is awake, referring to the sleep stage labels,
the potential respiration events during waking hours are not
considered.
C. SAHS Events Segmentation
The signals pre-processed are then segmented by sliding
window method. For each window, two features are extracted
for following processing. Since nasal pressure and temper-
ature signals have different characteristics, the method for
feature selection is of great importance. For the nasal airway
pressure signal, the main frequency of the signal segmented
Fig. 1. Block diagram of the proposed method. The left part is for the
segmentation and training process. The right part is the testing process.
is chosen as the main feature. And for the nasal airway
temperature signal, the ratio of the energy is selected. The
energy ratio is calculated by the total energy of current
window and the energy of the founded nearest normal signal
segment with the same length to the window. The normal
signal segment here is defined that the segment is not
included in the nasal temperature candidate segments. And
it is the nearest one to the current window.
A comparatively low threshold is set for the features to
extract the segments. This helps reduce the number of events
left out.
There are conditions that nasal pressure and nasal tem-
perature signals perform inconsistently during the same oc-
currence of respiration events. In order to keep all potential
SAHS events, all segments extracted on the two channels
are reserved. The extracted segments last less than 10s are
deleted and if one segment locates too close to another, they
are merged into one new segment. The main purpose of
this part is to find all potential locations that the respiration
events may occur as shown in figure 2. The classification and
distinguish of different type syndromes and normal segments
are performed in following procedure.
D. Classification
The chosen segments are of the same length to respiration
events. As the respiration events last range from 10s to 30s,
the chosen segments last range from 1000 points to 3000
points.
As introduced previously, the advantage of LSTM network
compared to other traditional neural networks is that LSTM
can take advantage of all information of the long sequence
selectively. Coincidentally, the respiration event diagnosis

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considers the signals far ahead as reference. On the one In classification stage, each segment is classified into
hand, this characteristic makes the LSTM network a great one of three classes: normal, apnea, hypopnea. The ground
advantage to learn. On the other hand, the segments fed truth comes from experts of cooperative hospitals. Generally,
into the network cannot be too long or too short. Too long the number of normal segments is far more than SAHS
segments may contain two or more sleep disorders which events. To overcome the imbalance of the database of the
can lead to the confusion of the specific syndrome of the three classes (normal signals are much more than abnormal
current location. Too long segments cannot be used to detect signals), random extraction on three classes are processed
the events because the exact location of the event’s feature both when training and testing.
that makes sense is unknown. Conversely, too short segment
loses valuable discriminative information of signals. As in
short term, the signal of the hypopnea events performs almost
the same as the normal signals.
Under this consideration, we take the time location of the
segments, and take longer sequences of signals into consid-
eration on the basis of the segments extracted. A certain
length of signal sequences before and after the segments
are also extracted. The segments fed into the network are
with two channels at the same location of the two signals,
nasal pressure and nasal temperature channel. The segments
with various locations can have various length, ranging from
30 seconds to 50 seconds,depending on the length of the Fig. 2. A sample of SAHS events segmentation on nasal temperature
signals . The red boxes are the candidate events extracted by our method
respiration events occurrence, the length of similar normal and the green boxes are the breathing events occurred.
signals.
Before feeding the resulting signal segments into the
network, the data is sorted by sequence length to reduce
the amount of padding or discarded data. The sorted and
split data is then normalized to fed into the LSTM network.
Figure 3 shows one observation of the data to be trained,
feature 1 represents the nasal pressure signal and feature 2
represents the nasal temperature signal. The sequence input
is with two dimensions acting as features.
The network adopted in the experiment is with 5 different
function layers. They are sequence input layer, LSTM layer,
fully connected layers, SoftMax layer and classification out-
put layer respectively. The numbers of each layer are related
to the sequence input. In this study, we try to classify the
signals into three classes, normal signals, sleep apnea events
and hypopnea events. The number of the fully connect layers
is three.
The trained model is then used to test the testing data. The
potential events segmentation is also operated on the testing Fig. 3. One training observation of the data to be trained. feature 1
signals. The trained LSTM model output the classification represents the nasal pressure signal and feature 2 represents the nasal
results of the segments. temperature signal.

IV. E XPERIMENTS A ND D ISCUSSION
Our clinical database consists of two oronasal airflow sig-
nals from PSG signals of 130 adult patients. All these records
are of breathing events of various occurrence frequency dur-
ing one night. The experimental procedures involving human
subjects described in this paper were approved by related
institute. The segmentation is processed on every subject.
And then the segments are shuffled randomly regardless of
the subjects. 70% of the segments are taken as training
data and the left 30% just for test. The candidate segments
detection as shown in figure 2 performs well and 99% of the
SAHS events are extracted.
Figure 3 shows an example of the segments derived from
the processed signal to fed to the network. It contains the
breathing events period, the normal period before and after
the normal period.
The segments classification results are shown in Table I,
which presents the recall of classification. The recall and
precision are calculated according to the events occurrence.
The total accuracy of the classification is 81.6%.
Our method is also performed on MIT-BIH polyso-
mnography database [23-24]. We take the 14 records which
include signal measured through nasal thermistor. However,
this database does not provide start and stop locations
annotations. It only provides 30 seconds epoch annotations.

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So we mark the 30 seconds epoch annotations as the events
and send the only respiration signal of this database into our
LSTM network. The recall of our method performed on MIT-
BIH polysomnography database is 90.0%, 87.1%, 83.2%,
representing norm, apnea and hypopnea events respectively.
TABLE I
C LASSIFICATION R ESULTS
Class Normal Apnea Hypopnea
Recall on our clinical database 81.3% 87.9% 75.5%
Recall on MIT-BIH database 90.0% 87.1% 83.2%
Precision on our clinical database 82.0% 84.5% 78.1%
Precision on MIT-BIH database 90.8% 83.6% 85.8%
F1-score on our clinical database 0.81 0.86 0.77
F1-score on MIT-BIH database 0.9 0.85 0.84
The classification of the hypopnea events is quite dif-
ficult issue in aspect of SAHS detection since it seems
extremely similar to normal signal. Our experiments show
when choosing only energy or frequency feature on nasal
temperature signals, the classification results of hypopnea
events and normal signals decrease. The feature extraction
on nasal temperature signal and the normal segments chosen
when calculating energy ratio help improve the classification
results of hypopnea events.
V. CONCLUSIONS
In this paper we develop a deep learning-based method
to detect sleep syndromes including sleep apnea syndrome
and hypopnea syndrome by using airflow signals segmen-
tation and LSTM network. Two respiration channels from
polysomnography recordings, nasal pressure and nasal tem-
perature, are analyzed in our study. We first extracted seg-
ments which may not occur with respiration events but with
exact time locations by feature extraction. Furthermore, the
candidate segments with longer time signal in both two
simultaneous channels are sent into the classifier, LSTM
network, to analyze the characteristics of two different
breathing events for classification. Most normal signals are
separated from abnormal signals in the first stage. In the
next stage, we focus on comparatively exact location of the
breathing disorder during sleep. The segmentation detects
the breathing events of exact occurrence moment and helps
remove interferential data. The network helps analyze the
characteristic of different syndromes. All these combination
mechanism makes our algorithm effective.
R EFERENCES
[1] S. Ryan and W.T. McNicholas, Obstructive Sleep Apnea, in: In-
ternational Encyclopedia of Public Health, Harald Kristian (Kris)
Heggenhougen, ed., Academic Press, Oxford, 2008, pp. 621-627.
[2] D.E. Wardly, Intracranial hypertension associated with obstructive
sleep apnea: A discussion of potential etiologic factors, Medical
Hypotheses 83 (2014), 792-797.
[3] Owen D. Lyons and Clodagh M. Ryan, Sleep apnea and stroke,
Canadian Journal of Cardiology 31 (2015), 918-927.
[4] A. Yadollahi, E. Giannouli and Z. Moussavi, ”Sleep apnea monitoring
and diagnosis based on pulse oximetry and tracheal sound signals,”
Medical & Biological Engineering & Computing, vol. 48, no. 11, pp.
1087-1097, 2010.
2579
[5] J. Marcos, R. Hornero, D. Alvarez, F. Campo and C. Zamarron, ”As-
sessment of four statistical pattern recognition techniques to assist in
obstructive sleep apnoea diagnosis from nocturnal oximetry,” Medical
Engineering & Physics, vol. 31, no. 8, pp. 971- 978, 2009.
[6] J. Marcos, R. Hornero, D. AAlvarez, F. Campo and M. Aboy, ”Au-
tomated detection of obstructive sleep apnoea syndrome from oxygen
saturation recordings using linear discriminant analysis,” Medical &
biological engineering & computing, vol. 48, no. 9, pp. 895-902, 2010.
[7] C. Cheng, C. Kan and H. Yang, ”Heterogeneous recurrence analysis
of heart beat dynamics for the identification of sleep apnea events,”
Computers in Biology and Medicine, vol. 75, pp. 10-18, 2016.
[8] A. Hassan, ”Computer-aided obstructive sleep apnea detection using
normal inverse Gaussian parameters and adaptive boosting,” Biomed-
ical Signal Processing and Control, vol. 29, no. 1, pp. 22- 30, 2016.
[9] C. Travieso, J. Alonso, M. Pozo-Banos, J. Ticay-Rivas and K. Lopez-
de-Ipina, ”Automatic Apnea Identification by Transformation of the
Cepstral Domain,” Cognitive Computation, vol. 5, no. 4, pp. 1-8, 2013.
[10] P. Chazal, T. Penzel and C. Heneghan, ”Automated Detection of
Obstructive Sleep Apnoea at Different Time Scales Using the Electro-
cardiogram,” Physiological Measurement, vol. 25, no. 4, pp.967-983,
2004.
[11] P. Caseiro, R. Fonseca-Pinto and A. Andrade, ”Screening of ob-
structive sleep apnea using Hilbert-Huang decomposition of oronasal
airway pressure recordings,” Medical Engineering & Physics, vol. 32,
no. 6, pp. 561-568, 2010.
[12] R. Haidar, I. Koprinska and B. Jeffries, ”Sleep Apnea Event De-
tection from Nasal Airflow Using Convolutional Neural Networks,”
in 2017 International Conference on Neural Information Processing,
Guangzhou, China, October, 2017.
[13] N. Selvaraj and R. Narasimhan, ”Detection of Sleep Apnea on a Per-
Second Basis Using Respiratory Signals,” in 35th Annual International
Conference of the IEEE Engineering in Medicine and Biology Society,
Osaka, Japan, July, 2013.
[14] A. Ng, T. Koh, E. Baey, T. Lee, U. Abeyratne and K. Puvanendran,
”Could formant frequencies of snore signals be an alternative means
for the diagnosis of obstructive sleep apnea?,” Sleep Medicine, vol. 9,
no. 8, pp. 894-898, 2008.
[15] R. Pozo, J. Murillo, L. Gomez, E. Gonzalo, J. Ramirez and D.
Toledano, ”Assessment of Severe Apnoea through Voice Analysis,
Automatic Speech, and Speaker Recognition Techniques,” EURASIP
Journal on Advances in Signal Processing, vol. 2009, no. 1, pp. 1-11,
2009.
[16] G. Ozdemir, H. Nasifoglu and O. Erogul, ”A Time-Series Approach
to Predict Obstructive Sleep Apnea (OSA) Episodes,” in The 2nd
World Congress on Electrical Engineering and Computer Systems and
Science, Budapest, Hungary, July, 2016.
[17] T. Praydas, B. Wongkittisuksa and S. Tanthanuch, ”Obstructive Sleep
Apnea Severity Multiclass Classification Using Analysis of Snoring
Sounds,” in 2nd World Congress on Electrical Engineering and Com-
puter Systems and Science, Budapest, Hungary, August, 2016.
[18] L. Almazaydeh, K. Elleithy, M. Faezipour and A. Abushakra, ”Apnea
Detection Based on Respiratory Signal Classification,” in The 3rd
International Conference on Current and Future Trends of Information
and Communication Technologies in Healthcare, Ontario, Canada,
October, 2013.
[19] B. Xie and H. Minn, ”Real-Time Sleep Apnea Detection by Classi-
fier Combination,” IEEE Transactions on Information Technology in
Biomedicine, vol. 16, no. 3, pp. 469-477, 2012.
[20] A. Ravelo-Garcia, J. Kraemer, J. Navarro-Mesa, E. Hernandez- Perez,
J. Navarro-Esteva, G. Julia-Serda, T. Penzel and N. Wessel, ”Oxy-
gen Saturation and RR Intervals Feature Selection for Sleep Apnea
Detection,” Entropy, vol. 17, no. 5, pp. 2932-2957, 2015.
[21] W. W. Flemons et al, ”Home Diagnosis of Sleep Apnea: A Systematic
Review of the Literature,” Chest, vol. 124, pp. 1543-1579, 2003.
[22] F.A.Gers,J.Schmidhuber,andF.Cummins.Learningtoforget:Continual
prediction with LSTM. NeuralComputation,12(10):2451-2471,2000.
[23] Ichimaru Y, Moody GB. Development of the polysomnographic
database on CD-ROM. Psychiatry and Clinical Neurosciences 53:175-
177, 1999.
[24] G. Goldberger et al., ”Physiobank, physiotoolkit, and physionet: Com-
ponents of a new research resource for complex physiologic signals,”
Circulation, vol. 101, no. 23, pp. 215-220, 2000.