Multimodal sleep stage classification and label-free abnormality scoring in mid-to-older adults

Abstract

Background: Sleep fragmentation and reduced sleep efficiency are markers of disrupted sleep architecture linked to cognitive and age-related decline. Current assessments rely on subjective reports prone to recall bias, limiting their effectiveness for longitudinal monitoring. Data-driven analysis of sleep using physiological signals such as EEG and EMG remains underutilised, particularly in mid-to-older adults. Objective: We present a deep learning pipeline for automated sleep staging and label-free abnormality scoring, with the primary objective of quantifying deviations in sleep architecture to capture progressive sleep disruption and longitudinal change. Methods: Temporal and attention-based models were benchmarked using datasets from the National Sleep Research Resource and PhysioBank. To improve class-specific performance, we introduce a stacking-based ensemble of sleep stage classifiers, each trained to specialise in a different stage. For longitudinal scoring, we develop a reconstruction loss-based abnormality metric using a temporal convolutional autoencoder trained on hypnograms generated by the sleep staging models. Results: Attention-based models, particularly AttnSleep, achieved the highest performance in both multimodal and single-channel settings (accuracy: 0.85 and 0.83; F1: 0.79 and 0.74, respectively). The encoder-decoder ensemble model improved overall classification accuracy by 3% compared to the best-performing biased base classifier, with a modest gain in N1-stage F1 score (0.444). The proposed abnormality score correlated with Pittsburgh Sleep Quality Index components and showed sensitivity to synthetic hypnogram degradation, highlighting its potential as a label-free indicator of sleep disruption. Conclusion: Automated classification and annotation-free scoring enable an end-to-end multimodal pipeline that supports scalable, objective sleep health monitoring, with relevance for future clinical deployment.