A Conflict-aware Evidential Framework for Reliable Sleep Stage Classification

Sleep stage classification is important for the diagnosis and management of sleep disorders, yet most automatic staging studies evaluate models against a single reference hypnogram despite known inter-scorer variability. This study investigates whether multi-scored datasets can be used to construct more reliable reference labels from the collective behavior of multiple experts. We use the publicly available DOD-H and DOD-O datasets. EEG (C3-M2) and chin EMG signals were segmented into 30-s epochs, and 30 features were extracted from each modality, yielding 60 features for EEG+EMG. We propose a learning-based hypnogram (LBH) that models the stage-specific behavior of each scorer using confusion matrices derived from machine-learning models. After column normalization, these matrices estimate the probability of each true sleep stage given each scorer's label; probabilities are aggregated across scorers to assign the final label for each epoch. LBH was evaluated with random forest, support vector machine, and multilayer perceptron classifiers under EEG-only and EEG+EMG settings, and compared with the dataset hypnogram (DH) and best-scorer hypnogram (BSH). LBH consistently improved overall performance. The best results were obtained with random forest and EEG+EMG, reaching 86.07% accuracy, 85.46% precision, and 85.29% F1-score on DOD-H, and 86.04% accuracy, 85.21% precision, and 84.70% F1-score on DOD-O. These findings suggest that personalized scorer modeling can improve reference hypnogram construction without discarding information from individual experts.

Automatic sleep staging is a critical role in sleep disorder diagnosis, sleep quality assessment, and long-term health monitoring; however, existing approaches suffer poor performance on ambiguous and transition-related sleep stages, caused by inadequate modeling of fine-grained intra-epoch structures and complex cross-region spectral dependencies. Traditional epoch-level encoders commonly fail to extract subtle temporal microstructures and intra-epoch cross-region interactions, resulting in unsatisfactory recognition accuracy for hard categories such as the N1 stage. To tackle these drawbacks, we propose SwinSleepNet, a hierarchical context-aware dual-stream framework that separately optimizes intra-epoch representation learning and inter-epoch contextual modeling. Concretely, we characterize each sleep epoch from two complementary perspectives: raw time-domain EEG signal and its time-frequency transformation. The time-domain branch adopts convolutional encoders to capture fine waveform temporal details, and the time-frequency branch uses Swin Transformer to extract local spectro-temporal features, hierarchical multi-scale information and long-range spatial dependencies. The multi-branch extracted features are fused into integrated embeddings, which are optimized by a bidirectional context module to capture cross-epoch temporal dependencies for final sleep stage classification. Comprehensive experiments on Sleep-EDF-20, Sleep-EDF-78 and SHHS datasets verify that our method achieves competitive overall performance, and exhibits stronger robustness and stability on difficult N1 stages and transitional epochs. The results prove that optimized intra-epoch representation learning based on hierarchical architecture greatly benefits automatic sleep staging tasks.

Automated sleep staging is commonly approached as a supervised machine learning problem, with deep learning methods dominating recent research. While machine learning models achieve near-human level agreement with human-scored reference sleep stages, their decisions are typically opaque and not designed to follow clinical scoring rules. We propose a transparent alternative: a deterministic, rule-based sleep staging method that explicitly operationalizes the American Academy of Sleep Medicine's (AASM) scoring logic as executable code, coupled with epoch-level natural-language justifications derived from an explanation trace. We evaluate the approach on 50 polysomnography recordings with a 10-scorer majority-vote consensus as reference. Across all recordings, the method agreed with the majority-vote reference in 60.5% of epochs ($κ=0.42$), with substantially higher agreement on a dataset used during development (77.1%, $κ=0.61$). Agreement with the reference was highest for sleep stage N2 (recall 83.5%) and moderate for sleep stage R (recall 68.7%), while Wake and N1 recall were low. Despite lower agreement with the reference than contemporary deep learning models, the method provides deterministic decisions and natural language explanations aligned with AASM scoring rules, making it a complementary tool for auditing, debugging, and governing deep learning-based sleep staging.