#### Pediatric Automatic Sleep Staging: Deep Learning Ensemble Improves Accuracy and Reduces Predictive Uncertainty

##### Huy Phan, Alfred Mertins, Mathias Baumert

Despite the tremendous progress recently made towards automatic sleep staging in adults, it is currently unknown if the most advanced algorithms generalize to the pediatric population, which displays distinctive characteristics in overnight polysomnography (PSG). To answer the question, in this work, we conduct a large-scale comparative study on the state-of-the-art deep learning methods for pediatric automatic sleep staging. A selection of six different deep neural networks with diverging features are adopted to evaluate a sample of more than 1,200 children across a wide spectrum of obstructive sleep apnea (OSA) severity. Our experimental results show that the individual performance of automated pediatric sleep stagers when evaluated on new subjects is equivalent to the expert-level one reported on adults. Combining the six stagers into ensemble models further boosts the staging accuracy, reaching an overall accuracy of 87.7%, a Cohen's kappa of 0.837, and a macro F1-score of 84.2% in case of single-channel EEG when evaluated on new subjects. The performance is further improved when dual-channel EEG$\cdot$EOG are used, reaching an accuracy of 88.8%, a Cohen's kappa of 0.852, and a macro F1-score of 85.8%. At the same time, the ensemble models lead to reduced predictive uncertainty. The results also show that the studied algorithms and their ensembles are robust to concept drift when the training and test data were recorded 7-months apart and after clinical intervention. Detailed analyses further demonstrate "almost perfect" agreement between the automatic stagers to one another and their similar patterns on the staging errors.

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