A Permutation Entropy Method for Sleep Disorder Screening

<b>Background/Objectives:</b> We present a novel approach for detecting generalized sleep pathologies through the fractal analysis of single-channel electroencephalographic (EEG) signals. We propose that the fractal scaling exponent of permutation entropy time series serves as a robust biomarker of pathological sleep patterns, capturing alterations in brain dynamics across multiple disorders. <b>Methods:</b> Using two public datasets (Sleep-EDF and CAP Sleep Database) comprising 200 subjects (112 healthy controls and 88 patients with various sleep pathologies), we computed the fractal scaling of the permutation entropy of these signals. <b>Results:</b> The results demonstrate significantly reduced scaling exponents in pathological sleep compared to healthy controls (mean = 1.24 vs. 1.06, p<0.001), indicating disrupted long-range temporal correlations in neural activity. The method achieved 90% classification accuracy for rapid-eye-movement (REM) sleep behavior disorder (F1-score: 0.89) and maintained 74% accuracy when aggregating all pathologies (insomnia, narcolepsy, sleep-disordered breathing, etc.). <b>Conclusions:</b> The advantages of this approach, including compatibility with single-channel EEG (enabling potential wearable applications), independence from sleep-stage annotations, and generalizability across recording montages and sampling rates, stablish a framework for non-specific sleep pathology detection. This is a computationally efficient method that could transform screening protocols and enable earlier intervention. The robustness of this biomarker could enable straightforward clinical applications for common sleep pathologies as well as diseases associated with neurodegenerative conditions.