Enhancing Survival Analysis Model Selection through XAI(t) in Healthcare

Artificial intelligence algorithms have become extensively utilized in survival analysis for high-dimensional, multi-source data. However, due to their complexity, these methods often yield poorly interpretable outcomes, posing challenges in the analysis of several conditions. One of these conditions is obstructive sleep apnea, a sleep disorder characterized by the simultaneous occurrence of comorbidities. Survival analysis provides a potential solution for assessing and categorizing the severity of obstructive sleep apnea, aiding personalized treatment strategies. Given the critical role of time in such scenarios and considering limitations in model interpretability, time-dependent explainable artificial intelligence algorithms have been developed in recent years for direct application to basic Machine Learning models, such as Cox regression and survival random forest. Our work aims to enhance model selection in OSA survival analysis using time-dependent XAI for Machine Learning and Deep Learning models. We developed an end-to-end pipeline, training several survival models and selecting the best performers. Our top models—Cox regression, Cox time, and logistic hazard—achieved good performance, with C-index scores of 0.81, 0.78, and 0.77, and Brier scores of 0.10, 0.12, and 0.11 on the test set. We applied SurvSHAP methods to Cox regression and logistic hazard to investigate their behavior. Although the models showed similar performance, our analysis established that the results of the log hazard model were more reliable and useful in clinical practice compared to those of Cox regression in OSA scenarios.