Holter-to-Sleep: AI-Enabled Repurposing of Single-Lead ECG for Sleep Phenotyping

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Hauptverfasser: Xie, Donglin, Zhao, Qingshuo, Wang, Jingyu, Geng, Shijia, Jin, Jiarui, Li, Jun, Guo, Rongrong, Nie, Guangkun, Tang, Gongzheng, Zhou, Yuxi, Penzel, Thomas, Hong, Shenda
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Veröffentlicht: 2026
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author Xie, Donglin
Zhao, Qingshuo
Wang, Jingyu
Geng, Shijia
Jin, Jiarui
Li, Jun
Guo, Rongrong
Nie, Guangkun
Tang, Gongzheng
Zhou, Yuxi
Penzel, Thomas
Hong, Shenda
author_facet Xie, Donglin
Zhao, Qingshuo
Wang, Jingyu
Geng, Shijia
Jin, Jiarui
Li, Jun
Guo, Rongrong
Nie, Guangkun
Tang, Gongzheng
Zhou, Yuxi
Penzel, Thomas
Hong, Shenda
contents Sleep disturbances are tightly linked to cardiovascular risk, yet polysomnography (PSG)-the clinical reference standard-remains resource-intensive and poorly suited for multi-night, home-based, and large-scale screening. Single-lead electrocardiography (ECG), already ubiquitous in Holter and patch-based devices, enables comfortable long-term acquisition and encodes sleep-relevant physiology through autonomic modulation and cardiorespiratory coupling. Here, we present a proof-of-concept Holter-to-Sleep framework that, using single-lead ECG as the sole input, jointly supports overnight sleep phenotyping and Holter-grade cardiac phenotyping within the same recording, and further provides an explicit analytic pathway for scalable cardio-sleep association studies. The framework is developed and validated on a pooled multi-center PSG sample of 10,439 studies spanning four public cohorts, with independent external evaluation to assess cross-cohort generalizability, and additional real-world feasibility assessment using overnight patch-ECG recordings via objective-subjective consistency analysis. This integrated design enables robust extraction of clinically meaningful overnight sleep phenotypes under heterogeneous populations and acquisition conditions, and facilitates systematic linkage between ECG-derived sleep metrics and arrhythmia-related Holter phenotypes. Collectively, the Holter-to-Sleep paradigm offers a practical foundation for low-burden, home-deployable, and scalable cardio-sleep monitoring and research beyond traditional PSG-centric workflows.
format Preprint
id arxiv_https___arxiv_org_abs_2603_18714
institution arXiv
publishDate 2026
record_format arxiv
spellingShingle Holter-to-Sleep: AI-Enabled Repurposing of Single-Lead ECG for Sleep Phenotyping
Xie, Donglin
Zhao, Qingshuo
Wang, Jingyu
Geng, Shijia
Jin, Jiarui
Li, Jun
Guo, Rongrong
Nie, Guangkun
Tang, Gongzheng
Zhou, Yuxi
Penzel, Thomas
Hong, Shenda
Signal Processing
Machine Learning
Sleep disturbances are tightly linked to cardiovascular risk, yet polysomnography (PSG)-the clinical reference standard-remains resource-intensive and poorly suited for multi-night, home-based, and large-scale screening. Single-lead electrocardiography (ECG), already ubiquitous in Holter and patch-based devices, enables comfortable long-term acquisition and encodes sleep-relevant physiology through autonomic modulation and cardiorespiratory coupling. Here, we present a proof-of-concept Holter-to-Sleep framework that, using single-lead ECG as the sole input, jointly supports overnight sleep phenotyping and Holter-grade cardiac phenotyping within the same recording, and further provides an explicit analytic pathway for scalable cardio-sleep association studies. The framework is developed and validated on a pooled multi-center PSG sample of 10,439 studies spanning four public cohorts, with independent external evaluation to assess cross-cohort generalizability, and additional real-world feasibility assessment using overnight patch-ECG recordings via objective-subjective consistency analysis. This integrated design enables robust extraction of clinically meaningful overnight sleep phenotypes under heterogeneous populations and acquisition conditions, and facilitates systematic linkage between ECG-derived sleep metrics and arrhythmia-related Holter phenotypes. Collectively, the Holter-to-Sleep paradigm offers a practical foundation for low-burden, home-deployable, and scalable cardio-sleep monitoring and research beyond traditional PSG-centric workflows.
title Holter-to-Sleep: AI-Enabled Repurposing of Single-Lead ECG for Sleep Phenotyping
topic Signal Processing
Machine Learning
url https://arxiv.org/abs/2603.18714