Time series classification (TSC) of biological signals has progressed from handcrafted, modality-specific approaches to deep architectures capable of representing the diverse waveform structures of underlying physiological processes (i.e., morphology). This review introduces a unified morphology--modality framework that connects waveform structure to a methodological design, revealing how spikes, bursts, oscillations, slow drift, and hierarchical rhythms inform model design. By analyzing electroencephalography, electromyography, electrocardiography, photoplethysmography, and ocular modalities (electrooculography, pupillometry, eye-tracking), the review demonstrates how morphology determines preprocessing and modeling strategies. Integrating evidence across these biological signals, the framework reveals that morphology, not model class, most strongly determines performance and interpretability. This provides insight into why deep models succeed when their inductive biases align with underlying waveform dynamics. This review also identifies future work including morphological data augmentation and evaluation metrics to improve generalization. Together, these insights position morphology-aware modeling as a unifying principle for developing generalizable, interpretable, and physiologically meaningful TSC models across biological signals.
Foundation models have recently emerged as a powerful paradigm for learning transferable representations from large scale biomedical data, yet existing approaches for physiological waveforms primarily optimize reconstruction or forecasting objectives that do not explicitly preserve clinically meaningful waveform morphology. Electrocardiograms (ECGs) and pulse oximetry (SpO2) waveforms encode rich cardiovascular and hemodynamic information through their morphological structure. In this work, we introduce MorphologyFM, a multimodal foundation model pretrained on paired ECG and SpO2 waveforms from the MIMIC critical care database using a morphology aware self supervised learning objective. MorphologyFM combines morphology guided masking, cross modal representation learning, and contrastive latent alignment to learn representations that capture clinically relevant physiological structure without requiring manual annotations. We evaluate MorphologyFM across multiple downstream prediction tasks, including arrhythmia classification, hypoxemia prediction, mortality prediction, and length of stay estimation, demonstrating consistent improvements over representative self supervised learning methods, including Masked Autoencoders (MAE), contrastive learning, Barlow Twins, and Joint Embedding Predictive Architectures (JEPA). Furthermore, we show that jointly modeling ECG and SpO2 waveforms produces more transferable representations than single modality pretraining. Our results establish waveform morphology as a powerful inductive bias for self supervised physiological representation learning and introduce MorphologyFM as a general purpose foundation model for continuous physiological monitoring.
Biosignals acquired from different locations on the body often provide temporally ordered views of the same underlying physiological process. However, most existing self supervised learning methods treat these signals as interchangeable views, overlooking the directional temporal dynamics that link them. A canonical example is the relationship between electrocardiography (ECG), which captures the electrical activation initiating each heartbeat, and photoplethysmography (PPG), which records the resulting peripheral pulse delayed by vascular dynamics. To capture this structured relationship, we introduce xMAE, a biosignal pretraining framework that leverages masked cross modal reconstruction across temporally ordered biosignals as a training time constraint to encourage physiologically meaningful timing structure in the learned representations. We show that pretraining with xMAE yields representations that outperform both unimodal and multimodal baselines on 15 of 19 downstream tasks, including cardiovascular outcome prediction, abnormal laboratory test detection, sleep staging, and demographic inference, while generalizing across devices, body locations, and acquisition settings. Further analysis suggests that the ECG PPG timing structure is reflected in the learned PPG representations. More broadly, xMAE demonstrates the effectiveness of incorporating temporal structure into multimodal pretraining when signals observe different stages of a shared underlying process. Code is available at https://github.com/hzhou3/xMAE.
Deep learning on physiological time series is interpreted through domain-specific features -- oscillatory rhythms in EEG, morphological complexes in ECG -- yet these signals sit atop a broadband aperiodic 1/f-like envelope that covaries with arousal, age, and pathology. We introduce a spectral audit framework combining aperiodic/periodic decomposition, phase-preserving Fourier interventions, sham controls, and simulation validation. Aperiodic reliance was task-dependent and architecture-general: across six neural architectures, flattening drops exceeded 0.42 balanced-accuracy points for sleep-wake classification, reached 0.07-0.13 for clinical abnormality detection, and remained minimal for motor imagery. Six of seven EEG foundation models showed FDR-significant aperiodic reliance on clinical EEG; age/sex and recording-era controls reduced but did not eliminate the effect. Applying the audit to PTB-XL ECG revealed neural drops of 0.32--0.36 persisting after demographic matching, confirming this confound class extends beyond EEG. Aperiodic controls should become standard for interpretable physiological time-series deep learning.