Predicting Future Cognitive Impairment Using Whole-night Sleep-derived Outcomes

Franz Ehrlich1, Alex Schmidt2, Sara Bäcker3, Nicolai Spicher4, Dagmar Krefting2, Miriam Goldammer1, Philip Hempel5
1TU Dresden, 2University Medical Center Göttingen, 3Institute for Medical Informatics and Biometry, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, 4DTU, 5Department of Medical Informatics, University Medical Center Goettingen


Abstract

Predicting cognitive impairment before clinical diagnosis may support earlier assessment, monitoring, and intervention. As team OOM_finder, we investigated as part of the George B. Moody PhysioNet Challenge whether overnight polysomnography (PSG) contains information predictive of cognitive impairment subsequently diagnosed 1--6 years later. We compared three levels of PSG representation: strongly regularized logistic regression using demographic and sleep-summary features, a hierarchical transformer operating on temporally resolved algorithmic sleep annotations, and a pretrained multimodal encoder of raw physiological signals. The raw-signal approach achieved the strongest internal discrimination with an age-conditioned AUROC of 0.804. However, this advantage did not transfer to the official hidden validation set, where the compact sleep-summary model achieved the highest age-conditioned AUROC of 0.703 and a reward of 0.157. The annotation-based and raw-signal models achieved hidden-validation age-conditioned AUROCs of 0.562 and 0.612, respectively. These results suggest that increased representational complexity does not necessarily improve cross-site generalization and that compact, clinically interpretable sleep features may help predict future cognitive impairment.