Validation of the sleep EEG headband ZMax

Abstract Polysomnography (PSG) is the gold standard for recording sleep. However, the standard PSG systems are bulky, expensive, and often confined to lab environments. These systems are also time-consuming in electrode placement and sleep scoring. Such limitations render standard PSG systems less suitable for large-scale or longitudinal studies of sleep. Recent advances in electronics and artificial intelligence enabled ‘wearable’ PSG systems. Here, we present a study aimed at validating the performance of ZMax, a widely-used wearable PSG that includes frontal electroencephalography (EEG) and actigraphy but no submental electromyography (EMG). We analyzed 135 nights with simultaneous ZMax and standard PSG recordings amounting to over 900 hours from four different datasets, and evaluated the performance of the headband’s proprietary automatic sleep scoring (ZLab) alongside our open-source algorithm (DreamentoScorer) in comparison with human sleep scoring. ZLab and DreamentoScorer compared to human scorers with moderate and substantial agreement and Cohen’s kappa scores of 59.61% and 72.18%, respectively. We further analyzed the competence of these algorithms in determining sleep assessment metrics, as well as shedding more lights on the bandpower computation, and morphological analysis of sleep microstructural features between ZMax and standard PSG. Relative bandpower computed by ZMax implied an error of 5.5% (delta), 4.5% (theta), 1.6% (alpha), 0.5% (sigma), 0.8% (beta), and 0.2% (gamma), compared to standard PSG. In addition, the microstructural features detected in ZMax did not represent exactly the same characteristics as in standard PSG. Besides similarities and discrepancies between ZMax and standard PSG, we measured and discussed the technology acceptance rate, feasibility of data collection with ZMax, and highlighted essential factors for utilizing ZMax as a reliable tool for both monitoring and modulating sleep.