Streaming biosignals vary across subjects and drift over time, so population-trained models lose accuracy during long-term monitoring. Test-time adaptation (TTA) enables online personalization by updating the model on incoming samples. But in a stream, a basic question is left open: \emph{which samples should drive each update?} Using all buffered samples blurs the update with irrelevant segments. Using only the latest segment makes the update noisy and unstable. The most useful samples are recent, aligned with the current physiological state, and reliable enough to learn from. We propose \textbf{RECAST} (REcent \& Context-Aware Sampling for TTA), a lightweight sampling module for buffered TTA frameworks. RECAST builds each adaptation batch from three signals: temporal recency, contextual similarity, and predictive reliability. It changes only which samples are used, leaving the model and the training objective unchanged. On two blood-pressure datasets, RECAST improves estimation accuracy and trend tracking over baselines and ablations. The per-patient gains are statistically significant on both datasets, with broad improvement on the regular benchmark and gains concentrated on the hardest patients in the emergency-department setting. RECAST stays practical, adding only sub-second latency per segment on a single GPU and CPU core.
The causal dynamics of sleep-disordered breathing are complex and vary across patient populations, hindering the development of targeted interventions. We learn dynamic causal graphs of sleep-disordered breathing from Home Sleep Apnea Test (HSAT) recordings, revealing systematic differences in causal structure across sex and age subcohorts. We do so using the PCMCI+ algorithm on windowed fractional variables derived from 105 HSAT recordings, exploiting domain knowledge via edge blacklisting and employing bootstrap aggregation to address small subcohort sizes. The learned graphs show that temporal self-dependencies and the apnea-desaturation relationship persist across all cohorts, while other relationships vary substantially.
Farhan Adam Mukadam, Harshit Mishra, Nachiket Makwana +3eess.SP cs.AI cs.LG
Accurate measurement of ECG intervals, including PR, QRS duration, and QT/QTc, is central to cardiac diagnosis, yet the published ECG delineation literature evaluates performance almost exclusively as fiducial-point timing errors on small curated databases, rather than as clinical interval accuracy on large unselected cohorts. We bridge this gap by evaluating a complete end-to-end pipeline on 10,646 clinical 12-lead ECGs and reporting the first large-scale interval measurement accuracy study with full statistical characterisation, including bias, 95% limits of agreement (Bland-Altman), bootstrap confidence intervals, and rhythm-stratified error analysis. The underlying delineation is performed by a Fast Fourier Convolution ResNet (FFCResNet), adapting local temporal convolutions with global spectral processing via FFT and augmented with register tokens for contextual feature learning. Three per-wave models (P, QRS, and T) are trained on six public databases with ECG-specific augmentation. On 10,646 ECGs, the system achieves a QT MAE of 17.5 ms [95% CI: 16.9-18.2], with a Bland-Altman bias of +8.5 ms (LoA: -68.5 to +85.5 ms); a QRS duration MAE of 14.8 ms [95% CI: 14.6-15.0], with a bias of +12.6 ms (LoA: -12.3 to +37.6 ms); and a ventricular rate MAE of 0.8 beats/min. All biases are statistically significant by the Wilcoxon signed-rank test (p < 0.001) but remain within or near published inter-observer variability bounds for sinus rhythms. Rhythm-stratified analysis reveals substantially higher QT errors for supraventricular tachycardias (SVT MAE: 75.0 ms; AVRT MAE: 85.3 ms) than for sinus bradycardia (SB MAE: 9.3 ms) and sinus rhythm (SR MAE: 8.9 ms), providing an honest characterisation of the deployment scope. Wave segmentation achieves internal Dice scores of 95.5%, 98.2%, and 96.1% for P, QRS, and T waves, respectively, and cross-database Dice scores of 78.1%, 85.5%, and 74.2%.
Generalizing sleep staging models to unseen datasets is challenging, and typical domain generalization (DG) methods often rely on multiple source domains or domain labels that are rarely available in practice. We tackle the stricter and more practical setting of single-source domain generalization: training on a single labeled source dataset, without domain labels or access to target data. We present SleepBand, a physiology-guided framework that embeds oscillatory priors via a learnable Morlet filter bank and a structured integration-and-recalibration pipeline. This anchors representations to domain-invariant sleep rhythms (e.g., slow waves, spindles), reducing reliance on dataset-specific artefacts. On five public datasets, SleepBand achieves state-of-the-art SDG performance and remains competitive under leave-one-domain-out (multi-source) DG. Analyses show that the learned filters align with canonical neurophysiology and that robustness stems from focusing on narrowband, physiologically meaningful cues. Our results suggest that principled, physiology-aware inductive biases are a promising path for robust single-domain sleep staging. Code is available at https://github.com/lzcn/sleep-band
Magnus Ruud Kjaer, Haejun Han, Ashish Neupane +1cs.LG cs.AI cs.ET
Foundation models for wearable biosignals have matched or exceeded supervised specialists across a range of clinical tasks, yet all rely on modalities that require deliberate user action--wearing a device or visiting a sleep lab. We introduce BCG-FM, the first foundation model for ambient mechanical biosignals. A piezoelectric sensor embedded in the bed surface records ballistocardiography (BCG) each night without user effort; we pretrain BCG-FM with participant-level contrastive learning and using a total of 2.75 million hours of nightly recordings from 145,985 individuals, the largest raw-waveform biosignal pretraining corpus to date. Frozen BCG-FM embeddings achieve 3.26-year MAE on biological-age estimation (the lowest reported for any ambient, contactless modality) and yield clinically relevant discrimination across 15 self-reported health conditions and three independent external cohorts. Pretrained representations from only 500 labeled participants outperform a fully supervised baseline trained on 3,372, and representation quality scales log-linearly with contrastive batch size. These results establish ambient, longitudinal mechanical biosignals as a viable modality for health foundation models.