Not yet reviewed by Pith; the record is open.

Background: Sleep staging is a fundamental component in the diagnosis of sleep disorders and the management of sleep health. Traditionally, this analysis is conducted in clinical settings and involves a time-consuming scoring procedure. Recent data-driven algorithms for sleep staging, using the photoplethysmogram (PPG) time series, have shown high performance on local test sets but lower performance on external datasets due to data drift. Methods: This study aimed to develop a generalizable deep learning model for the task of four class (wake, light, deep, and rapid eye movement (REM)) sleep staging from raw PPG physiological time-series. Six sleep datasets, totaling 2,574 patients recordings, were used. In order to create a more generalizable representation, we developed and evaluated a deep learning model called SleepPPG-Net2, which employs a multi-source domain training approach.SleepPPG-Net2 was benchmarked against two state-of-the-art models. Results: SleepPPG-Net2 showed consistently higher performance over benchmark approaches, with generalization performance (Cohen's kappa) improving by up to 19%. Performance disparities were observed in relation to age, sex, and sleep apnea severity. Conclusion: SleepPPG-Net2 sets a new standard for staging sleep from raw PPG time-series.