Research article Special Issues

Logistic regression and artificial neural network-based simple predicting models for obstructive sleep apnea by age, sex, and body mass index

  • Received: 19 May 2022 Revised: 18 July 2022 Accepted: 21 July 2022 Published: 10 August 2022
  • Age, sex, and body mass index (BMI) were associated with obstructive sleep apnea (OSA). Although various methods have been used in OSA prediction, this study aimed to develop predictions using simple and general predictors incorporating machine learning algorithms. This single-center, retrospective observational study assessed the diagnostic relevance of age, sex, and BMI for OSA in a cohort of 9, 422 patients who had undergone polysomnography (PSG) between 2015 and 2020. The participants were randomly divided into training, testing, and independent validation groups. Multivariable logistic regression (LR) and artificial neural network (ANN) algorithms used age, sex, and BMI as predictors to develop risk-predicting models for moderate-and-severe OSA. The training-testing dataset was used to assess the model generalizability through five-fold cross-validation. We calculated the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the independent validation set to assess the performance of the model. The results showed that age, sex, and BMI were significantly associated with OSA. The validation AUCs of the generated LR and ANN models were 0.806 and 0.807, respectively. The independent validation set's accuracy, sensitivity, specificity, PPV, and NPV were 76.3%, 87.5%, 57.0%, 77.7%, and 72.7% for the LR model, and 76.4%, 87.7%, 56.9%, 77.7%, and 73.0% respectively, for the ANN model. The LR- and ANN-boosted models with the three simple parameters effectively predicted OSA in patients referred for PSG examination and improved insight into risk stratification for OSA diagnosis.

    Citation: Yi-Chun Kuan, Chien-Tai Hong, Po-Chih Chen, Wen-Te Liu, Chen-Chih Chung. Logistic regression and artificial neural network-based simple predicting models for obstructive sleep apnea by age, sex, and body mass index[J]. Mathematical Biosciences and Engineering, 2022, 19(11): 11409-11421. doi: 10.3934/mbe.2022532

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  • Age, sex, and body mass index (BMI) were associated with obstructive sleep apnea (OSA). Although various methods have been used in OSA prediction, this study aimed to develop predictions using simple and general predictors incorporating machine learning algorithms. This single-center, retrospective observational study assessed the diagnostic relevance of age, sex, and BMI for OSA in a cohort of 9, 422 patients who had undergone polysomnography (PSG) between 2015 and 2020. The participants were randomly divided into training, testing, and independent validation groups. Multivariable logistic regression (LR) and artificial neural network (ANN) algorithms used age, sex, and BMI as predictors to develop risk-predicting models for moderate-and-severe OSA. The training-testing dataset was used to assess the model generalizability through five-fold cross-validation. We calculated the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the independent validation set to assess the performance of the model. The results showed that age, sex, and BMI were significantly associated with OSA. The validation AUCs of the generated LR and ANN models were 0.806 and 0.807, respectively. The independent validation set's accuracy, sensitivity, specificity, PPV, and NPV were 76.3%, 87.5%, 57.0%, 77.7%, and 72.7% for the LR model, and 76.4%, 87.7%, 56.9%, 77.7%, and 73.0% respectively, for the ANN model. The LR- and ANN-boosted models with the three simple parameters effectively predicted OSA in patients referred for PSG examination and improved insight into risk stratification for OSA diagnosis.



    Let T be the Calderón-Zygmund singular integral operator and b be a locally integrable function on Rn. The commutator generated by b and T is defined by [b,T]f=bT(f)T(bf). The investigation of the commutator begins with Coifman-Rochberg-Weiss pioneering study and classical result (see [6]). The classical result of Coifman, Rochberg and Weiss (see [6]) states that the commutator [b,T]f=T(bf)bTf is bounded on Lp(Rn) for 1<p< if and only if bBMO(Rn). The major reason for considering the problem of commutators is that the boundedness of commutator can produces some characterizations of function spaces (see [1,6]). Chanillo (see [1]) proves a similar result when T is replaced by the fractional integral operator. In [11], the boundedness properties of the commutators for the extreme values of p are obtained. In recent years, the theory of Herz space and Herz type Hardy space, as a local version of Lebesgue space and Hardy space, have been developed (see [8,9,12,13]). The main purpose of this paper is to establish the endpoint continuity properties of some multilinear operators related to certain non-convolution type fractional singular integral operators on Herz and Herz type Hardy spaces.

    First, let us introduce some notations (see [8,9,10,12,13,15]). Throughout this paper, Q will denote a cube of Rn with sides parallel to the axes. For a cube Q and a locally integrable function f, let fQ=|Q|1Qf(x)dx and f#(x)=supQx|Q|1Q|f(y)fQ|dy. Moreover, f is said to belong to BMO(Rn) if f#L and define ||f||BMO=||f#||L; We also define the central BMO space by CMO(Rn), which is the space of those functions fLloc(Rn) such that

    ||f||CMO=supr>1|Q(0,r)|1Q|f(y)fQ|dy<.

    It is well-known that (see [9,10])

    ||f||CMOsupr>1infcC|Q(0,r)|1Q|f(x)c|dx.

    For kZ, define Bk={xRn:|x|2k} and Ck=BkBk1. Denote by χk the characteristic function of Ck and ˜χk the characteristic function of Ck for k1 and ˜χ0 the characteristic function of B0.

    Definition 1. Let 0<p< and αR.

    (1) The homogeneous Herz space ˙Kαp(Rn) is defined by

    ˙Kαp(Rn)={fLploc(Rn{0}):||f||˙Kαp<},

    where

    ||f||˙Kαp=k=2kα||fχk||Lp;

    (2) The nonhomogeneous Herz space Kαp(Rn) is defined by

    Kαp(Rn)={fLploc(Rn):||f||Kαp<},

    where

    ||f||Kαp=k=02kα||f˜χk||Lp.

    If α=n(11/p), we denote that ˙Kαp(Rn)=˙Kp(Rn), Kαp(Rn)=Kp(Rn).

    Definition 2. Let 0<δ<n and 1<p<n/δ. We shall call Bδp(Rn) the space of those functions f on Rn such that

    ||f||Bδp=supd>1dn(1/pδ/n)||fχQ(0,d)||Lp<.

    Definition 3. Let 1<p<.

    (1) The homogeneous Herz type Hardy space H˙Kp(Rn) is defined by

    H˙Kp(Rn)={fS(Rn):G(f)˙Kp(Rn)},

    where

    ||f||H˙Kp=||G(f)||˙Kp.

    (2) The nonhomogeneous Herz type Hardy space HKp(Rn) is defined by

    HKp(Rn)={fS(Rn):G(f)Kp(Rn)},

    where

    ||f||HKp=||G(f)||Kp.

    where G(f) is the grand maximal function of f.

    The Herz type Hardy spaces have the atomic decomposition characterization.

    Definition 4. Let 1<p<. A function a(x) on Rn is called a central (n(11/p),p)-atom (or a central (n(11/p),p)-atom of restrict type), if

    1) SuppaB(0,d) for some d>0 (or for some d1),

    2) ||a||Lp|B(0,d)|1/p1,

    3) a(x)dx=0.

    Lemma 1. (see [9,13]) Let 1<p<. A temperate distribution f belongs to H˙Kp(Rn)(or HKp(Rn)) if and only if there exist central (n(11/p),p)-atoms(or central (n(11/p),p)-atoms of restrict type) aj supported on Bj=B(0,2j) and constants λj, j|λj|< such that f=j=λjaj (or f=j=0λjaj)in the S(Rn) sense, and

    ||f||H˙Kp( or ||f||HKp)j|λj|.

    In this paper, we will consider a class of multilinear operators related to some non-convolution type singular integral operators, whose definition are following.

    Let m be a positive integer and A be a function on Rn. We denote that

    Rm+1(A;x,y)=A(x)|β|m1β!DβA(y)(xy)β

    and

    Qm+1(A;x,y)=Rm(A;x,y)|β|=m1β!DβA(x)(xy)β.

    Definition 5. Fixed ε>0 and 0<δ<n. Let Tδ:SS be a linear operator. Tδ is called a fractional singular integral operator if there exists a locally integrable function K(x,y) on Rn×Rn such that

    Tδ(f)(x)=RnK(x,y)f(y)dy

    for every bounded and compactly supported function f, where K satisfies:

    |K(x,y)|C|xy|n+δ

    and

    |K(y,x)K(z,x)|+|K(x,y)K(x,z)|C|yz|ε|xz|nε+δ

    if 2|yz||xz|. The multilinear operator related to the fractional singular integral operator Tδ is defined by

    TAδ(f)(x)=RnRm+1(A;x,y)|xy|mK(x,y)f(y)dy;

    We also consider the variant of TAδ, which is defined by

    ˜TAδ(f)(x)=RnQm+1(A;x,y)|xy|mK(x,y)f(y)dy.

    Note that when m=0, TAδ is just the commutators of Tδ and A (see [1,6,11,14]). It is well known that multilinear operator, as a non-trivial extension of commutator, is of great interest in harmonic analysis and has been widely studied by many authors (see [3,4,5]). In [7], the weighted Lp(p>1)-boundedness of the multilinear operator related to some singular integral operator are obtained. In [2], the weak (H1, L1)-boundedness of the multilinear operator related to some singular integral operator are obtained. In this paper, we will study the endpoint continuity properties of the multilinear operators TAδ and ˜TAδ on Herz and Herz type Hardy spaces.

    Now we state our results as following.

    Theorem 1. Let 0<δ<n, 1<p<n/δ and DβABMO(Rn) for all β with |β|=m. Suppose that TAδ is the same as in Definition 5 such that Tδ is bounded from Lp(Rn) to Lq(Rn) for any p,q(1,+] with 1/q=1/pδ/n. Then TAδ is bounded from Bδp(Rn) to CMO(Rn).

    Theorem 2. Let 0<δ<n, 1<p<n/δ, 1/q=1/pδ/n and DβABMO(Rn) for all β with |β|=m. Suppose that ˜TAδ is the same as in Definition 5 such that ˜TAδ is bounded from Lp(Rn) to Lq(Rn) for any p,q(1,+) with 1/q=1/pδ/n. Then ˜TAδ is bounded from H˙Kp(Rn) to ˙Kαq(Rn) with α=n(11/p).

    Theorem 3. Let 0<δ<n, 1<p<n/δ and DβABMO(Rn) for all β with |β|=m. Suppose that ˜TAδ is the same as in Definition 5 such that ˜TAδ is bounded from Lp(Rn) to Lq(Rn) for any p,q(1,+) with 1/q=1/pδ/n. Then the following two statements are equivalent:

    (ⅰ) ˜TAδ is bounded from Bδp(Rn) to CMO(Rn);

    (ⅱ) for any cube Q and z3Q2Q, there is

    1|Q|Q||β|=m1β!|DβA(x)(DβA)Q|(4Q)cKβ(z,y)f(y)dy|dxC||f||Bδp,

    where Kβ(z,y)=(zy)β|zy|mK(z,y) for |β|=m.

    Remark. Theorem 2 is also hold for nonhomogeneous Herz and Herz type Hardy space.

    To prove the theorem, we need the following lemma.

    Lemma 2. (see [5]) Let A be a function on Rn and DβALq(Rn) for |β|=m and some q>n. Then

    |Rm(A;x,y)|C|xy|m|β|=m(1|˜Q(x,y)|˜Q(x,y)|DβA(z)|qdz)1/q,

    where ˜Q(x,y) is the cube centered at x and having side length 5n|xy|.

    Proof of Theorem 1. It suffices to prove that there exists a constant CQ such that

    1|Q|Q|TAδ(f)(x)CQ|dxC||f||Bδp

    holds for any cube Q=Q(0,d) with d>1. Fix a cube Q=Q(0,d) with d>1. Let ˜Q=5nQ and ˜A(x)=A(x)|β|=m1β!(DβA)˜Qxβ, then Rm+1(A;x,y)=Rm+1(˜A;x,y) and Dβ˜A=DβA(DβA)˜Q for all β with |β|=m. We write, for f1=fχ˜Q and f2=fχRn˜Q,

    TAδ(f)(x)=RnRm+1(˜A;x,y)|xy|mK(x,y)f(y)dy=RnRm(˜A;x,y)|xy|mK(x,y)f1(y)dy|β|=m1β!RnK(x,y)(xy)β|xy|mDβ˜A(y)f1(y)dy+RnRm+1(˜A;x,y)|xy|mK(x,y)f2(y)dy,

    then

    1|Q|Q|TAδ(f)(x)T˜Aδ(f2)(0)|dx1|Q|Q|Tδ(Rm(˜A;x,)|x|mf1)(x)|dx+|β|=m1β!1|Q|Q|Tδ((x)β|x|mDβ˜Af1)(x)|dx+|T˜Aδ(f2)(x)T˜Aδ(f2)(0)|dx:=I+II+III.

    For I, note that for xQ and y˜Q, using Lemma 2, we get

    Rm(˜A;x,y)C|xy|m|β|=m||DβA||BMO,

    thus, by the Lp(Rn) to Lq(Rn)-boundedness of TAδ for 1<p,q< with 1/q=1/pδ/n, we get

    IC|Q|Q|Tδ(|β|=m||DβA||BMOf1)(x)|dxC|β|=m||DβA||BMO(1|Q|Q|Tδ(f1)(x)|qdx)1/qC|β|=m||DβA||BMO|Q|1/q||f1||LpC|β|=m||DβA||BMOrn(1/pδ/n)||fχ˜Q||LpC|β|=m||DβA||BMO||f||Bδp.

    For II, taking 1<s<p such that 1/r=1/sδ/n, by the (Ls,Lr)-boundedness of Tδ and Holder's inequality, we gain

    IIC|Q|Q|Tδ(|β|=m(DβA(DβA)˜Q)f1)(x)|dxC|β|=m(1|Q|Q|Tδ((DβA(DβA)˜Q)f1)(x)|rdx)1/rC|Q|1/r|β|=m||(DβA(DβA)˜Q)f1||LsC|Q|1/r||f1||Lp|β|=m(1|Q|˜Q|DβA(y)(DβA)˜Q|ps/(ps)dy)(ps)/(ps)|Q|(ps)/(ps)C|β|=m||DβA||BMOrn/q||fχ˜Q||LpC|β|=m||DβA||BMO||f||Bδp.

    To estimate III, we write

    T˜Aδ(f2)(x)T˜Aδ(f2)(0)=Rn[K(x,y)|xy|mK(0,y)|y|m]Rm(˜A;x,y)f2(y)dy+RnK(0,y)f2(y)|y|m[Rm(˜A;x,y)Rm(˜A;0,y)]dy|β|=m1β!Rn(K(x,y)(xy)β|xy|mK(0,y)(y)β|y|m)Dβ˜A(y)f2(y)dy:=III1+III2+III3.

    By Lemma 2 and the following inequality (see [15])

    |bQ1bQ2|Clog(|Q2|/|Q1|)||b||BMO for Q1Q2,

    we know that, for xQ and y2k+1˜Q2k˜Q,

    |Rm(˜A;x,y)|C|xy|m|β|=m(||DβA||BMO+|(DβA)˜Q(x,y)(DβA)˜Q|)Ck|xy|m|β|=m||DβA||BMO.

    Note that |xy||y| for xQ and yRn˜Q, we obtain, by the condition of K,

    |III1|CRn(|x||y|m+n+1δ+|x|ε|y|m+n+εδ)|Rm(˜A;x,y)||f2(y)|dyC|β|=m||DβA||BMOk=02k+1˜Q2k˜Qk(|x||y|n+1δ+|x|ε|y|n+εδ)|f(y)|dyC|β|=m||DβA||BMOk=1k(2k+2εk)(2kr)n(1/pδ/n)||fχ2k˜Q||LpC|β|=m||DβA||BMOk=1k(2k+2εk)||f||BδpC|β|=m||DβA||BMO||f||Bδp.

    For III2, by the formula (see [5]):

    Rm(˜A;x,y)Rm(˜A;x0,y)=|γ|<m1γ!Rm|γ|(Dγ˜A;x,x0)(xy)γ

    and Lemma 2, we have

    |Rm(˜A;x,y)Rm(˜A;x0,y)|C|γ|<m|β|=m|xx0|m|γ||xy||γ|||DβA||BMO,

    thus, similar to the estimates of III1, we get

    |III2|C|β|=m||DβA||BMOk=02k+1˜Q2k˜Q|x||y|n+1δ|f(y)|dyC|β|=m||DβA||BMO||f||Bδp.

    For III3, by Holder's inequality, similar to the estimates of III1, we get

    |III3|C|β|=mk=02k+1˜Q2k˜Q(|x||y|n+1δ+|x|ε|y|n+εδ)|Dβ˜A(y)||f(y)|dyC|β|=mk=1(2k+2εk)(2kr)n(1/pδ/n)(|2k˜Q|12k˜Q|DβA(y)(DβA)˜Q|pdy)1/p||fχ2k˜Q||LpC|β|=m||DβA||BMOk=1(2k+2εk)(2kr)n(1/pδ/n)||fχ2k˜Q||LpC|β|=m||DβA||BMO||f||Bδp.

    Thus

    IIIC|β|=m||DβA||BMO||f||Bδp,

    which together with the estimates for I and II yields the desired result. This finishes the proof of Theorem 1.

    Proof of Theorem 2. Let fH˙Kp(Rn), by Lemma 1, f=j=λjaj, where ajs are the central (n(11/p),p)-atom with suppajBj=B(0,2j) and ||f||H˙Kpj|λj|. We write

    ||˜TAδ(f)||˙Kαq=k=2kn(11/p)||χk˜TAδ(f)||Lqk=2kn(11/p)k1j=|λj|||χk˜TAδ(aj)||Lq+k=2kn(11/p)j=k|λj|||χk˜TAδ(aj)||Lq=J+JJ.

    For JJ, by the (Lp,Lq)-boundedness of ˜TAδ for 1/q=1/pδ/n, we get

    JJCk=2kn(11/p)j=k|λj|||aj||LpCk=2kn(11/p)j=k|λj|2jn(1/p1)Cj=|λj|jk=2(kj)n(11/p)Cj=|λj|C||f||H˙Kp.

    To obtain the estimate of J, we denote that ˜A(x)=A(x)|β|=m1β!(DβA)2Bjxβ. Then Qm(A;x,y)=Qm(˜A;x,y) and Qm+1(A;x,y)=Rm(A;x,y)|β|=m1β!(xy)βDβA(x). We write, by the vanishing moment of a and for xCk with kj+1,

    ˜TAδ(aj)(x)=RnK(x,y)Rm(A;x,y)|xy|maj(y)dy|β|=m1β!RnK(x,y)Dβ˜A(x)(xy)β|xy|maj(y)dy=Rn[K(x,y)|xy|mK(x,0)|x|m]Rm(˜A;x,y)aj(y)dy+RnK(x,0)|x|m[Rm(˜A;x,y)Rm(˜A;x,0)]aj(y)dy|β|=m1β!Rn[K(x,y)(xy)β|xy|mK(x,0)xβ|x|m]Dβ˜A(x)aj(y)dy.

    Similar to the proof of Theorem 1, we obtain

    |˜TAδ(aj)(x)|CRn[|y||x|m+n+1δ+|y|ε|x|m+n+εδ]|Rm(˜A;x,y)||aj(y)|dy+C|β|=mRn[|y||x|n+1δ+|y|ε|x|n+εδ]|Dβ˜A(x)||aj(y)|dyC|β|=m||DβA||BMO[2j2k(n+1δ)+2jε2k(n+εδ)]+C|β|=m[2j2k(n+1δ)+2jε2k(n+εδ)]|Dβ˜A(x)|,

    thus

    JC|β|=m||DβA||BMOk=2kn(11/p)k1j=|λj|[2j2k(n+1δ)+2jε2k(n+εδ)]2kn/q+C|β|=mk=2kn(11/p)k1j=|λj|[2j2k(n+1δ)+2jε2k(n+εδ)](Bk|Dβ˜A(x)|qdx)1/qC|β|=m||DβA||BMOk=2kn(1δ/n)k1j=|λj|[2j2k(n+1δ)+2jε2k(n+εδ)]C|β|=m||DβA||BMOj=|λj|k=j+1[2jk+2(jk)ε]C|β|=m||DβA||BMOj=|λj|C|β|=m||DβA||BMO||f||H˙Kp.

    This completes the proof of Theorem 2.

    Proof of Theorem 3. For any cube Q=Q(0,r) with r>1, let fBδp and ˜A(x)=A(x)|β|=m1β!(DβA)˜Qxβ. We write, for f=fχ4Q+fχ(4Q)c=f1+f2 and z3Q2Q,

    ˜TAδ(f)(x)=˜TAδ(f1)(x)+RnRm(˜A;x,y)|xy|mK(x,y)f2(y)dy|β|=m1β!(DβA(x)(DβA)Q)(Tδ,β(f2)(x)Tδ,β(f2)(z))|β|=m1β!(DβA(x)(DβA)Q)Tδ,β(f2)(z)=I1(x)+I2(x)+I3(x,z)+I4(x,z),

    where Tδ,β is the singular integral operator with the kernel (xy)β|xy|mK(x,y) for |β|=m. Note that (I4(,z))Q=0, we have

    ˜TAδ(f)(x)(˜TAδ(f))Q=I1(x)(I1())Q+I2(x)I2(z)[I2()I2(z)]QI3(x,z)+(I3(x,z))QI4(x,z).

    By the (Lp,Lq)-bounded of ˜TAδ, we get

    1|Q|Q|I1(x)|dx(1|Q|Q|˜TAδ(f1)(x)|qdx)1/qC|Q|1/q||f1||LpC||f||Bδp.

    Similar to the proof of Theorem 1, we obtain

    |I2(x)I2(z)|C||f||Bδp

    and

    1|Q|Q|I3(x,z)|dxC||f||Bδp.

    Then integrating in x on Q and using the above estimates, we obtain the equivalence of the estimate

    1|Q|Q|˜TAδ(f)(x)(˜TAδ(f))Q|dxC||f||Bδp

    and the estimate

    1|Q|Q|I4(x,z)|dxC||f||Bδp.

    This completes the proof of Theorem 3.

    In this section we shall apply the theorems of the paper to some particular operators such as the Calderón-Zygmund singular integral operator and fractional integral operator.

    Application 1. Calderón-Zygmund singular integral operator.

    Let T be the Calderón-Zygmund operator defined by (see [10,11,15])

    T(f)(x)=RnK(x,y)f(y)dy,

    the multilinear operator related to T is defined by

    TA(f)(x)=RnRm+1(A;x,y)|xy|mK(x,y)f(y)dy.

    Then it is easily to see that T satisfies the conditions in Theorems 1–3, thus the conclusions of Theorems 1–3 hold for TA.

    Application 2. Fractional integral operator with rough kernel.

    For 0<δ<n, let Tδ be the fractional integral operator with rough kernel defined by (see [2,7])

    Tδf(x)=RnΩ(xy)|xy|nδf(y)dy,

    the multilinear operator related to Tδ is defined by

    TAδf(x)=RnRm+1(A;x,y)|xy|m+nδΩ(xy)f(y)dy,

    where Ω is homogeneous of degree zero on Rn, Sn1Ω(x)dσ(x)=0 and ΩLipε(Sn1) for some 0<ε1, that is there exists a constant M>0 such that for any x,ySn1, |Ω(x)Ω(y)|M|xy|ε. Then Tδ satisfies the conditions in Theorem 1. In fact, for suppf(2Q)c and xQ=Q(x0,d), by the condition of Ω, we have (see [16])

    |Ω(xy)|xy|nδΩ(x0y)|x0y|nδ|C(|xx0|ε|x0y|n+εδ+|xx0||x0y|n+1δ),

    thus, the conclusions of Theorems 1–3 hold for TAδ.

    The author would like to express his deep gratitude to the referee for his/her valuable comments and suggestions. This research was supported by the National Natural Science Foundation of China (Grant No. 11901126), the Scientific Research Funds of Hunan Provincial Education Department. (Grant No. 19B509).

    The authors declare that they have no competing interests.



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