Multimodal cardiovascular risk profiling using self-supervised learning of polysomnography

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STUDY OBJECTIVES: Polysomnography (PSG) provides a comprehensive assessment of brain, cardiac, and respiratory activity during sleep. While it is widely used for diagnosing sleep disorders, its potential to assess future health risks has not been fully explored. This study aimed to develop and evaluate an interpretable framework to identify physiological patterns in PSG data linked to cardiovascular disease (CVD) outcomes, without relying on manual annotations (e.g. sleep stages). METHODS: We developed a self-supervised deep learning model that extracts meaningful patterns from multi-modal signals (electroencephalography [EEG], electrocardiography [ECG], and respiratory signals [Resp]). The model was trained on data from 4398 participants. Projection scores were derived by contrasting embeddings from individuals with and without CVD outcomes. External validation was conducted in an independent cohort with 1093 participants. The source code is available on https://github.com/miraclehetech/sleep-ssl. RESULTS: The projection scores revealed distinct and clinically meaningful patterns across modalities. ECG-derived features were predictive of both prevalent and incident cardiac conditions, particularly CVD mortality. EEG-derived features were predictive of incident hypertension and CVD mortality. Resp added complementary predictive value. Combining projection scores with the Framingham Risk Score consistently improved prediction, with area under the curve values ranging from 0.607 to 0.965 in the Sleep Heart Health Study test cohort and 0.710 to 0.807 across four of five outcomes in the external validation cohort, demonstrating robust cross-cohort generalizability. CONCLUSIONS: Our findings demonstrate that the proposed framework can generate individualized CVD risk scores directly from PSG data. The resulting projection scores have the potential to be integrated into clinical practice, enhancing risk assessment and supporting personalized care. Statement of Significance This study is among the first to apply a self-supervised framework for cardiovascular risk profiling using polysomnography (PSG) data. By transforming electroencephalography, electrocardiography, and Resp into interpretable projection scores, we identified physiological markers predictive of multiple cardiovascular outcomes. These risk profiles, combined with traditional risk scores, significantly improved prediction across both internal and external cohorts. Our findings highlight the untapped potential of PSG signals beyond sleep staging, providing an interpretable, scalable, and clinically actionable approach for personalized cardiovascular risk stratification.

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