Umberto S. P. Melia

Mutual information measures applied to EEG signals for sleepiness characterization

Excessive daytime sleepiness (EDS) is one of the main symptoms of several sleep related disorders with a great impact on the patient lives. While many studies have been carried out in order to assess daytime sleepiness, the automatic EDS detection still remains an open problem. In this work, a novel approach to this issue based on non-linear dynamical analysis of EEG signal was proposed. Multichannel EEG signals were recorded during five maintenance of wakefulness (MWT) and multiple sleep latency (MSLT) tests alternated throughout the day from patients suffering from sleep disordered breathing. A group of 20 patients with excessive daytime sleepiness (EDS) was compared with a group of 20 patients without daytime sleepiness (WDS), by analyzing 60-s EEG windows in waking state. Measures obtained from cross-mutual information function (CMIF) and auto-mutual-information function (AMIF) were calculated in the EEG. These functions permitted a quantification of the complexity properties of the EEG signal and the non-linear couplings between different zones of the scalp. Statistical differences between EDS and WDS groups were found in β band during MSLT events (p-value < 0.0001). WDS group presented more complexity than EDS in the occipital zone, while a stronger nonlinear coupling between occipital and frontal zones was detected in EDS patients than in WDS. The AMIF and CMIF measures yielded sensitivity and specificity above 80% and AUC of ROC above 0.85 in classifying EDS and WDS patients.

Filtering and thresholding the analytic signal envelope in order to improve peak and spike noise reduction in EEG signals

To remove peak and spike artifacts in biological time series has represented a hard challenge in the last decades. Several methods have been implemented mainly based on adaptive filtering in order to solve this problem. This work presents an algorithm for removing peak and spike artifacts based on a threshold built on the analytic signal envelope. The algorithm was tested on simulated and real EEG signals that contain peak and spike artifacts with random amplitude and frequency occurrence. The performance of the filter was compared with commonly used adaptive filters. Three indexes were used for testing the performance of the filters: Correlation coefficient (ρ), mean of coherence function (C), and rate of absolute error (RAE). All these indexes were calculated between filtered signal and original signal without noise. It was found that the new proposed filter was able to reduce the amplitude of peak and spike artifacts with ρ>0.85, C>0.8, and RAE<0.5. These values were significantly better than the performance of LMS adaptive filter (ρ<0.85, C<0.6, and RAE>1).

Clinical Decision Support System to Enhance Quality Control of Spirometry Using Information and Communication Technologies

Background We recently demonstrated that quality of spirometry in primary care could markedly improve with remote offline support from specialized professionals. It is hypothesized that implementation of automatic online assessment of quality of spirometry using information and communication technologies may significantly enhance the potential for extensive deployment of a high quality spirometry program in integrated care settings. Objective The objective of the study was to elaborate and validate a Clinical Decision Support System (CDSS) for automatic online quality assessment of spirometry. Methods The CDSS was done through a three step process including: (1) identification of optimal sampling frequency; (2) iterations to build-up an initial version using the 24 standard spirometry curves recommended by the American Thoracic Society; and (3) iterations to refine the CDSS using 270 curves from 90 patients. In each of these steps the results were checked against one expert. Finally, 778 spirometry curves from 291 patients were analyzed for validation purposes. Results The CDSS generated appropriate online classification and certification in 685/778 (88.1%) of spirometry testing, with 96% sensitivity and 95% specificity. Conclusions Consequently, only 93/778 (11.9%) of spirometry testing required offline remote classification by an expert, indicating a potential positive role of the CDSS in the deployment of a high quality spirometry program in an integrated care setting.

Prediction of nociceptive responses during sedation by time-frequency representation

The level of sedation in patients undergoing medical procedures evolves continuously, such as the effect of the anesthetic and analgesic agents is counteracted by pain stimuli. The monitors of depth of anesthesia, based on the analysis of the electroencephalogram (EEG), have been progressively introduced into the daily practice to provide additional information about the state of the patient. However, the quantification of analgesia still remains an open problem. The purpose of this work is to analyze the capability of prediction of nociceptive responses based on the time-frequency representation (TFR) of EEG signal. Functions of spectral entropy, instantaneous power and instantaneous frequency were calculated in order to predict the presence or absence of the nociceptive responses to different stimuli during sedation in endoscopy procedure. Values of prediction probability of Pk above 0.75 and percentages of sensitivity and specificity above 70% and 65% respectively were achieved combining TFR functions with bispectral index (BIS) and with concentrations of propofol (CeProp) and remifentanil (CeRemi).

Auto-mutual information function of the EEG as a measure of depth of anesthesia

Monitoring the depth of anesthesia (DOA) is necessary in order to decrease the incident of awareness in anesthesia and to prevent delays in the recovery phase. In the last decades a number of noninvasive methods have been proposed for the analysis of the electroencephalogram (EEG) for monitoring DOA. The objective of this work was to apply auto mutual information function (AMIF) to EEGs of patients under anesthesia in order to find variables able to characterize the following 4 states: awake, sedated, anesthetized and burst suppression episodes. The results show that the single and combined AMIF parameters were able to correctly classify the states in the range 72.2%–94.1% and 61.1%–100%, respectively.

Removal of peak and spike noise in EEG signals based on the analytic signal magnitude

Peak and spike artifacts in time series represent a serious problem for signal analysis especially in biomedical field. From the last decades, different techniques have been used for their removal mainly based on adaptive filters. This work presents a new approach for removing peak and spike artifacts based on the analytic signal envelope, filtered with a low-pass filter. The proposed algorithm was tested on electroencephalogram signals containing peak and spike artifacts. Results showed that this method permitted to remove the peak and spike artifacts preserving both high correlation (ρ>;0.9) and spectral coherence (C(f))̅ >; 0.85) with the original signal.

Algorithm for automatic forced spirometry quality assessment: technological developments.

We hypothesized that the implementation of automatic real-time assessment of quality of forced spirometry (FS) may significantly enhance the potential for extensive deployment of a FS program in the community. Recent studies have demonstrated that the application of quality criteria defined by the ATS/ERS (American Thoracic Society/European Respiratory Society) in commercially available equipment with automatic quality assessment can be markedly improved. To this end, an algorithm for assessing quality of FS automatically was reported. The current research describes the mathematical developments of the algorithm. An innovative analysis of the shape of the spirometric curve, adding 23 new metrics to the traditional 4 recommended by ATS/ERS, was done. The algorithm was created through a two-step iterative process including: (1) an initial version using the standard FS curves recommended by the ATS; and, (2) a refined version using curves from patients. In each of these steps the results were assessed against one experts opinion. Finally, an independent set of FS curves from 291 patients was used for validation purposes. The novel mathematical approach to characterize the FS curves led to appropriate FS classification with high specificity (95%) and sensitivity (96%). The results constitute the basis for a successful transfer of FS testing to non-specialized professionals in the community.

Auto-Mutual Information Function for Predicting Pain Responses in EEG Signals during Sedation

The level of sedation in patients undergoing medical procedures evolves continuously, such as the effect of the anesthetic and analgesic agents is counteracted by pain stimuli. The monitors of depth of anesthesia, based on the analysis of the electroencephalogram (EEG), have been progressively introduced into the daily practice to provide additional information about the state of the patient. However, the quantification of analgesia still remains an open problem. The purpose of this work was to analyze the capability of prediction of nociceptive responses based on the auto-mutual information function (AMIF). AMIF measures were calculated on EEG signal in order to predict the presence or absence of the nociceptive responses to endoscopy tube insertion during sedation in endoscopy procedure. Values of prediction probability of Pk above 0.80 and percentages of sensitivity and specificity above 70% and 70% respectively were achieved combining AMIF with power spectral density and concentrations of remifentanil.

Measuring Instantaneous and Spectral Information Entropies by Shannon Entropy of Choi-Williams Distribution in the Context of Electroencephalography

The theory of Shannon entropy was applied to the Choi-Williams time-frequency distribution (CWD) of time series in order to extract entropy information in both time and frequency domains. In this way, four novel indexes were defined: (1) partial instantaneous entropy, calculated as the entropy of the CWD with respect to time by using the probability mass function at each time instant taken independently; (2) partial spectral information entropy, calculated as the entropy of the CWD with respect to frequency by using the probability mass function of each frequency value taken independently; (3) complete instantaneous entropy, calculated as the entropy of the CWD with respect to time by using the probability mass function of the entire CWD; (4) complete spectral information entropy, calculated as the entropy of the CWD with respect to frequency by using the probability mass function of the entire CWD. These indexes were tested on synthetic time series with different behavior (periodic, chaotic and random) and on a dataset of electroencephalographic (EEG) signals recorded in different states (eyes-open, eyes-closed, ictal and non-ictal activity). The results have shown that the values of these indexes tend to decrease, with different proportion, when the behavior of the synthetic signals evolved from chaos or randomness to periodicity. Statistical differences (p-value < 0.0005) were found between values of these measures comparing eyes-open and eyes-closed states and between ictal and non-ictal states in the traditional EEG frequency bands. Finally, this paper has demonstrated that the proposed measures can be useful tools to quantify the different periodic, chaotic and random components in EEG signals.

Analysis of epileptic EEG signals in children by symbolic dynamics

Epilepsy is one of the most prevalent neurological disorders among children. The study of surface EEG signals in patients with epilepsy by techniques based on symbolic dynamics can provide new insights into the epileptogenic process and may have considerable utility in the diagnosis and treatment of epilepsy. The goal of this work was to find patterns from a methodology based on symbolic dynamics to characterize seizures on surface EEG in pediatric patients with intractable epilepsy. A total of 76 seizures were analyzed by their pre-ictal, ictal and post-ictal phases. An analytic signal envelope algorithm was applied to each EEG segment and its performance was evaluated. Several variables were defined from the distribution of words constructed on the EEG transformed into symbols. The results showed strong evidences of detectable non-linear changes in the EEG dynamics from pre-ictal to ictal phase and from ictal to post-ictal phase, with an accuracy higher than 70%.