Abstract
This study investigates whether heart rate asymmetry (HRA) parameters offer insights into sleep stages beyond those provided by conventional heart rate variability (HRV) and complexity measures. Utilizing 31 polysomnographic recordings, we focused exclusively on electrocardiogram (ECG) data, specifically the RR interval time series, to explore heart rate dynamics associated with different sleep stages. Employing both statistical techniques and machine learning models, with the Generalized Estimating Equation model as the foundational approach, we assessed the effectiveness of HRA in identifying and differentiating sleep stages and transitions. The models including asymmetric variables for detecting deep sleep stages, N2 and N3, achieved AUCs of 0.85 and 0.89, respectively, those for transitions N2-R, R-N2, i.e., falling in and out of REM sleep, achieved AUCs of 0.85 and 0.80, and those for W-N1, i.e., falling asleep, an AUC of 0.83. All these models were highly statistically significant. The findings demonstrate that HRA parameters provide significant, independent information about sleep stages that is not captured by HRV and complexity measures alone. This additional insight into sleep physiology potentially leads to a better understanding of hearth rhythm during sleep and devising more precise diagnostic tools, including cheap portable devices, for identifying sleep-related disorders.