Evaluating Bayesian deep learning for robust biomedical time-series classification under distribution shift: A sleep scoring case study

Time series out-of-distribution generalization requires forecasters to remain reliable when deployment dynamics differ from training conditions due to covariate shift, concept shift, and temporal dependence. Probably Approximately Correct Bayesian domain adaptation provides computable certificates by decomposing target risk into a source risk term, a source-to-target mismatch term, and a complexity term, but standard analyses rely on independent sampling and distributional stability, assumptions that are violated in time series by serial dependence and nonstationary shift. We propose a model-agnostic online martingale Probably Approximately Correct Bayesian framework that yields finite-sample certificates under temporal dependence and distribution shift. The certificate replaces independent-sample concentration with martingale concentration that adapts to loss scale and predictable variation. We use the certificate as a surrogate regularizer for online calibration by training a gated residual Bayesian head on top of a fixed forecasting backbone, producing a corrective update that reverts to the backbone prediction when the gate is closed. Online calibration combines a source risk anchor, a posterior-shift penalty, and a time-adaptive mismatch term computed from target windows observed before forecasting. It follows a predict-then-update protocol in which outcomes become available only after forecasting and are used to update subsequent predictions. Experiments across convolutional, attention-based, and large language model-based forecasters show improved stability and accuracy under covariate and concept shift.

Standard evaluations of Bayesian deep learning methods assume that metric estimates are reliable, but we show this assumption fails under data scarcity. Method rankings are not only unreliable at small $n$, but also dataset-dependent in ways that point estimates cannot reveal: the same method comparison yields $P(\mathrm{MCD} \prec \mathrm{Ensemble}) = 1.000$ at $n = 50$ on one dataset and remains below $0.95$ even at $n = 500$ on another. Across the datasets we consider, no universal sample size threshold exists, which is precisely why dataset-specific posterior inference is necessary. To address this, we use a Bayesian hierarchical model with method-specific variances to treat evaluation metrics as random variables across data realizations, and we use a predictive Minimum Detectable Difference curve to assess whether an observed gap would be detectable at a given training size. Across six Bayesian deep learning methods and five regression datasets, our results show that uncertainty-aware evaluation is necessary in low-data settings, because current evidence for method superiority and predictive detectability at the same training size can diverge substantially. Our framework provides practitioners with principled tools to determine whether their evaluation data is sufficient before drawing conclusions about method superiority.

Conformal prediction provides distribution-free uncertainty quantification under exchangeability. However, this assumption is violated by label shift, where the marginal distribution of labels changes while the conditional distribution of inputs given labels remains stable. Under such shifts, standard conformal procedures no longer maintain their intended coverage behavior. Existing approaches address this via importance weighting. They pair the reweighting with residual-based nonconformity scores that ignore predictive uncertainty. The resulting intervals have uniform width. Bayesian conformal methods produce adaptive intervals by leveraging predictive distributions. They evaluate conformity under the source predictive, which is misaligned with the target domain under label shift. We propose the Label-Shift-Adjusted Bayesian Score (LSA score), a nonconformity score derived from a posterior predictive tilting identity. This identity shows that the target predictive is an importance-weighted transformation of the source predictive. We use it to derive a direct correction to the Bayesian score. We evaluate the method on molecular property prediction under controlled label shift. The LSA score consistently yields shorter intervals than residual-based and source-based Bayesian scores. Coverage in the target domain remains comparable. Under stronger shift, all methods incur some coverage loss due to pseudo-label-based density-ratio estimation. The LSA score is defined for any source predictive with a tractable log-density. We instantiate it with Bayesian Ridge Regression, where the correction admits a closed form.