SleepVLM: A Rule-Grounded Vision-Language Model for Auditable Sleep Staging

arXiv:2603.26738v4 Announce Type: replace-cross Abstract: Sleep staging is essential for sleep assessment and disorder diagnosis. In recent years, automatic sleep staging systems have achieved accuracy approaching that of human experts, but the black-box nature of their predictions hinders clinical adoption. Existing interpretability methods offer partial insight into model behavior, but their outputs still require expert reinterpretation and do not provide a direct basis for auditing individual predictions. To improve trustworthiness, we propose the task of auditable sleep staging. To solve this task, we present SleepVLM, a vision-language model that casts sleep staging as visual reasoning over rendered polysomnography (PSG) waveform images. For each epoch, SleepVLM outputs a stage together with the applicable American Academy of Sleep Medicine (AASM) rules and an auditable rationale. The model is trained using a two-stage framework: Waveform-Perceptual Pre-training followed by Rule-Grounded Supervised Fine-tuning over a mixture of fine-grained and coarse annotations. Experiments on four datasets show that SleepVLM outperforms state-of-the-art methods on average. An automated AASM-feature audit shows broad coverage of stage-defining evidence in the rationales, and independent experts validate their reasoning quality. To facilitate further research, we construct and release MASS-EX, an expert-annotated dataset for rule-grounded sleep staging with AASM rule annotations and expert-written rationales.

Abstract:Sleep staging is essential for sleep assessment and disorder diagnosis. In recent years, automatic sleep staging systems have achieved accuracy approaching that of human experts, but the black-box nature of their predictions hinders clinical adoption. Existing interpretability methods offer partial insight into model behavior, but their outputs still require expert reinterpretation and do not provide a direct basis for auditing individual predictions. To improve trustworthiness, we propose the task of auditable sleep staging. To solve this task, we present SleepVLM, a vision-language model that casts sleep staging as visual reasoning over rendered polysomnography (PSG) waveform images. For each epoch, SleepVLM outputs a stage together with the applicable American Academy of Sleep Medicine (AASM) rules and an auditable rationale. The model is trained using a two-stage framework: Waveform-Perceptual Pre-training followed by Rule-Grounded Supervised Fine-tuning over a mixture of fine-grained and coarse annotations. Experiments on four datasets show that SleepVLM outperforms state-of-the-art methods on average. An automated AASM-feature audit shows broad coverage of stage-defining evidence in the rationales, and independent experts validate their reasoning quality. To facilitate further research, we construct and release MASS-EX, an expert-annotated dataset for rule-grounded sleep staging with AASM rule annotations and expert-written rationales.

Computer Vision and Pattern Recognition (cs.CV); Artificial Intelligence (cs.AI); Computation and Language (cs.CL)

arXiv:2603.26738 [cs.CV]

(or arXiv:2603.26738v4 [cs.CV] for this version)

https://doi.org/10.48550/arXiv.2603.26738 Focus to learn more arXiv-issued DOI via DataCite

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SleepVLM: A Rule-Grounded Vision-Language Model for Auditable Sleep Staging

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