Prediction of cardiovascular outcomes using electrocardiography from overnight polysomnography

Abstract Study Objectives Polysomnography (PSG) is the gold standard for diagnosing sleep disorders, which are recognized as cardiovascular risk factors. Single-lead electrocardiograms (ECGs) are recorded during PSG but rarely analyzed, presenting an opportunity to leverage overnight ECGs for cardiovascular risk prediction. Materials and Methods We applied a deep residual neural network with attention to single-lead ECGs from PSG, combined with sleep stage data, to predict 10-year risk of atrial fibrillation (AF), stroke, myocardial infarction (MI), heart failure (HF), and death. The network, trained for arrhythmia detection, was finetuned on 15 809 Massachusetts General Hospital patients. External validation used cohorts from Emory University Hospital (EUH) (n = 9810) and Beth Israel Deaconess Medical Center (BIDMC) (n = 12 576), with outcomes derived from electronic health records (ICD-9/10 codes). Results Cox proportional hazards models showed that neural-network output (NN-output) was strongly associated with long-term cardiovascular risk (p  Conclusions Deep learning applied to nocturnal ECGs with sleep stage information captures cardiac abnormalities, offering a tool for cardiovascular risk stratification. Integrating such prediction into PSG could enhance detection and support personalized clinical decision-making.