Intelligent systems are increasingly present in various areas of society, gaining special relevance in healthcare environments. In this work, grounded on previous developments proposed by the authors, the evolution and improvement of a novel intelligent system focused on the diagnosis of obstructive sleep apnea (OSA) is addressed. To do this, starting from two packages of information of a heterogeneous nature, and deploying a set of Machine Learning classification algorithms, focused each of them on different levels of the apnea-hypopnea index (AHI), as well as a set of cascaded expert systems, it is possible to obtain a series of risk metric pairs (Statistical Risk, Symbolic Risk) for each AHI level, understood as a warning forecast associated with the early detection of the pathology. The risk indicators of each pair are subsequently aggregated by means of a symbolic inference system, whose knowledge base was determined using the automatic rule generation approach proposed by Wang and Mendel. At the output of each inference system, a risk indicator is obtained for each AHI level, the Apnea Risk, whose interpretation makes it possible to discriminate between patients who could suffer OSA and those who do not, as well as to generate the appropriate recommendations. For the initial tests of the system, the design and development of a specific software artifact was carried out using data from 4,400 patients from the Álvaro Cunqueiro Hospital in Vigo, obtaining when applied to the test set AUC values within the range 0.74–0.88, which invites optimism and points to the benefits expected from the architecture of the proposed intelligent system.

Obstructive Sleep Apnea (OSA) is nowadays one of the respiratory pathologies with a higher in-cidence globally in developed countries. This situation led to an increase in the demand for medical appointments and diagnostic studies related to that condition, especially those based on poly-somnographies and cardiorespiratory polygraphies. These studies are limited in resources, causing long waiting lists with the subsequent impact on the patients’ health. Furthermore, it is necessary to mention that OSA’s symptomatology is not very specific, and it is typically present in the general population (excessive sleepiness, snore, etc.). In this regard, this paper proposes a novel intelligent clinical decision support system for the diagnosis of OSA which could be used to help medical teams, both in primary care settings and in units specialized in respiratory pathologies. The aim of the proposed system is to help discriminate the patients suspected of suffering from the pathology from those who are not. To this end, two types of information sets of heterogeneous nature are consid-ered. The first one encompasses objective data, related to the patient's health profile with infor-mation usually available in electronic health records. The second type comprises subjective data, referred to the symptomatology reported by the patient in a previous interview. To process the first group of information, a Machine Learning classification algorithm is used, Bagged Trees in this case. For processing the second information set, related with the symptomatology of the patient, a col-lection of expert systems based on fuzzy inferential systems arranged in cascade are employed. As a result, the system is able to determine two risk indicators related to the patient's risk of suffering from OSA: the Statistical Risk and the Symbolic Risk respectively. Subsequently, by interpreting both risk indicators mentioned it will be possible to determine the severity of the patients’ health, proposing a preliminary evaluation on their condition. For the initial tests of the system, a software artifact has been built using a dataset with 4,978 selected patients, suspected of suffering from OSA, from the Álvaro Cunqueiro Hospital in Vigo. The results obtained are promising, demonstrating the potential usefulness of this type of tools in medical diagnosis. Once the system has been validated with new data from clinical environments, it is considered as possible to obtain a relevant improvement in the quality of the healthcare services, and a reduction in the associated costs.