PaperarXiv:2610.23727
ECG-SDI: Single-lead Electrocardiogram Enables Continuous Sleep Depth Index Profiling and Scalable Digital Biomarkers for Sleep Health
arXiv 2610.23727v1 (eess.SP), submitted 2026-10-16, announced 2026-10-19
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TL;DR
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Abstract
Conventional sleep staging provides a coarse-grained representation that obscures within-stage depth variation. We developed ECG-SDI, a single-lead electrocardiography (ECG) framework for continuous sleep-depth profiling and digital biomarker extraction. Using 12,392 overnight polysomnographic recordings, we trained and validated a two-stage deep learning model supervised by conventional sleep-stage labels. Correlations with ordered stages excluding rapid eye movement (REM) sleep were 0.828 in the pooled internal test set and 0.848 in the external Cleveland Family Study; corresponding REM classification AUROCs were 0.954 and 0.977. Overnight trajectories captured within-stage variation. Biomarker-based phenotyping identified a disturbed subtype associated with poorer subjective sleep quality and higher all-cause mortality in the Sleep Heart Health Study (adjusted hazard ratio, 1.20; 95% CI, 1.05-1.38). Among 507 participants with paired recordings before and after continuous positive airway pressure (CPAP), normalized sleep-depth area increased by 6.1% and shallow-sleep burden below 0.3 decreased by 16.0%. Exploratory analyses linked reductions in approximate entropy and depth variability to reduced oxygen desaturation and increased sleep efficiency, respectively (Spearman rho = 0.24 and 0.12); both associations remained positive after covariate adjustment. Mean ECG-SDI within N2 increased by 0.017 (95% CI, 0.004-0.030). A wearable proof-of-concept illustrated the acquisition-to-report workflow. These findings support ECG-based sleep phenotyping and further evaluation of CPAP response monitoring at home.
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Results on ChatPPG leaderboards · 2
All leaderboards| Leaderboard | Method | Result | Rank |
|---|---|---|---|
| Cleveland Family Study (CFS) AUROCSleep staging | ECG-SDI | 0.977AUROC, higher is better | #1 of 1 |
| SHHS, NSRR AUROCSleep staging | ECG-SDI | 0.908AUROC, higher is better | #1 of 1 |
2 rows are credited to this paper. Ranks apply within each leaderboard only, as reported by the source.
Tasks & signals
Tasks
Signals
Keywords
Datasets
- Cleveland Family Study (CFS)NSRR family sleep-apnea PSG2,284 subjects · PPG · PSG
- MESA SleepNSRR polysomnography + wrist actigraphy (Multi-Ethnic Study of Atherosclerosis)2,237 subjects · PPG · ECG · IMU
- MrOS Sleep Study (Osteoporotic Fractures in Men, NSRR)ECG · SpO₂ · Resp
- Sleep Heart Health Study (SHHS, NSRR)ECG · SpO₂ · Resp
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Cite this paper
APA
Xie, D., Zhao, Q., Zhou, S., Wang, H., Wang, J., Zhou, Y., Penzel, T., & Hong, S. (2026). ECG-SDI: Single-lead Electrocardiogram Enables Continuous Sleep Depth Index Profiling and Scalable Digital Biomarkers for Sleep Health. arXiv 2610.23727v1 , submitted 2026-10-16, announced 2026-10-19. https://arxiv.org/abs/2610.23727
BibTeX
@misc{xie2026ecgsdi,
title = {{ECG-SDI: Single-lead Electrocardiogram Enables Continuous Sleep Depth Index Profiling and Scalable Digital Biomarkers for Sleep Health}},
author = {Xie, Donglin and Zhao, Qingshuo and Zhou, Songchi and Wang, Haoyu and Wang, Jingyu and Zhou, Yuxi and Penzel, Thomas and Hong, Shenda},
year = {2026},
howpublished = {arXiv 2610.23727v1 , submitted 2026-10-16, announced 2026-10-19},
eprint = {2610.23727},
archivePrefix = {arXiv}
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