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Qi Y, Zhang A, Ma Y, Chang T, Xu J. Comparison of pulse rate variability from post-auricula and heart rate variability during different body states for healthy subjects. J Med Eng Technol 2023; 47:179-188. [PMID: 36794319 DOI: 10.1080/03091902.2023.2175061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Heart rate variability (HRV) extracted from the electrocardiogram (ECG) is an essential indicator for assessing the autonomic nervous system in clinical. Some scholars have studied the feasibility of pulse rate variability (PRV) instead of HRV. However, there is little qualitative research in different body states. In this paper, the photoplethysmography (PPG) of postauricular and finger and the ECG of fifteen subjects were synchronously collected for comparative analysis. The eleven experiments were designed according to the daily living state, including the stationary state, limb movement state, and facial movement state. The substitutability of nine variables was investigated in the time, frequency, and nonlinearity domain by Passing Bablok regression and Bland Altman analysis. The results showed that the PPG of the finger was destroyed in the limb movement state. There were six variables of postauricular PRV, which showed a positive linear relationship and good agreement (p > 0.05, ratio ≤0.2) with HRV in all experiments. Our study suggests that the postauricular PPG could retain the necessary information of the pulse signal under the limb movement state and facial movement state. Therefore, postauricular PPG could be a better substitute for HRV, daily PPG detection, and mobile health than finger PPG.
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Affiliation(s)
- Yusheng Qi
- College of Electrical and Information Engineering, Lanzhou University of Technology, Lanzhou, China.,Key Laboratory of Gansu Advanced Control for Industrial Processes, Lanzhou University of Technology, Lanzhou, China.,National Demonstration Center for Experimental Electrical and Control Engineering Education, Lanzhou University of Technology, Lanzhou, China
| | - Aihua Zhang
- College of Electrical and Information Engineering, Lanzhou University of Technology, Lanzhou, China.,Key Laboratory of Gansu Advanced Control for Industrial Processes, Lanzhou University of Technology, Lanzhou, China.,National Demonstration Center for Experimental Electrical and Control Engineering Education, Lanzhou University of Technology, Lanzhou, China.,College of Computer and Communication, Lanzhou University of Technology, Lanzhou, China
| | - Yurun Ma
- College of Electrical and Information Engineering, Lanzhou University of Technology, Lanzhou, China.,Key Laboratory of Gansu Advanced Control for Industrial Processes, Lanzhou University of Technology, Lanzhou, China.,National Demonstration Center for Experimental Electrical and Control Engineering Education, Lanzhou University of Technology, Lanzhou, China
| | - Tingting Chang
- College of Electrical and Information Engineering, Lanzhou University of Technology, Lanzhou, China.,Key Laboratory of Gansu Advanced Control for Industrial Processes, Lanzhou University of Technology, Lanzhou, China.,College of Computer and Communication, Lanzhou University of Technology, Lanzhou, China
| | - Jianwen Xu
- College of Electrical and Information Engineering, Lanzhou University of Technology, Lanzhou, China.,Key Laboratory of Gansu Advanced Control for Industrial Processes, Lanzhou University of Technology, Lanzhou, China.,National Demonstration Center for Experimental Electrical and Control Engineering Education, Lanzhou University of Technology, Lanzhou, China
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2
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Cluster analysis of clinical phenotypic heterogeneity in obstructive sleep apnea assessed using photoplethysmography. Sleep Med 2023; 102:134-141. [PMID: 36641931 DOI: 10.1016/j.sleep.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/15/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND We evaluated heterogeneity in clinical phenotypes among patients with obstructive sleep apnea syndrome (OSAHS) using photoplethysmography (PPG) in cluster analysis. METHODS All enrolled patients underwent polysomnography (PSG) monitoring while wearing a PPG device. Pulse wave signals were recorded with a modified pulse oximetry probe in the PPG device. The pulse wave-derived cardiac risk composite parameter (CRI) and eight derived signal parameters were used to assess OSAHS phenotype. We defined a high cardiovascular risk OSAHS group (CRI ≥0.5) and low cardiovascular risk OSAHS group (CRI <0.5). K-means clustering was performed for analysis of clinical phenotype heterogeneity in OSAHS by combining the CRI and its derived signals. RESULTS The OSAHS group had high cardiovascular risk for sex, age, body mass index, systolic and diastolic blood pressure, apnea hypopnea index, and obstructive arousal index and higher risk of developing hypertension, diabetes, and cerebrovascular comorbidities. The low cardiovascular risk OSAHS group had higher blood oxygen levels. Three clinical phenotypes were identified in CRI clustering: 1) typical OSAHS with high risk of hypertension (characterized by middle age, obesity, hypertension with severe OSAHS); 2) older women and mild OSAHS; 3) older men and mild OSAHS. Three subtypes were obtained based on the eight cardiac risk-derived parameters: 1) hypoxia combined with decreased pulse wave amplitude variation; 2) decreased vascular pulse wave amplitude combined with decreased pulse frequency; 3) arrhythmia combined with hypoxia. CONCLUSIONS Establishing OSAHS clinical phenotypes with the CRI and derived parameters using PPG may help in establishing multi-dimensional assessment of cardiovascular risk in OSAHS.
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3
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Hajipour M, Baumann B, Azarbarzin A, Allen AH, Liu Y, Fels S, Goodfellow S, Singh A, Jen R, Ayas NT. Association of alternative polysomnographic features with patient outcomes in obstructive sleep apnea: a systematic review. J Clin Sleep Med 2023; 19:225-242. [PMID: 36106591 PMCID: PMC9892740 DOI: 10.5664/jcsm.10298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES Polysomnograms (PSGs) collect a plethora of physiologic signals across the night. However, few of these PSG data are incorporated into standard reports, and hence, ultimately, under-utilized in clinical decision making. Recently, there has been substantial interest regarding novel alternative PSG metrics that may help to predict obstructive sleep apnea (OSA)-related outcomes better than standard PSG metrics such as the apnea-hypopnea index. We systematically review the recent literature for studies that examined the use of alternative PSG metrics in the context of OSA and their association with health outcomes. METHODS We systematically searched EMBASE, MEDLINE, and the Cochrane Database of Systematic Reviews for studies published between 2000 and 2022 for those that reported alternative metrics derived from PSG in adults and related them to OSA-related outcomes. RESULTS Of the 186 initial studies identified by the original search, data from 31 studies were ultimately included in the final analysis. Numerous metrics were identified that were significantly related to a broad range of outcomes. We categorized the outcomes into 2 main subgroups: (1) cardiovascular/metabolic outcomes and mortality and (2) cognitive function- and vigilance-related outcomes. Four general categories of alternative metrics were identified based on signals analyzed: autonomic/hemodynamic metrics, electroencephalographic metrics, oximetric metrics, and respiratory event-related metrics. CONCLUSIONS We have summarized the current landscape of literature for alternative PSG metrics relating to risk prediction in OSA. Although promising, further prospective observational studies are needed to verify findings from other cohorts, and to assess the clinical utility of these metrics. CITATION Hajipour M, Baumann B, Azarbarzin A, et al. Association of alternative polysomnographic features with patient outcomes in obstructive sleep apnea: a systematic review. J Clin Sleep Med. 2023;19(2):225-242.
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Affiliation(s)
- Mohammadreza Hajipour
- Department of Experimental Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Brett Baumann
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - A.J. Hirsch Allen
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Yu Liu
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Pharmacology, Shanxi Medical University, Taiyuan, China
| | - Sidney Fels
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sebastian Goodfellow
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amrit Singh
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Rachel Jen
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Najib T. Ayas
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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4
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Glos M, Triché D. Home Sleep Testing of Sleep Apnea. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:147-157. [PMID: 36217083 DOI: 10.1007/978-3-031-06413-5_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Measurement methods with graded complexity for use in the lab as well as for home sleep testing (HST) are available for the diagnosis of sleep apnea, and there are different classification systems in existence. Simplified HST measurements, which record fewer parameters than traditional four- to six-channel devices, can indicate sleep apnea and can be used as screening tool in high-prevalence patient groups. Peripheral arterial tonometry (PAT) is a technique which can be suitable for the diagnosis of sleep apnea in certain cases. Different measurement methods are used, which has an influence on the significance of the results. New minimal-contact and non-contact technologies of recording and analysis of surrogate parameters are under development. If they are validated by clinical studies, it will be possible to detect sleep apnea in need of treatment more effectively. In addition, this could become a solution to monitor the effectiveness of such treatment.
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Affiliation(s)
- Martin Glos
- Interdisciplinary Center for Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Dora Triché
- Department of Respiratory Medicine, Allergology, Sleep Medicine, Paracelsus Medical University Nuremberg, Nuremberg General Hospital, Nuremberg, Germany
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5
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Abstract
New trends in sleep medicine make use of the increased computational power of digital transformation. A current trend toward fewer sensors on the body of the sleeper and to more data processing from derived signals is observed. Telemedicine technologies are used for data transmission and for better patient management in terms of diagnosis and in terms of treatment of chronic conditions.
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6
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Strassberger C, Zou D, Penzel T, Fietze I, Hedner J, Ficker JH, Randerath W, Sanner B, Sommermeyer D, Grote L. Beyond the AHI-pulse wave analysis during sleep for recognition of cardiovascular risk in sleep apnea patients. J Sleep Res 2021; 30:e13364. [PMID: 34032334 DOI: 10.1111/jsr.13364] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
Recent evidence supports the use of pulse wave analysis during sleep for assessing functional aspects of the cardiovascular system. The current study compared the influence of pulse wave and sleep study-derived parameters on cardiovascular risk assessment. In a multi-centric study design, 358 sleep apnea patients (age 55 ± 13 years, 64% male, body mass index 30 ± 6 kg m-2 , apnea-hypopnea index 13 [5-26] events per hr) underwent a standard overnight sleep recording. A novel cardiac risk index was computed based on pulse wave signals derived from pulse oximetry, reflecting vascular stiffness, cardiac variability, vascular autonomic tone and nocturnal hypoxia. Cardiovascular risk was determined using the ESC/ESH cardiovascular risk matrix, and categorized to high/low added cardiovascular risk. Comparisons between cardiac risk index and sleep parameters were performed for cardiovascular risk prediction. Apnea-hypopnea index, oxygen desaturation index and cardiac risk index were associated with high cardiovascular risk after adjustment for confounders (p = .002, .001, < .001, respectively). In a nested reference model consisting of age, gender and body mass index, adding cardiac risk index but not apnea-hypopnea index or oxygen desaturation index significantly increased the area under the receiver operating characteristic curve (p = .012, .22 and .16, respectively). In a direct comparison of oxygen desaturation index and cardiac risk index, only the novel risk index had an independent effect on cardiovascular risk prediction (pCRI < .001, pODI = .71). These results emphasize the association between nocturnal pulse wave and overall cardiovascular risk determined by an established risk matrix. Thus, pulse wave analysis during sleep provides a powerful approach for cardiovascular risk assessment in addition to conventional sleep study parameters.
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Affiliation(s)
- Christian Strassberger
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ding Zou
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Thomas Penzel
- Center of Sleep Medicine, CC12, University Hospital Charité, Berlin, Germany
| | - Ingo Fietze
- Center of Sleep Medicine, CC12, University Hospital Charité, Berlin, Germany
| | - Jan Hedner
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Sleep Disorders Centre, Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nurenberg, Germany
| | | | - Bernd Sanner
- Department of Pulmonary Medicine, Agaplesion Bethesda Krankenhaus Wuppertal, Wuppertal, Germany
| | - Dirk Sommermeyer
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ludger Grote
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Sleep Disorders Centre, Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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7
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8
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Hirotsu C, Betta M, Bernardi G, Marques-Vidal P, Vollenweider P, Waeber G, Pichot V, Roche F, Siclari F, Haba-Rubio J, Heinzer R. Pulse wave amplitude drops during sleep: clinical significance and characteristics in a general population sample. Sleep 2021; 43:5715731. [PMID: 31978212 PMCID: PMC7355400 DOI: 10.1093/sleep/zsz322] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/06/2019] [Indexed: 11/13/2022] Open
Abstract
Study Objectives To explore the clinical significance of pulse wave amplitude (PWA)-drops during sleep as a biomarker for cardiometabolic disorders and describe their main characteristics in a general population sample. Methods Cross-sectional study of HypnoLaus cohort, in which 2162 individuals underwent clinical assessment and in-home full polysomnography. PWA-drops were derived from photoplethysmography and processed using a validated automated algorithm. Associations between PWA-drop features (index, mean duration, and mean area under the curve [AUC]) with hypertension, diabetes, and previous cardiovascular (CV) event were analyzed using multivariable-adjusted logistic regression. Results Two thousand one hundred forty-nine participants (59 ± 11 years, 51% women, 9.9% diabetes, 41.3% hypertension, 4.4% CV event) were included. Mean ± standard deviation (SD) of PWA-drop index, duration, and AUC during sleep were 51.0 ± 20.3 events/hour, 14.0 ± 2.7 seconds, and 527±115 %seconds, respectively. PWA-drop index was lower in women and decreased with age, while its mean duration and AUC increased in men and elderly. Overall, lower PWA-drop index, longer duration and greater AUC were associated with increased odds of hypertension, diabetes, or CV event after adjustment for confounders. Participants in the lowest quartile of mean duration-normalized PWA-drop index had a significantly higher odds ratio (OR) of hypertension (OR = 1.60 [1.19–2.16]), CV event (OR = 3.26 [1.33–8.03]), and diabetes (OR = 1.71 [1.06–2.76]) compared to those in the highest quartile. Similar results were observed for mean AUC-normalized PWA-drop index regarding hypertension (OR = 1.59 [1.19–2.13]), CV event (OR = 2.45 [1.14–5.26]) and diabetes (OR = 1.76 [1.10–2.83]). Conclusions PWA-drop features during sleep seem to be an interesting biomarker independently associated with cardiometabolic outcomes in the general population.
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Affiliation(s)
- Camila Hirotsu
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland (Institution where the work was performed)
| | - Monica Betta
- IMT School for Advanced Studies Lucca, Lucca, Italy
| | | | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Gérard Waeber
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Vincent Pichot
- University Hospital of Saint-Étienne, Clinical and Exercise Physiology, Saint-Étienne, France
| | - Frederic Roche
- University Hospital of Saint-Étienne, Clinical and Exercise Physiology, Saint-Étienne, France
| | - Francesca Siclari
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland (Institution where the work was performed)
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland (Institution where the work was performed)
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland (Institution where the work was performed).,Pulmonary Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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9
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The novel three-dimensional pulse images analyzed by dynamic L-cube polynomial model. Med Biol Eng Comput 2021; 59:315-326. [PMID: 33438109 DOI: 10.1007/s11517-020-02289-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
A dynamic L-cube polynomial is proposed to analyze dynamic three-dimensional pulse images (d3DPIs), as an extension of the previous static L-cube polynomial. In this paper, a weighted least squares (WLS) method is proposed to fit the amplitude C(t) of d3DPI at four physiological key points in addition to the best fit of L-cube polynomials to the measured normal and cold-pressor-test (CPT)-induced taut 3DPIs. Compared with other two fitting functions, C(t) of a dynamic L-cube polynomial can be well matched by the proposed WLS method with the least relative error at four physiological key points in one beat with statistical significance, in addition to the best fit of the measured 3DPIs. Therefore, a dynamic L-cube polynomial can reflect dynamic time characteristics of normal and CPT-induced hypertensive taut 3DPIs, which can be used as an evidence of hypertension diagnosis.
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10
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Pandey RK, Chao PCP. External temperature sensor assisted a new low power photoplethysmography readout system for accurate measurement of the bio-signs. MICROSYSTEM TECHNOLOGIES : SENSORS, ACTUATORS, SYSTEMS INTEGRATION 2020; 27:2315-2343. [PMID: 33281302 PMCID: PMC7695241 DOI: 10.1007/s00542-020-05106-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/07/2020] [Indexed: 06/12/2023]
Abstract
This study presents an external temperature sensor assisted a new low power, time-interleave, wide dynamic range, and low DC drift photoplethysmography (PPG) signal acquisition system to obtain the accurate measurement of various bio signs in real-time. The designed chip incorporates a 2-bit control programmable transimpedance amplifier (TIA), a high order filter, a 3:8 programmable gain amplifier (PGA) and 2 × 2 organic light-emitting diode (OLED) driver. Temperature sensor is used herein to compensate the adverse effect of low-skin-temperature on the PPG signal quality. The analog front-end circuit is implemented in the integrated chip with chip area of 2008 μm × 1377 μm and fabricated via TSMC T18 process. With the standard 1.8 V, the experimental result shows that the measured current sensing range is 20 nA-100 uA. The measured dynamic range of the designed readout circuit is 80 dB. The estimated signal to noise ratio is 60 dB@1 uA, and the measured input referred noise is 60.2 pA/Hz½. The total power consumption of the designed chip is 31.32 µW (readout) + 1.62 mW (OLED driver@100% duty cycle). The non-invasive PPG sensor is applied to the wrist artery of the 40 healthy subjects for sensing the pulsation of the blood vessel. The experimental results show that for every 1 °C decrease in mean ambient temperature tends to 0.06 beats/min, 0.125 mmHg and 0.063 mmHg increase in hear rate (HR), systolic (SBP) and diastolic (DBP), respectively. Similarly, for every 1 °C increase in mean ambient temperature tends to 0.13 beats/min, 0.601 mmHg and 0.121 mmHg increase in HR, SBP and DBP, respectively. The measured accuracy and standard error for the HR estimation are 96%, and - 0.022 ± 2.589 beats/minute, respectively. The oxygen stauration (SpO2) measurement results shows that the mean absolute percentage error is less than 5%. The resultant errors for the SBP and DBP measurement are - 0.318 ± 5.19 mmHg and - 0.5 ± 1.91 mmHg, respectively.
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Affiliation(s)
- Rajeev Kumar Pandey
- EECS International Graduate Program, National Chiao Tung University, Hsinchu, 300 Taiwan
| | - Paul C.-P. Chao
- Department of Electrical Engineering, National Chiao Tung University, Hsinchu, 300 Taiwan
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11
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Laharnar N, Grote L, Zou D, Hedner J, Sommermeyer D, Straßberger C, Marciniak A, Potzka S, Lederer K, Glos M, Zimmermann S, Fietze I, Penzel T. Overnight pulse wave analysis to assess autonomic changes during sleep in insomnia patients and healthy sleepers. PLoS One 2020; 15:e0232589. [PMID: 32379833 PMCID: PMC7205215 DOI: 10.1371/journal.pone.0232589] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/18/2020] [Indexed: 01/16/2023] Open
Abstract
Insomnia has been associated with increased cardiovascular (CV) risk, which may be linked to sympathetic activation. Non-invasive overnight pulse wave analysis may be a useful tool to detect early signs of autonomic changes during sleep in insomniacs. Fifty-two participants (26 men, 37±13 years, BMI: 24±5 kg/m2, 26 insomniacs/ 26 controls) underwent overnight polysomnography with pulse oximetry and pulse wave analysis including pulse rate, vascular stiffness (pulse propagation time, PPT), and a composite cardiac risk index based on autonomic function and overnight hypoxia. We identified two subgroups of insomniacs, with and without objectively disturbed sleep (sleep efficiency SE≤80%, n = 14 vs. SE>80%, n = 12), and observed increased pulse rate and vascular stiffness in insomnia cases when diagnosis was based on both, subjective and objective criteria. Both insomnia groups were associated with higher overnight pulse rate than controls (median/ IQR: low-SE (low sleep efficiency): 67/ 58-70bpm; high-SE: 66/ 63-69bpm; controls: 58/ 52-63bpm; p = 0.01). Vascular stiffness was higher (reduction of PPT) in low-SE insomniacs compared with high-SE insomniacs and controls (169/ 147-232ms; 237/ 215-254ms; 244/ 180-284ms; p = 0.01). The cardiac risk index was increased in low-SE insomniacs (0.2/ 0.0–0.7; 0.0/ 0.0–0.4; 0.0/ 0.0–0.3; p = 0.05). Our results suggest a hyperarousal state in young and otherwise healthy insomniacs during sleep. The increased pulse rate and vascular stiffness in insomniacs with low SE suggest early signs of rigid vessels and potentially, an elevated CV risk. Overnight pulse wave analysis may be feasible for CV risk assessment in insomniacs and may provide a useful tool for phenotyping insomnia in order to provide individualized therapy.
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Affiliation(s)
- Naima Laharnar
- Interdisciplinary Center of Sleep Medicine, Charité –Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Ludger Grote
- Center for Sleep and Vigilance Disorders, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ding Zou
- Center for Sleep and Vigilance Disorders, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Hedner
- Center for Sleep and Vigilance Disorders, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dirk Sommermeyer
- Institute for Digital Signal Processing, Faculty of Information Technology, University Mannheim, Mannheim, Germany
| | - Christian Straßberger
- Center for Sleep and Vigilance Disorders, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Albert Marciniak
- Center for Sleep and Vigilance Disorders, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sabrina Potzka
- Interdisciplinary Center of Sleep Medicine, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Lederer
- Interdisciplinary Center of Sleep Medicine, Charité –Universitätsmedizin Berlin, Berlin, Germany
- Advanced Sleep Research GmbH, Berlin, Germany
| | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Zimmermann
- Interdisciplinary Center of Sleep Medicine, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité –Universitätsmedizin Berlin, Berlin, Germany
- Saratov State University, Saratov, Russia
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12
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Betta M, Handjaras G, Ricciardi E, Pietrini P, Haba-Rubio J, Siclari F, Heinzer R, Bernardi G. Quantifying peripheral sympathetic activations during sleep by means of an automatic method for pulse wave amplitude drop detection. Sleep Med 2020; 69:220-232. [DOI: 10.1016/j.sleep.2019.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/19/2019] [Accepted: 12/23/2019] [Indexed: 12/28/2022]
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13
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Fischer C, Penzel T. Continuous non-invasive determination of nocturnal blood pressure variation using photoplethysmographic pulse wave signals: comparison of pulse propagation time, pulse transit time and RR-interval. Physiol Meas 2019; 40:014001. [PMID: 30523856 DOI: 10.1088/1361-6579/aaf298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Cardiovascular diseases are the leading cause of death, whereas nocturnal ambulatory blood pressure (BP) is the most potent predictor for cardiovascular risk. The volume clamp and pulse transit time (PTT) are common methods for continuous non-invasive BP measurement, but have drawbacks during unsupervised ambulatory use and undisturbed sleep. The pulse propagation time (PPT), defined as the time between pulse wave systolic peak and diastolic peak, provides valid information about the pressure pulse waveform. However, the use of PPT for nocturnal BP variation determination and whether such variation is affected by BP or heart rate (i.e. RR-interval or RRI) has not been investigated. APPROACH To assess whether the PPT method is suitable for ubiquitous nocturnal BP monitoring, we compared systolic blood pressure (SBP) estimates derived from PPT, PTT, and RRI signals with parallel recorded BP measurements. The RRI-derived SBP signals were used as a baseline for testing a potential heart rate dependency. This work provides an overview of BP measurements, presents the developed real-time signal analysis, and describes the performance assessment. The signal analysis was validated with data records from 42 subjects acquired from an ergometry and sleep laboratory in equal parts. MAIN RESULTS The algorithms applied to the ergometry laboratory database achieved a correlation coefficient between reference SBP and estimated SBPPPT of 0.89 (p < 0.001) with bias 0.1 mmHg and limits of agreement (LoA) -29.8 to 30.0 mmHg, SBPPTT of 0.97 (p < 0.001) with bias 0.0 mmHg and LoA -15.2 to 15.3 mmHg, and SBPRRI of 0.96 (p < 0.001) with bias 0.0 mmHg and LoA -19.5 to 19.5 mmHg. For the sleep laboratory database, the correlation coefficient was 0.95 (p < 0.001) with bias 0.2 mmHg and LoA -18.3 to 18.8 mmHg for SBPPPT, 0.88 (p < 0.001) with bias 0.0 mmHg and LoA -25.0 to 24.9 mmHg for SBPPTT, and 0.88 (p < 0.001) with bias of 0.1 mmHg and LoA -23.6 to 23.7 mmHg for SBPRRI. A heart rate dependency of PPT or PTT could not be found. The analysis of variance shows no significant differences between the reference SBP values and the estimated values for either the ergometry (F(3, 627) = 2.27, p = 0.08) or the sleep laboratory (F(3, 327) = 2.28, p = 0.08). SIGNIFICANCE In conclusion, the PPT method seems to be an interesting alternative for continuous determination of SBP during simplified cardiovascular monitoring and sleep screening compared to more expensive devices based on volume clamp or PTT methods.
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Affiliation(s)
- Christoph Fischer
- Roche Diabetes Care GmbH, Mannheim, Germany. Interdisziplinäres Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Fricke K, Schneider H, Biselli P, Hansel NN, Zhang ZG, Sowho MO, Grote L. Nasal high flow, but not supplemental O 2, reduces peripheral vascular sympathetic activity during sleep in COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:3635-3643. [PMID: 30464446 PMCID: PMC6220426 DOI: 10.2147/copd.s166093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Patients with COPD have increased respiratory loads and altered blood gases, both of which affect vascular function and sympathetic activity. Sleep, particularly rapid eye movement (REM) sleep, is known to exacerbate hypoxia and respiratory loads. Therefore, we hypothesize that nasal high flow (NHF), which lowers ventilatory loads, reduces sympathetic activity during sleep and that this effect depends on COPD severity. Methods We performed full polysomnography in COPD patients (n=17; FEV1, 1.6±0.6 L) and in matched controls (n=8). Participants received room air (RA) at baseline and single night treatment with O2 (2 L/min) and NHF (20 L/min) in a random order. Finger pulse wave amplitude (PWA), a measure of vascular sympathetic tone, was assessed by photoplethysmography. Autonomic activation (AA) events were defined as PWA attenuation ≥30% and indexed per hour for sleep stages (AA index [AAI]) at RA, NHF, and O2). Results In COPD, sleep apnea improved following O2 (REM-apnea hypopnea index [AHI] with RA, O2, and NHF: 18.6±20.9, 12.7±18.1, and 14.4±19.8, respectively; P=0.04 for O2 and P=0.06 for NHF). REM-AAI was reduced only following NHF in COPD patients (AAI-RA, 21.5±18.4 n/h and AAI-NHF, 9.9±6.8 n/h, P=0.02) without changes following O2 (NHF-O2 difference, P=0.01). REM-AAI reduction was associated with lung function expressed as FEV1 and FVC (FEV1: r=−0.59, P=0.001; FEV1/FVC: r=−0.52 and P=0.007). Conclusion NHF but not elevated oxygenation reduces peripheral vascular sympathetic activity in COPD patients during REM sleep. Sympathetic off-loading by NHF, possibly related to improved breathing mechanics, showed a strong association with COPD severity.
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Affiliation(s)
- K Fricke
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Department for Pulmonary, Sleep, and Intensive Care Medicine, Helios Klinikum, Wuppertal, Germany
| | - H Schneider
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA,
| | - P Biselli
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Intensive Care Unit, Medical Division, University Hospital, University of Sao Paolo, Sao Paolo, Brazil
| | - N N Hansel
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA,
| | - Z G Zhang
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Department for Geriatrics, Peking University First Hospital, Beijing, China
| | - M O Sowho
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA,
| | - L Grote
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, .,Sleep Disorders Center, Department for Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Center for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Moraes JL, Rocha MX, Vasconcelos GG, Vasconcelos Filho JE, de Albuquerque VHC, Alexandria AR. Advances in Photopletysmography Signal Analysis for Biomedical Applications. SENSORS (BASEL, SWITZERLAND) 2018; 18:E1894. [PMID: 29890749 PMCID: PMC6022166 DOI: 10.3390/s18061894] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/27/2018] [Accepted: 06/06/2018] [Indexed: 02/04/2023]
Abstract
Heart Rate Variability (HRV) is an important tool for the analysis of a patient’s physiological conditions, as well a method aiding the diagnosis of cardiopathies. Photoplethysmography (PPG) is an optical technique applied in the monitoring of the HRV and its adoption has been growing significantly, compared to the most commonly used method in medicine, Electrocardiography (ECG). In this survey, definitions of these technique are presented, the different types of sensors used are explained, and the methods for the study and analysis of the PPG signal (linear and nonlinear methods) are described. Moreover, the progress, and the clinical and practical applicability of the PPG technique in the diagnosis of cardiovascular diseases are evaluated. In addition, the latest technologies utilized in the development of new tools for medical diagnosis are presented, such as Internet of Things, Internet of Health Things, genetic algorithms, artificial intelligence and biosensors which result in personalized advances in e-health and health care. After the study of these technologies, it can be noted that PPG associated with them is an important tool for the diagnosis of some diseases, due to its simplicity, its cost⁻benefit ratio, the easiness of signals acquisition, and especially because it is a non-invasive technique.
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Affiliation(s)
- Jermana L Moraes
- Programa de Pós-Graduação em Engenharia de Telecomunicações, Instituto Federal de Educação, Ciência e Tecnologia do Ceará, Fortaleza 60040-531, Ceará, Brazil.
| | - Matheus X Rocha
- Programa de Pós-Graduação em Engenharia de Telecomunicações, Instituto Federal de Educação, Ciência e Tecnologia do Ceará, Fortaleza 60040-531, Ceará, Brazil.
| | - Glauber G Vasconcelos
- Hospital de Messejana⁻Dr. Carlos Alberto Studart⁻Avenida Frei Cirilo, 3480⁻Messejana, Fortaleza 60846-190, Ceará, Brazil.
| | - José E Vasconcelos Filho
- Programa de Pós-Graduação em Informática Aplicada, Laboratório de Bioinformática, Universidade de Fortaleza, Fortaleza 60811-905, Ceará, Brazil.
| | - Victor Hugo C de Albuquerque
- Programa de Pós-Graduação em Informática Aplicada, Laboratório de Bioinformática, Universidade de Fortaleza, Fortaleza 60811-905, Ceará, Brazil.
| | - Auzuir R Alexandria
- Programa de Pós-Graduação em Engenharia de Telecomunicações, Instituto Federal de Educação, Ciência e Tecnologia do Ceará, Fortaleza 60040-531, Ceará, Brazil.
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Grote L, Sommermeyer D, Ficker J, Randerath W, Penzel T, Fietze I, Sanner B, Hedner J, Schneider H. REM Sleep Imposes a Vascular Load in COPD Patients Independent of Sleep Apnea. COPD 2017; 14:565-572. [PMID: 28949781 DOI: 10.1080/15412555.2017.1365119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Arterial stiffness, a marker for cardiovascular risk, is increased in patients with Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnea (OSA). The specific influence of both on arterial stiffness during sleep is unknown. Nocturnal arterial stiffness (Pulse Propagation Time (PPT) of the finger pulse wave) was calculated in 142 individuals evaluated for sleep apnea: 27 COPD patients (64.7 ± 11y, 31.2 ± 8 kg/m2), 72 patients with cardiovascular disease (CVD group, 58.7 ± 13y, 33.6 ± 6 kg/m2) and 43 healthy controls (HC group 49.3 ± 12y, 27.6 ± 3 kg/m2). Sleep stage related PPT changes were assessed in a subsample of COPD patients and matched controls (n = 12/12). Arterial stiffness during sleep was increased in COPD patients (i.e. shortened PPT) compared to healthy controls (158.2 ± 31 vs. 173.2 ± 38 ms, p = 0.075) and to patients with CVD (161.4 ± 41 ms). Arterial stiffening was particular strong during REM sleep (145.9 ± 28 vs. 172.4 ± 43 ms, COPD vs. HC, p = 0.003). In COPD, time SaO2 < 90% was associated with reduced arterial stiffness (Beta +1.7 ms (1.1-2.3)/10 min, p < 0.001). Sleep apnea did not affect PPT. In COPD, but not in matched controls, arterial stiffness increased from wakefulness to REM-sleep (ΔPPT-8.9 ± 10% in COPD and 3.7 ± 12% in matched controls, p = 0.021). Moreover, REM-sleep related arterial stiffening was correlated with elevated daytime blood pressure (r = -0.92, p < 0.001) and increased myocardial oxygen consumption (r = -0.88, p < 0.01). Hypoxia and REM sleep modulate arterial stiffness. In contrast to healthy controls, REM sleep imposes a vascular load in COPD patients independent of sleep apnea indices, intermittent and sustained hypoxia. The link between REM-sleep, vascular stiffness and daytime cardiovascular function suggests that REM-sleep plays a role for increased cardiovascular morbidity of COPD patients.
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Affiliation(s)
- Ludger Grote
- a Center for Sleep and Wakefulness Disorders , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.,b Department of Respiratory and Critical Care Medicine , Johns Hopkins University , Baltimore , USA
| | - Dirk Sommermeyer
- a Center for Sleep and Wakefulness Disorders , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.,c ochschule Mannheim - University of Applied Sciences , Department of Information Technology , Mannheim , Germany
| | - Joachim Ficker
- d Department of Respiratory Medicine, Allergology and Sleep Medicine , Klinikum Nuremberg/ Paracelsus Medical University , Nuremberg , Germany
| | - Winfried Randerath
- e Department of Pulmonary Medicine, Bethanien Hospital , Solingen , Germany
| | - Thomas Penzel
- f Department of Cardiology , University Hospital Charité , Berlin , Germany
| | - Ingo Fietze
- f Department of Cardiology , University Hospital Charité , Berlin , Germany
| | - Bernd Sanner
- g Department of Pulmonary Medicine , Bethesda Hospital , Wuppertal , Germany
| | - Jan Hedner
- a Center for Sleep and Wakefulness Disorders , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Hartmut Schneider
- b Department of Respiratory and Critical Care Medicine , Johns Hopkins University , Baltimore , USA
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Randerath WJ, Treml M, Priegnitz C, Hedner J, Sommermeyer D, Zou D, Ficker JH, Fietze I, Penzel T, Sanner B, Grote L. Parameters of Overnight Pulse Wave under Treatment in Obstructive Sleep Apnea. Respiration 2016; 92:136-43. [DOI: 10.1159/000448248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/08/2016] [Indexed: 11/19/2022] Open
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