AI Generalisation Gap In Comorbid Sleep Disorder Staging

Automated polysomnography after ischemic stroke is challenging because of altered sleep-related neural activity and concurrent respiratory disturbances. Existing stroke-specific approaches mainly address sleep-stage classification, leaving joint analysis of sleep architecture and respiratory events underexplored. Moreover, adapting pretrained EEG encoders introduces a representation inconsistency when downstream models are trained on embeddings from previously seen patients but evaluated on unseen individuals. We propose MM-Net, a multimodal multi-task framework that resolves this inconsistency through cross-fitting and ridge-based embedding alignment. Sleep-adapted EEG-EOG representations and engineered neural descriptors are fused with learned cardiorespiratory features through cross-attention and shared temporal modeling for simultaneous sleep staging and respiratory-event detection. On iSLEEPS (99 patients with subacute ischemic stroke), ten-fold patient-independent evaluation achieved 76.3% staging accuracy (Cohen's $κ$ = 0.656) and 0.825 respiratory-event AUC, outperforming the evaluated baselines under matched protocols. The sleep-adapted encoder improved the downstream model when its embeddings were aligned, raising staging accuracy by 1.4 percentage points over the frozen encoder ($p$ = 0.020) versus 0.2 points without alignment. MM-Net also achieved 86.4% staging accuracy on Sleep-EDF, above every single-EEG architecture reimplemented on the same recordings, and 80.3% staging accuracy with 0.889 respiratory AUC on ISRUC-I, exceeding its retrained staging baselines. Without retraining, the iSLEEPS-trained model retained respiratory AUCs of 0.833 on ISRUC-I and 0.841 on UCD. These findings support representation-consistent neural adaptation and joint physiological modeling across stroke, healthy-sleep, and sleep-disorder cohorts.

Sleep is essential for health, yet studying its dynamics requires manual sleep staging, a labor-intensive step in research and clinical care. Across centers, polysomnography (PSG) recordings are traditionally scored in 30-s epochs for pragmatic, not physiological, reasons and vary in electrode count, montage, and subject characteristics. These constraints challenge harmonized multi-center studies and the discovery of robust biomarkers on shorter timescales. We present AnySleep, a deep neural network that scores sleep from any electroencephalography (EEG) or electrooculography (EOG) data at adjustable temporal resolutions. We trained and validated the model on over 20,000 overnight recordings (> 200,000 hours of EEG and EOG) from 28 datasets across multiple clinics to promote robust generalization across sites. The model attains state-of-the-art performance and surpasses or equals established baselines at 30-s epochs. Performance improves with more channels, yet remains strong when EOG is absent or only EOG or single EEG derivations (frontal, central, or occipital) are available. On sub-30-s timescales, the model captures short wake intrusions consistent with arousals and improves prediction of pathophysiological conditions (obstructive sleep apnea, narcolepsy type 1, insomnia) over 30-s scoring. We make the model publicly available to facilitate large-scale studies with heterogeneous electrode setups and accelerate biomarker discovery in sleep.

Existing deep learning approaches for automatic sleep staging suffer from limited robustness under heterogeneous recording conditions, where non-stationary noise, inter-subject differences and cross-dataset distribution shifts cause unstable features and poor generalization. This work proposes DualStabSleepNet (DSSNet), a dual-domain diffusion stabilization network for robust sleep staging, which improves robustness in both data and feature domains. After preprocessing multi-channel polysomnography (PSG), a continuous-scale diffusion-based stabilization module suppresses noise while preserving physiological signal structures. Stabilized signals are converted to time-frequency representations and fed into a Vision Transformer backbone. A teacher-student guided diffusion feature stabilization module further mitigates feature drift and enforces multi-level feature consistency. Evaluated on four public PSG datasets SleepEDF-20, SleepEDF-78, SHHS and ISRUC-S3, DSSNet achieves state-of-the-art accuracy of 89.2%, 88.0%, 89.7%, 86.7% with improved macro-F1 and Cohen's kappa. It obtains notable improvements on hard transitional stages (e.g., 12.5% gain for N1 on SHHS) and boosts N2/REM recognition. Under cross-dataset settings, DSSNet is robust to distribution shift and performs on par with or superior to target-dataset trained baselines, demonstrating its practical potential for real-world sleep staging across heterogeneous cohorts.