MAF-SleepNet: A Multimodal Attention-Enhanced Fusion Network for Automatic Multi-Class Sleep Disorder Classification from Polysomnography

Background/Objectives: Sleep disorders are heterogeneous conditions with diverse neural, muscular, and ocular manifestations, making polysomnography (PSG) the gold standard for accurate diagnosis. Artificial intelligence-based approaches, particularly deep learning (DL) models capable of integrating heterogeneous information, offer a promising solution for reliable decision-making in such clinical scenarios. However, most existing DL studies have focused on a single disorder, relied on limited datasets, or employed epoch-level labeling strategies that overlook the episodic nature of sleep pathophysiology, thereby limiting clinical applicability. To address these gaps, we propose a novel multimodal attention-enhanced fusion network (MAF-SleepNet) for automatic multi-class sleep disorder classification based on the International Classification of Sleep Disorders. Methods: MAF-SleepNet jointly processes electroencephalography (EEG), electrooculography (EOG), and leg electromyography (EMG) signals through modality-specific feature extraction and adaptive attention mechanisms, capturing both intra- and inter-modality dependencies. The model was evaluated on a combined dataset of 141 recordings from three public databases, including five PSG-requiring disorders and a healthy class. Results: Experimental results demonstrated that MAF-SleepNet achieved 86.07 ± 3.66% accuracy and 82.67 ± 4.46% macro-F1 under a strict subject-independent cross-validation, and 98.96 ± 0.66% accuracy and 98.93 ± 0.60% macro-F1 under subject-dependent cross-validation. Conclusions: These results demonstrate that the proposed approach provides a more reliable and clinically meaningful assessment compared to many existing studies that rely on subject-dependent evaluation or epoch-level labeling. The findings highlight the effectiveness of adaptive multimodal fusion for robust and clinically relevant sleep disorder classification. Future work should investigate the integration of respiratory and autonomic modalities and validation on larger multi-center cohorts.