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fully edited. Content may change prior to final publication. Citation information: DOI 10.1109/JSEN.2018.2883716, IEEE Sensors
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Force-Sensing-Based Unobtrusive System for
Awakening and Respiration Rate Analysis during
Sleep
Sooji Park, Student Member, IEEE, Hyong-Ho Cho, Hyung Chae Yang, Jin-Sang Yoon and Hangsik Shin,
Member, IEEE
Abstract — In this study, we designed an unobtrusive strip-type
sleep monitoring system including a force sensor and algorithms
for the detection of awakening and respiration rate. The developed
system is installed on a mattress across the user's chest in order to
measure the trunk movement induced by respiration or body mo-
tion. Thirty subjects’ clinical data, which contain signals that were
measured simultaneously using the developed system and a poly-
somnograph (PSG), are used to validate the accuracy of the devel-
oped system. The awakening detection, accuracy, sensitivity, spec-
ificity, and Kappa coefficient of the designed system were 79.4%,
48.3%, 86.9%, and 0.6, respectively, and the average sleep effi-
ciency was 82.3% in the developed system and 84.0% in the PSG
with root-mean-square- error of 17.7%. In terms of respiration
rate detection, it was shown that the respiration rate measured
with the developed system can trace the PSG-measured respira-
tion rate. The accuracy to detect respiration rates within one, two,
and three breaths per minute error were 76.4%, 97.2%, and
99.4%, respectively.
Index Terms — Awakening state detection, PVDF (polyvinyli-
dene fluoride), Respiration rate detection, Sleep monitoring, Un-
obtrusive measuremnt
I.
INTRODUCTION
P olysomnography (PSG) is the gold standard sleep monitor-
ing method that is used clinically to diagnose sleep disor-
ders. While PSG has the advantage of being able to accu-
rately diagnose sleep disease, it also has several limitations: it
is necessary for the subject to sleep with a large number of
Submit Date :
* This research was supported by the MSIP(Ministry of Science, ICT and
Future Planning), Korea, under the ITRC(Information Technology Research
Center) support program (IITP-2018-2014-1-00720) supervised by the
IITP(Institute for Information & communications Technology Promotion) and
by the Bio & Medical Technology Development Program of the NRF funded
by the Korean government, MSIP (NRF-2016M3A9F1941328).
S. Park is with the Department of Biomedical Engineering, Chonnam Na-
tional University, 50 Daehak-ro, Yeosu, South Korea (e-mail:
susie.soo718@gmail.com)
H.-H. Cho is with the Department of Otolaryngology-Head and Neck Sur-
gery, Chonnam National University Medical School and Chonnam National
University Hospital, Gwangju, South Korea. (e-mail: victocho@jnu.ac.kr)
H. C. Yang is with Department of Otolaryngology-Head and Neck Surgery,
Chonnam National University Medical School and Chonnam National Univer-
sity Hospital, Gwangju, South Korea. (e-mail: dr.yang@hanmail.net)
J.-S. Yoon is with the Department of Psychiatry, Chonnam National Univer-
sity Medical School, Gwangju, South Korea (e-mail: jsyoon@jnu.ac.kr)
H. Shin is with the Department of Biomedical Engineering, Chonnam Na-
tional University, 50 Daehak-ro, Yeosu, South Korea (e-mail: hang-
sik.shin@jnu.ac.kr).
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sensors attached to them, and it is only possible to perform PSG
sleep monitoring in a designated laboratory, as opposed to a
normal sleeping environment. In addition, the monitoring pro-
cess is expensive, requires a skilled technician, and is limited to
one-time monitoring. Considering that sleep is a repetitive ac-
tivity that occurs daily, PSG is difficult to apply to daily sleep
health management.
There have been several attempts to simplify PSG. Wrist
actigraphy is a representative alternative for daily sleep moni-
toring [1-3]. It measures the amount of activity that occurs in
one’s wrist during sleep and uses this to analyze the person’s
sleep patterns and awakening during sleep. Among the wrist-
type sleep monitoring devices, Actiwatch (Philips Respironics,
Oregon, USA) has been approved by the US Food and Drug
Administration (FDA) and is used to clinically analyze the sleep
patterns of insomnia patients [4]. Wearable devices can monitor
sleep status more easily than PSG. Therefore, they are much
more suitable for sleep health management in daily life; how-
ever, they constrain a user’s body because they have to be worn
at all times during sleep. It is also difficult to use for continuous
monitoring because it must be actively managed by the user.
In recent years, studies have been conducted for both remote
and unobtrusive measurement methods to improve conven-
tional constrained-type sleep monitoring devices. Remote
measurement methods monitor the human body without the
need for contact. The methods typically used to remotely meas-
ure body signals include radiometry based on radar signals [5],
microphones measuring sounds generated by bio-activity or
snoring during sleep [6, 7], thermal cameras for measuring tem-
perature changes of the face during sleep [8], fiber optics for
measuring body movement monitoring [9], millimeter wave for
heart rate and respiration rate detection [10], infrared camera
and motion sensor for sleep monitoring [11], ultrasonic piezo
transducer for capturing ultrasound reflections from heart and
surrounding organ motions due to the breathing [12], and Dop-
pler rader for respiration monitoring [13]. Remote methods
have the advantage of the user being free from the measuring
device. However, they are limited in that the results can be eas-
ily distorted by exceptional environmental changes, such as ra-
dio signals, ambient noise, room temperature changes, and so
on.
The unobtrusive method measures physiological signals with
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Journal

minimal contact and without needing to attach the sensor di-

rectly to the body. In representative unobtrusive sleep monitor-
ing studies, sleep efficiency has been derived based on measur-
ing movement using a piezoelectric sensor under the subject’s
back [14]; a load cell on a bed leg [15]; and a pressure sensor
and an air mattress [16]. These unobtrusive methods can meas-
ure biological signals without interfering with the subject’s
sleep. Moreover, they are advantageous in that continuous and
long-term monitoring can be performed after the initial instal-
lation of the monitoring devices.
The purpose of this study is to develop an unobtrusive sleep
health management system that overcomes the limitations of
typical sleep monitoring devices, such as the burden of exami-
nation, constraining the subject’s body, and requiring user man-
agement, and to develop algorithms for distinguishing awaken-
ing and for detecting respiration rates, which is an important
indication in sleep health management. Awakening detection is
the basis for calculating sleep efficiency, and respiration is one
of the most important physiological activities, so it should be
monitored at every moment in daily life. Moreover, respiration
rate analysis can be a first step toward analyzing representative
sleep disorders, such as sleep apnea or snoring caused by ab-
normal breathing during sleep.
There are several unobtrusive onbed type sleep tracking de-
vices that have different structures and schemes. Representative
examples include Beddit(Apple inc., CA, USA), Nokia
Sleep(Nokia, Espoo, Finland), and EarlySense(EarlySense inc.,
MA, USA). However, they have different structures and are
constantly being updated, so optimization and clinical valida-
tion are still required. In the process of this development, our
research has meaning as an another attempt involving its own
structure and algorithm. In particular, clinical studies on the
onbed type devices included in our study can provide useful im-
plications, because clinically validated results are hard to find
in other related studies.
II.
UNOBTRUSIVE FORCE SENSING SYSTEM
A.
Strip-type force sensor
We developed a flexible ultra-thin sensor using Polyvinyli-
dene fluoride (PVDF) film (Fils inc., Sungnam, South Korea)
to measure the force generated from body movement. PVDF
film has previously been used for unobtrusive monitoring be-
cause it is thin and flexible and generates electricity in response
to mechanical stress [17]. Table I shows the general properties
of the PVDF film [18].
The developed strip-type sensor has sufficient width and
TABLE I
PROPERTIES OF PVDF FILM
Mechanical property
Tensile strength (@Break) 35-50
Elongation (@Break) 100-250
Tensile modulus 2500
Electrical property
Dielectric strength, 1 mil 160
Dielectric constant, 1 kHz 8.2-10
Dissipation factor, 1 kHz 0.005-0.02


Fig. 1. Developed strip-type force sensor and the pattern of electrode


Fig. 2. The sensor interface for analog front-end. (a) interface’s side structure,
(b) interface’s top structure, and (c) appearance of sensor interface
thickness to prevent the user from recognizing the presence of
the sensor and to allow the user's chest to be positioned on the
sensor even when the user changes their sleeping position. In
order to measure the electrical response of the PVDF film, elec-
trodes were screen-printed using silver paste (Silveray-JM,
Exax inc., Cheonan, South Korea) on both sides of the film,
then heat curing the film for 30 minutes at a 60
.The pattern
of the electrodes was staggered so as to prevent the generation
of electromagnetic (EM) noise from electrostatic induction
when the bilateral electrodes were superposed.
The fabricated line force sensor has a size of 12 mm × 720
mm × 0.13 mm (width × length × thickness), and a under 4 ms
response time. Two rows of line sensors were packed in parallel
with a 0.05 mm thick adhesive polyethylene terephthalate (PET)
film, except for 20 mm from the edge for interfacing. Electro-
magnetic field shielding fabrics(WPD-330-GG, Ajin electron,
Busan, South Korea) was used as a cover for the sensor in order
to reduce external EM noise. The developed two-channel sensor
size was ultimately 40 mm × 750 mm × 0.25 mm (width ×
length × thickness) with a 10 mm gap between line sensors. The
interface between the sensor and the system was fabricated us-
ing a ring terminal, an eyelet, and insulating tape for robust fix-
Unit ation. Fig. 1 and Fig. 2 show the developed two-channel strip-
MPa type force sensor and the pattern of the electrode, as well as the
% sensor interface for the analog front end, respectively.
MPa
Unit
B.
Analog front-end
kV/mm An analog front-end was designed to preprocess the signal
- measured with the strip-type force sensor, which includes a
-

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  TABLE II

 SPECIFICATION OF THE DEVELOPED DATA ACQUISITION MODULE
Property Description Unit


 Number of ADC channel 24 -
ADC bit depth 14 bit
 ADC range 0-1.45 V

ADC resolution (about) 88.5 

 kHz/Chan-
Maximum sampling frequency 1
nel

 Connectivity WiFi, Bluetooth 4.0 -




Fig. 3. Analog front-end circuit of a single channel

charge-amplifier and a voltage amplifier circuit (Gain = 11). A

reference voltage-generating circuit was added to measure a
negative signal (Vref = 670 mV). Fig. 3 shows the analog front-
end circuit. Because the electrical specifications of the
fabricated sensor and the charge amp’s gain are not obvious, we
set the value of the resistor or the capacitor empirically.
C.
Data acquisition module
The data acquisition module was designed to receive up to
24-channel analog signals, and it consists of a micro-controller Fig. 4. Internal block diagram of data acquisition module
unit (MCU), a Bluetooth module, a microSD card slot, a real-
time clock (RTC), and an internal battery. MSP432P401R
(Texas Instruments, Dallas, USA), which supports low-power
operation and a 14-bit analog-to-digital converter (ADC), was
used for data conversion and transmission. The ADC range of
the data acquisition module is 0 to 1.45 V with 88.5 uV resolu-
tion, and the sampling frequency is 1 kHz. The measured data
is transmitted through a serial communication method via USB
interface or ESP-32s (AI-Thinker Co. Ltd, Shenzhen, China), a
Bluetooth and WiFi integration module. An analog front-end
and data acquisition module was designed as an assembly type

for possible future expansion. Table II presents the specification Fig. 5. Unobtrusive force measurement system. (a) Overall system, (b) Assem-
of the developed data acquisition module. Fig. 4 and Fig. 5 bly of analog front-end circuit, data acquisition module, and case, (c) PCB of
analog front-end circuit and data acquisition module.
show an internal block diagram of the data acquisition module
and the developed unobtrusive force measurement system, re- and a part of awakening detection precedes the respiration rate
spectively. detection. The overall algorithm flow is shown in Fig. 6.
A.
Awakening detection
III.
ALGORITHM DEVELOPMENT When some movement occurs during sleep, a large pressure
This research consists of multiple algorithms to analyze awak- change is induced between the human body and the force meas-
ening and respiration rate. These algorithms are interconnected, urement system. In this study, abrupt changes in the amplitude
of the measured signal are regarded as movement during sleep

Fig. 6. Algorithms for awakening and respiration rate detection using movement signals.

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Fig. 8. The process of threshold decision for awakening state detection

Fig. 7. An example of preprocessing to detect motion signal. (a) Original signal

by the strip-type force sensor signal, (b) Signal after applying the IIR notch fil- awakening (, 1 ) if the result was greater than or
ter, and (c) Signal after applying IIR BPF equal to 0.5. Otherwise, it was classified as sleep (, 1
). This can be expressed as (2), and
, is the total number of
and are classified as awakening. The awakening detection algo- instances of (, in a 30-second period.
rithm consists of preprocessing, threshold determination, and

awakening detection stages.
! ,4(, 5 3  45
Preprocessing enhances the movement signal from the meas- , 1 7 /.0 (2)
ured signals. In the preprocessing stage, a second-order IIR
notch filter is applied so as to remove 60 Hz powerline interfer-
ence. Next, a third-order IIR band pass filter (BPF) with a pass-
band of 0.4 to 1 Hz is applied in order to enhance the movement
component. Fig. 7 shows an example preprocessing result.
In order to determine the proper decision criteria for awaken-
ing, a histogram of the standard deviation of the measured sig-
nal is used. (see Fig. 8). First, we repeatedly calculate the stand-
ard deviation of a seven-second time duration with overlapping

! ,4(, 5 2  45






/.0
B.
Respiratory rate detection
Noise removal precedes extracting the respiratory component
from the force signal using the proposed system or the ab-
dominal movement signal using the PSG equipment. Except for
the fact that the proposed system uses a second-order IIR notch
filter to remove the 60 Hz powerline noise, all procedures are
( ,&%)$' ). We then draw the histogram of  ,&%)$' and calcu-
late a Gaussian curve using bins less than the maximum value
of histogram. Then, the 5σ on the positive side of the histogram
is determined as a criterion for awakening state classification.
In this process, we empirically selected a window length of
seven seconds for calculating standard deviation and a
coefficient threshold of 5σ.
The awakening is determined in two steps. (see Fig. 6) In the
the same as the signals obtained by the developed system and
the abdominal respiratory movement signal of PSG; excluding
the awakening section ((, 1 ) which includes a mo-
tion artifact; interpolating the removed interval with neighbor
data; applying third-order IIR BPF with a pass band of 0.1 to
0.5 Hz to extract the respiration component; and applying a
moving average filter (MAF) of 2 seconds length for smoothing.
Spectrograms are useful for analyzing frequency components
first step, if the  ,&%)$' is greater than or equal to the threshold,
it is classified as awakening ((, 1 ); in contrast, if the
value is less than the threshold, it is classified as sleep
((, 1 ). This can be expressed as (1)
over time. In this study, we used a spectrogram to find the res-
piration rate for the force signal of the developed system and
the abdomen movement of PSG. We assume that the respiratory
frequency component is the most prevalent in the filtered sig-
nals, and that the maximum value of the power spectral density

 ,&%)$' 3
 
45 could reflect the respiration rate. In spectrogram analysis, we
(, 1
6 (1) set a window size of 120 seconds and an overlap of 60 seconds.
 ,&%)$' 2
 
45






The notation, ‘5ms’, of the awakening state means that values
were sampled every 5 ms because force signals were recorded
with 1 kHz sampling frequency, but it was down-sampled to
200 Hz to match the sampling frequency of the PSG equipment.
In the second step, we determine awakening every 30 seconds.
The 30-second period is the reference epoch of PSG’s sleep di-
agnosis. By averaging the previously obtained awakening
((, 1 ) of 30-second duration, it was classified as
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Next, we find the frequency that has the maximum power spec-
tral density for each window, and then calculate the respiration
rate per minute.
IV.
ALGORITHM EVALUATION
A.
Dataset
An experiment was conducted in order to evaluate the perfor-
mance of the measurement system in comparison with PSG.
The experiment was conducted at Chonnam National
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TABLE III
SUBJECT’S INFORMATION
Gender Age BMI Total Sleep
No. (M/F) (years) (kg/m2) Time* Diagnosis
(minutes)
1 M 38 22.9 427 IS, SN
2 M 47 25.0 484 OSA, SN
3 M 36 28.7 551 OSA
4 M 51 27.5 424 OSA, SN, PLMS
5 M 51 23.8 493 IS
6 M 22 24.5 464 SN
7 M 23 36.8 499 OSA, SN
8 M 51 24.5 467 PLMS

9 M 52 26.1 442 OSA, SN
Fig. 9. Experimental setup of an unobtrusive force measurement system
10 M 57 23.4 505 IS, SN, PLMS
11 F 56 19.5 497 IS, SN, PLMS (SpO2), chest and abdominal respiratory movement signal, res-
12 M 64 26.6 482 OSA, SN
piratory air flow, sound of snoring, and the position of the body
13 M 31 26.3 514 IS
14 M 55 26.0 505 IS
were all recorded using PSG equipment, Embla N7000 (Embla
15 F 65 27.8 413 IS, OSA
systems, Ontario, Canada) [19].
16 M 63 24.3 511 OSA, SN The developed system was installed between the mattress and
17 M 63 29.7 529 OSA, SN, PLMS the mattress cover, and attached with adhesive tape. It was laid
18 M 74 24.9 292 OSA, SN, PLMS across the subject's chest in order to measure the force changes
19 M 21 22.0 519 OSA, SN caused by the subject's motion during sleep. The signal was
20 M 21 24.7 481 Normal measured at a sampling frequency of 1 kHz. Fig. 9 shows the
21 M 23 30.0 538 OSA, SN experimental setup of the developed system.
22 M 50 24.1 496 OSA, SN
23 M 62 23.0 424 OSA, SN B.
Preprocessing
24 M 49 29.4 535 OSA, SN Although the measurements using the developed system and
25 M 52 19.8 517 OSA, SN PSG were performed simultaneously, a timing difference be-
26 M 63 22.5 379 OSA, SN tween the two different measuring instruments is inevitable.
27 F 54 27.2 447 IS, OSA, SN Therefore, post-synchronization is required for accurate evalu-
28 M 54 31.2 483 OSA, SN ation. Cross correlation is used to analyze how similar signals
29 M 51 25.1 493 OSA are over time. In order to compensate for timing difference, we
30 M 24 19.0 494 Normal
find the time lag that maximizes the correlation coefficient, then
SN (N=21), OSA adjust the timing with that time lag. If time synchronization can-
Mean M 27 47.0 25.8 476.8 (N=20), IS (N=8)
(SD) F3 (16.0) (3.8) (53.6) PLMS (N=6), nor- not be achieved through the above method, the time difference
mal (N=2)
is then corrected manually.
*
Total Sleep Time is defined as a time between light-off ans light-on In analysis, only the data between the 'light off', which is the
IS: Insomnia, SN: Snoring, BMI: body mass index, OSA: Obstructive sleep
apnea syndrome, PLMS: Periotic limb movement in sleep, SD: Standard de-
start point of the analysis of PSG, and 'light on' at the end point
viation was used. In addition, the signal measured by the proposed sys-
University Hospital sleep testing laboratory and approved by tem used only the second channel data, having excellent meas-
the Institutional Review Board (IRB) of Chonnam National urement results of the two channels. Matlab R2016a (Math-
University biomedical research ethics committee. (IRB No. works, Inc., Natick, USA) was used for signal preprocessing,
CNUH-2017-274) algorithm development, and evaluation.
As an experiment, diagnostic overnight PSG was performed, C.
Awakening detection
and a total of 39 subjects participated. Ultimately, data from 30
The sleep stage, which is one of the results of PSG, was di-
participants were used; nine subjects were excluded because
vided into WAKE, NREM (stage 1, stage 2, stage 3, stage 4),
their data was not properly acquired due to operational error. In
and REM based on the characteristics of EEG and EOG [19].
evaluating the respiration rate detection, only data from 26 sub-
In this study, we divided sleep state into two classes; ‘awaken-
jects were used because four subjects whose reference signals
ing’ and ’sleep’. A WAKE sleep stage was considered an
were not measured were excluded.
‘awakening’ state, while NREM and REM were considered to
The subjects included patients who had sleep disorders, such
correspond to a ‘sleep’ state.
as obstructive sleep apnea (OSA), snoring (SN), periodic limb
In order to evaluate the awakening detection algorithm, we
movement during sleep (PLMS), or insomnia (IS). All subjects
evaluated its accuracy, sensitivity, specificity, Cohen's Kappa
who participated in the experiment were provided with suffi-
coefficient, and sleep efficiency in comparison to PSG. In this
cient information regarding the purpose and method of the
evaluation, 'accuracy' refers to the probability of classifying a
study and informed consent was obtained from all subjects. Ta-
awakening state in PSG as an awakening state in the proposed
ble III shows a summary of the subjects’ information.
system, and classifying a sleep state in PSG as a sleep state in
PSG was performed according to the reference sleep test man-
the proposed system; 'sensitivity' refers to the probability of a
ual. Electrocardiogram (ECG), electrooculogram (EOG), chin
result being classified as an awakening state in the proposed
electromyogram (EMG), saturation of percutaneous oxygen

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system among the results of classified as awakening state in TABLE V

RESPIRATION RATE DETECTION ACCURACY OF THE UNOBTRUSIVE FORCE
PSG; 'specificity' refers to the probability of a result being clas- MEASUREMENT SYSTEM
sified as sleep state in the proposed system among the results of
Detection error Accuracy (%)
those classified as sleep state in PSG; ‘Cohen's Kappa coeffi-
≤ 1 bpm 76.4
cient’ indicates the degree of agreement between the two test
≤ 2 bpm 97.2
results. It has a value between 0 and 1; 0 indicates no agreement,
≤ 3 bpm 99.4
0–0.20 slight agreement, 0.21–0.40 fair agreement, 0.41–0.60
moderate agreement, 0.61–0.80 substantial agreement, and
0.81–1.00 near perfect agreement [20]. The 'sleep efficiency' is
defined as the ratio of sleep time to total recording time.
The accuracy, sensitivity, specificity, and Kappa coefficients
of the awakening state detection algorithm were 79.4%, 48.3%,
86.9%, and 0.6, respectively. In addition, the average sleep ef-
ficiency values were 82.3% and 84.0% in the developed system
and PSG, respectively, and the mean absolute error and root-
mean-square error were 12.9% and 17.7%, respectively. Table
IV shows the evaluation results of awakening state detection by
subjects.
D.
Respiration rate detection
We used abdominal respiratory movement signal, which is one Fig. 10. An example of respiration rate estimation process based on maximum
of the measurands of PSG, as the reference breathing signal. Fig. frequency of spectrogram. (a) Spectrogram and maximum frequency graph by
10 and Fig. 11 respectively represent an example of the respira- the unobtrusive force measurement system, (b) Spectrogram and maximum
frequency graph by the PSG’s abdominal respiratory movement signal
tion rate estimation process based on maximum frequency of
spectrogram, and an example of respiration rate measured by
the developed system and by PSG. In this study, Bland-Altman
analysis was performed between the reference respiration rate
of PSG and the detection error of the estimated respiration rate.
The respiration rate per minute was used as the average respi-
ration rate of the 26 subjects over two minutes. Fig. 12 shows a
Bland-Altman plot indicating the difference against the respira-
tion rate of the developed system and the PSG-measured respi-
ration rate. Table V shows the respiration rate detection accu-
racy of the unobtrusive force measurement system. As can be
seen in the table, 76.4%, 97.2%, and 99.4% of the respiratory
rates per minute were less than one, two, and three breaths per Fig. 11. An example of respiration rate measured by developed system and by
minute (bpm), respectively. PSG. #-+&* is the mean respiration rate of the proposed system, "# is the
mean respiration rate of PSG, and bpm is breaths per minute
V.
DISCUSSION
In this study, we developed an unobtrusive sleep health man-
agement system that can overcome the limitations of existing
sleep monitoring devices, such as being physically constraining
and the requirement of user management. In addition,
TABLE IV
PERFORMANCE COMPARISON WITH PREVIOUS METHOD
Mean (SD) (%)
Type of Sen- Subjects
Author Awakening Detection Sleep Efficiency
sor Ndisorder/N
Ac Se Sp proposed PSG
this 79.4 48.3 86.9 82.3 84.0
PVDF film 28/30
study* (11.0) (21.9) (12.7) (13.2) (10.8)
Kushida 77 48 92 72.8 68.4
Actigraphy 100/100a
[2] (11.0) (17.5) (6.9) (15.9) (18.6)
92.0
Actigraphyb - - -
(7.0)
Weiss 92.0 87.0
Actigraphyc 0/30 - - -
[3] (7.0) (10.0) Fig. 12. Bland-Altman plot showing the difference against the respiration rate
94.0 of the developed system and PSG-measured respiration rate with limits of
Actigraphyd - - -
(6.0) agreement (dashed line). #-+&* is the mean respiration rate of the proposed
*Cohen’s Kappa value of awakening detection was 0.6 and mean absolute error and system, "# is the mean respiration rate of PSG, SD is standard deviation,
root-mean-square error were 12.9 ± 11.0% and 17.7% in sleep effiency, respectively.
and bpm is breathd per minute
SD: standard deviation, N: number of subject, Ndisorder: number of sleep disorder pa-
tient, Ac: accuracy, Se: sensitivity, Sp: specificity, SE: sleep efficiency, aOSA,
PLMS, insomnia, other, bSleepwatch (Ambulatory Monitoring, Inc., Ardsley, NY),
c
Actiwatch (Respironics, Pittsburgh, PA), dActical (Respironics, Pittsburgh, PA)

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algorithms for awakening state detection and respiration rate
detection, which are important indicators in sleep health man-
agement, have been developed.
The performance of the awakening state detection algorithm
of the proposed system can be compared with the results of pre-
vious studies that have focused on actigraphy, which is a repre-
sentative motion-based sleep monitoring method (see Table IV).
Kushida et al. developed an actigraphy-based awakening state
detection algorithm and compared it with PSG across 100 pa-
tients with sleep disorders [2]. Compared to the results of pre-
vious studies, the average accuracy and average sensitivity of
the proposed system are higher, but the average specificity is
lower. This means that the proposed system achieves perfor-
mance comparable to that of the actigraphy, but that the mis-
classification rate of sleep states as awakening states is higher.
In addition, the Kappa statistics showed that the awakening
state detection results of the proposed system show significant
similarities with the PSG results. The reason for the low speci-
ficity in both the proposed system and Kushida’s study is that
both studies distinguish the awakening state based on move-
ment during sleep, while PSG distinguishes the awakening state
based on EEG and EOG. In other words, in motion-based re-
search, sleep is inevitably classified as a case of awakening but
with less motion.
In addition, sleep efficiency was overestimated based on the
wrist-type actigraphy used by Kushida [2] and Weiss [3], but it
tended to be underestimated in this study. However, it should
be considered that variations in the number of subjects, the pres-
ence of sleep disorders, and sleep efficiency among the three
studies can affect the outcome.
The result of using the proposed system to detect the respira-
tion rate during sleep were confirmed to follow the same trend
as the respiration rates measured by PSG. The Bland-Altman
analysis showed that most of the respiration rates detected by
the proposed system were within a 95% confidence interval, but
that the error tended to increase linearly with increasing respi-
ration rate. It can be seen that most of the detected respiration
rates were concentrated in the interval of six to seven bpm, be-
cause respiration tends to remain steady during sleep, and the
respiration rate decreases. The proposed system can be used for
studies on central sleep apnea, in which a patient has an abnor-
mally low respiration rate during sleep.
In order to improve the reliability of the system and algorithm
developed in this study, further experiments and evaluations
should be conducted with more subjects. In addition, a wider
variety of sleep health parameters, such as sleep time measure-
ment and sleep-stage classification, should be analyzed using
the proposed system. This study showed the potential of the
proposed method for monitoring sleep health during daily life
without having to rely on medical devices. The proposed sys-
tem can be used to monitor the health statuses of elderly people
living alone or those living with chronic diseases that require
continuous management. It can also be used to collect daily
health data for medical big data studies in the future.
VI.
CONCLUSION
Using the unobtrusive force measurement system developed
in this study, it is possible to detect the respiration rate per mi-
nute during sleep, and the awakening state is expected to be
1558-1748 (c) 2018 IEEE. Personal use is permitted, but republication/redistribution requires IEEE permission. See http://www.ieee.org/publications_standards/publications/rights/index.html for more information.
distinguishable with a performance similar to those of existing
motion-based sleep monitoring devices. This will overcome the
disadvantages of wearable devices that require direct wearing
of the sensor during sleep, and it will enable periodic and long-
term sleep monitoring in an easy and convenient way. However,
in order to apply it to everyday life, optimization processes and
furthur validations are needed through various cases of clinical
trials, including sleep disorders or simple testing in daily living.
Furthermore, there is a need to expand the parameters for mon-
itoring sleep health, such as sleep apnea detection and others.
ACKNOWLEDGMENT
We would like to thank to Ji Yhea Kim and Han Byeon of
Clinical Trial Center, Chonnam National University Hospital,
Geun Ho Lee and Youyang Jin of the sleep testing laboratory,
Chonnam National University Hospital for assistance in data
collection and scoring polysomnography.
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