Semi-Automatic Quantification of REM Sleep Without Atonia in Natural Sleep Environment

Semi-Automatic Quantification of REM Sleep Without Atonia in Natural Sleep Environment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Semi-Automatic Quantification of REM Sleep Without Atonia in Natural Sleep Environment Yael Hanein, Daniel Possti, Shani Oz, Aaron Gerston, Danielle Wasserman, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4431097/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Nov, 2024 Read the published version in npj Digital Medicine → Version 1 posted 11 You are reading this latest preprint version Abstract Background: Polysomnography (PSG), the gold standard diagnostic tool in sleep medicine, typically evaluates sleep patterns and sleep-related disorders in an artificial environment, potentially leading to distorted sleep. Sleep macro-structures such as sleep stages are particularly sensitive to environmental effects, whereas micro-structures (i.e., sleep spindles, REM sleep without atonia, RSWA) tend to remain more stable. Objective: This study aimed to apply automated algorithms to capture RSWA and sleep spindles and to compare between values measured in the lab and those recorded under natural sleep conditions at home. Methods: The analysis included 107 full-night recordings from 55 subjects: 24 healthy adults , 28 patients with Parkinson’s disease (PD), and three individuals with isolated Rem sleep behavior disorder (RBD). The PD population included 15 PD patients with RBD and 13 PD patients without RBD. All sessions were manually scored for sleep staging. An automatic algorithm for quantifying RSWA was developed and tested against manual scoring. Automatic artifact removal was incorporated into the process. Results: Home versus lab RSWA, derived using the semi-automatic algorithm were moderately correlated (60% correlation).RBD detection in the home environment was achieved with 83% sensitivity, 79% specificity, and 81% balanced accuracy. Discussion: A semi-automated algorithm was found to accurately quantify RSWA in the lab and in the home environment, enabling the detection of RBD patients. These findings could enhance clinical research, facilitate more frequent and accessible sleep testing, and provide a possible alternative for screening RBD. Full Text Additional Declarations There is a conflict of interest Shani Oz, Aaron Gerston, and Yael Hanein declare a financial interest in X-trodes Ltd, which developed the screen-printed electrode technology used in this paper. These authors have no other relevant financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Cite Share Download PDF Status: Published Journal Publication published 28 Nov, 2024 Read the published version in npj Digital Medicine → Version 1 posted Editorial decision: revise 11 Jul, 2024 Review # 2 received at journal 09 Jul, 2024 Review # 3 received at journal 27 Jun, 2024 Review # 1 received at journal 27 Jun, 2024 Reviewer # 3 agreed at journal 17 Jun, 2024 Reviewer # 2 agreed at journal 12 Jun, 2024 Reviewer # 1 agreed at journal 06 Jun, 2024 Reviewers invited by journal 29 May, 2024 Editor assigned by journal 18 May, 2024 Submission checks completed at journal 17 May, 2024 First submitted to journal 16 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4431097","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":308367723,"identity":"f32b2b6c-0876-4694-847d-f591ebeca17f","order_by":0,"name":"Yael Hanein","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIie2PsWrDMBCGzxSSxYnXy9Cmj3Ala8izSAg0GZqx0NJoytiseY2+geAgXkK9CrLYBDwV6qlkKlWhLSUk8tpBHxzopPv4TwCRyP8kYYDp0Z2Yhx2vaPwe/VGoU+EjBQIKFWx5/lA+Zmu1weQwk6bPFVQhZasFrzc7RKcVgVDSpJqCi5HNidPeDsHlNxWIC2kgD/+FyreW048XHLvb1oJYSJO9diguBx4sLfpD4lNYGuxIGbmGePCkRs/bZkJCF5MlNmRDyrBU9T59n2VXhWqwnd5frjJV14e788q1/dsJXz1f9sTkL2MTeo1EIpHIF59BjVN/ZC8M4QAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-4213-9575","institution":"Tel Aviv University","correspondingAuthor":true,"prefix":"","firstName":"Yael","middleName":"","lastName":"Hanein","suffix":""},{"id":308367724,"identity":"516894b5-76d2-41c6-b656-2e67503282c2","order_by":1,"name":"Daniel Possti","email":"","orcid":"","institution":"X-trodes","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Possti","suffix":""},{"id":308367725,"identity":"61598411-701c-4eb9-8c18-d4055704fc12","order_by":2,"name":"Shani Oz","email":"","orcid":"","institution":"X-trodes","correspondingAuthor":false,"prefix":"","firstName":"Shani","middleName":"","lastName":"Oz","suffix":""},{"id":308367726,"identity":"d18b0ce6-b1d9-4fd9-9b5a-848b95f6265e","order_by":3,"name":"Aaron Gerston","email":"","orcid":"","institution":"X-trodes","correspondingAuthor":false,"prefix":"","firstName":"Aaron","middleName":"","lastName":"Gerston","suffix":""},{"id":308367727,"identity":"5999bda1-05b6-4e86-9ff5-c321a29632da","order_by":4,"name":"Danielle Wasserman","email":"","orcid":"","institution":"Neurology Department Shaare Zedek","correspondingAuthor":false,"prefix":"","firstName":"Danielle","middleName":"","lastName":"Wasserman","suffix":""},{"id":308367728,"identity":"d1cd8f10-e859-4725-9b38-c933747af720","order_by":5,"name":"Iain Duncan","email":"","orcid":"","institution":"Sleep Disorders Centre, St. Thomas’ and Guy’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Iain","middleName":"","lastName":"Duncan","suffix":""},{"id":308367729,"identity":"c35dbf6d-7ce2-4b4a-a7fc-1c8f06b27c8b","order_by":6,"name":"Matteo Cesari","email":"","orcid":"","institution":"Department of Neurology, Medical University of Innsbruck","correspondingAuthor":false,"prefix":"","firstName":"Matteo","middleName":"","lastName":"Cesari","suffix":""},{"id":308367730,"identity":"4af20815-d1ed-49e5-993b-c43ae487c0f2","order_by":7,"name":"Andrew Dagay","email":"","orcid":"","institution":"Tel Aviv Sourasky Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Dagay","suffix":""},{"id":308367731,"identity":"e35020a1-d318-40ce-961f-89928d441106","order_by":8,"name":"Riva Tauman","email":"","orcid":"","institution":"Tel Aviv Sourasky Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Riva","middleName":"","lastName":"Tauman","suffix":""},{"id":308367732,"identity":"571a061e-4532-42a8-8415-f70bb2f32634","order_by":9,"name":"Anat Mirelman","email":"","orcid":"","institution":"Tel Aviv University","correspondingAuthor":false,"prefix":"","firstName":"Anat","middleName":"","lastName":"Mirelman","suffix":""}],"badges":[],"createdAt":"2024-05-16 12:35:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4431097/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4431097/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41746-024-01354-8","type":"published","date":"2024-11-28T05:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70178562,"identity":"674c915a-18f8-4e15-ae19-09b89edc1c19","added_by":"auto","created_at":"2024-11-29 08:05:43","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1651784,"visible":true,"origin":"","legend":"","description":"","filename":"SleepRSWA.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4431097/v1_covered_7c9b90e8-9283-4795-b058-9ae9ed5b7c53.pdf"}],"financialInterests":"There is a conflict of interest\nShani Oz, Aaron Gerston, and Yael Hanein declare a financial interest in X-trodes Ltd, which developed the screen-printed electrode technology used in this paper. These authors have no other relevant financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.","formattedTitle":"Semi-Automatic Quantification of REM Sleep Without\r\nAtonia in Natural Sleep Environment","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"npj-digital-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"npjdigitalmed","sideBox":"Learn more about [npj Digital Medicine](http://www.nature.com/npjdigitalmed/)","snPcode":"41746","submissionUrl":"https://submission.springernature.com/new-submission/41746/3","title":"npj Digital Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4431097/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4431097/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Polysomnography (PSG), the gold standard diagnostic tool in sleep medicine, typically evaluates sleep patterns and sleep-related disorders in an artificial environment, potentially leading to distorted sleep. Sleep macro-structures such as sleep stages are particularly sensitive to environmental effects, whereas micro-structures (i.e., sleep spindles, REM sleep without atonia, RSWA) tend to remain more stable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eObjective: This study aimed to apply automated algorithms to capture RSWA and sleep spindles and to compare between values measured in the lab and those recorded under natural sleep conditions at home.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: The analysis included 107 full-night recordings from 55 subjects: 24 healthy adults , 28 patients with Parkinson’s disease (PD), and three individuals with isolated Rem sleep behavior disorder (RBD). The PD population included 15 PD patients with RBD and 13 PD patients without RBD. All sessions were manually scored for sleep staging. An automatic algorithm for quantifying RSWA was developed and tested against manual scoring. Automatic artifact removal was incorporated into the process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Home versus lab RSWA, derived using the semi-automatic algorithm were moderately correlated (60% correlation).RBD detection in the home environment was achieved with 83% sensitivity, 79% specificity, and 81% balanced accuracy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDiscussion: A semi-automated algorithm was found to accurately quantify RSWA in the lab and in the home environment, enabling the detection of RBD patients. These findings could enhance clinical research, facilitate more frequent and accessible sleep testing, and provide a possible alternative for screening RBD.\u003c/p\u003e","manuscriptTitle":"Semi-Automatic Quantification of REM Sleep Without\nAtonia in Natural Sleep Environment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 16:29:27","doi":"10.21203/rs.3.rs-4431097/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2024-07-11T15:19:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2024-07-09T17:45:41+00:00","index":2,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2024-06-27T18:06:54+00:00","index":3,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2024-06-27T17:24:19+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2024-06-17T09:09:18+00:00","index":3,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2024-06-12T21:24:19+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2024-06-06T19:08:22+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2024-05-29T19:55:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-18T18:57:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-17T11:15:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"npj Digital Medicine","date":"2024-05-16T12:32:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"npj-digital-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"npjdigitalmed","sideBox":"Learn more about [npj Digital Medicine](http://www.nature.com/npjdigitalmed/)","snPcode":"41746","submissionUrl":"https://submission.springernature.com/new-submission/41746/3","title":"npj Digital Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6584f6db-ec67-4a3f-8294-3b362022ad53","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-29T08:05:35+00:00","versionOfRecord":{"articleIdentity":"rs-4431097","link":"https://doi.org/10.1038/s41746-024-01354-8","journal":{"identity":"npj-digital-medicine","isVorOnly":false,"title":"npj Digital Medicine"},"publishedOn":"2024-11-28 05:00:00","publishedOnDateReadable":"November 28th, 2024"},"versionCreatedAt":"2024-06-11 16:29:27","video":"","vorDoi":"10.1038/s41746-024-01354-8","vorDoiUrl":"https://doi.org/10.1038/s41746-024-01354-8","workflowStages":[]},"version":"v1","identity":"rs-4431097","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4431097","identity":"rs-4431097","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}