Pattern Analysis of Oxygen Saturation Variability in Healthy Individuals: Entropy of Pulse Oximetry Signals Carries Information about Mean Oxygen Saturation

Arterial blood pressure monitoring in stroke cohorts: the impact of reduced sampling rates to optimise remote patient monitoring

OBJECTIVE

Remote patient monitoring (RPM) beat-to-beat blood pressure (BP) provides an opportunity to measure poststroke BP variability (BPV), which is associated with clinical stroke outcomes. BP sampling interval (SI) influences ambulatory BPV, but RPM BP SI optimisation research is limited. SI and RPM device capabilities require compromises, meaning SI impact requires investigation. Therefore, this study assessed healthy and stroke subtype BPV via optimised BP sampling, aiding sudden BP change identification and potentially assisting cardiovascular event (recurrent stroke) prediction.

METHODS

Leicester Cerebral Haemodynamic Database ischaemic [acute ischaemic stroke (AIS), n  = 68] and haemorrhagic stroke (intracerebral haemorrhage, n  = 12) patient and healthy control (HC, n  = 40) baseline BP data were analysed. Intrasubject and interpatient SD (SD i /SD p ) represented individual/population variability with synthetically altered SIs. Matched-filter approaches using cross-correlation function detected sudden BP changes.

RESULTS

At SIs between 1 and 180 s, SBP and DBP SD i staticised while SD p increased at SI < 30 s. Mean BP and HR SD i and SD p increased at SI < 60s. AIS BPV, normalised to SI1s, increased at SI30s (26%-131%) and SI120s (1%-274%). BPV increased concomitantly with SI. Cross-correlation analysis showed HC and AIS BP sudden change detection accuracy reductions with increasing SI. Positive BP deviation detection fell 48.48% (SI10s) to 78.79% (SI75s) in HC and 67.5% (SI10s) to 100% (SI75s) in AIS. Negative BP deviation detection fell 50% (SI10s) to 82.35% (SI75s) in HC and 52.27% (SI10s) to 95.45% (SI75s) in AIS.

CONCLUSION

Sudden BP change detection and BPV are relatively robust to SI increases within certain limits, but accuracy reductions generate unacceptable estimates, considerable within RPM device design. This research warrants further SI optimisation.

Hospital Is Not the Home: Lessons From Implementing Remote Technology to Support Acute Inpatient and Transitional Care in the Home in the United States and United Kingdom

The COVID-19 pandemic, patient preference, and economic opportunity are shifting acute care from the hospital to the home, supported by the transformation in remote monitoring technology. Monitoring patients with digital medical devices gives unprecedented insight into their physiology. However, this technology does not exist in a vacuum. Distinguishing pathology from physiological variability, user error, or device limitations is challenging. In a hospital, patients are monitored in a contrived environment. Monitoring at home instead captures activities of daily living alongside patients' trajectory of disease and recovery. Both settings make for "noisy" data. However, we are familiar with hospital noise, accounting for it in our practice and perceptions of normal. Home monitoring as a diagnostic intervention introduces a new set of downstream consequences, dependent on device, cadence of collection, adherence, duration, alarm thresholds, and escalation criteria. We must accept greater ambiguity and contextualize vital signs. All devices balance accuracy with acceptability, so compromises are inevitable and perfect data should not be expected. Alarms must be specific as well as sensitive, balancing clinical risk with capacity for response. By setting expectations around data from the home, we can smooth the adoption of remote monitoring and accelerate the transition of acute care.

Heart Rate Variability, Blood Pressure and Peripheral Oxygen Saturation during Yoga Adham and Mahat Breathing Techniques without Retention in Adult Practitioners

Background: Heart rate variability (HRV) is the change in time intervals between heart beats, reflecting the autonomic nervous system's ability to adapt to psychological and physiological demands. Slow breathing enhances parasympathetic activity, increasing HRV. Pranayama, a yoga breathing technique, affords the conscious regulation of respiration frequency. This study aimed to characterize HRV, blood pressure and peripheral oxygen saturation of basic yoga breathing slow techniques with regular yoga practitioners. Methods: In total, 45 yoga practitioners were included in the study (including 7 males, mean age of 54.04 ± 11.97 years) with varying levels of yoga experience (minimum 3 months, maximum 37 years). Participants performed three breathing conditions: baseline (control) and two yoga techniques (abdominal (adham) and complete (mahat)) breathing, each for 10 min in the supine position (i.e., savasana). For each condition, respiratory frequency, heart rate (HR), blood pressure and peripheral oxygen levels were collected. Results: The findings revealed that both abdominal and complete yoga breathing techniques promoted a decrease in respiratory frequency (p < 0.001, r = 0.61; p < 0.001, r = 0.61, respectively), and an increase in peripheral oxygen saturation (p < 0.001, r = 0.50; p < 0.001, r = 0.46, respectively), along with blood pressure decreases in all mean values, and a significant decrease in systolic pressure, considering all conditions (p = 0.034, W = 0.08). There were significant increases in standard deviation of HR during abdominal and complete yoga breathing techniques compared with the baseline (p = 0.003, r = 0.31; p < 0.001, r = 0.47, respectively), indicating enhanced parasympathetic activity. Moreover, the complete breathing technique exhibited the greatest variability in HRV measures, with several significant differences compared with abdominal breathing (standard deviation of HR, p < 0.001, r = 0.42; SD2, standard deviation of points perpendicular to the Poincaré parallel line, p < 0.003, r = 0.31; SD1/SD2, p < 0.003, r = 0.31), suggesting a more profound impact on autonomic modulation. Conclusions: simple, inexpensive and non-intrusive abdominal and complete yoga breathing techniques can effectively and momentarily enhance HRV and oxygen saturation in adults, mature adults and the elderly.

Changes in physiological signal entropy in patients with obstructive sleep apnoea: a systematic review

Background and Objective.Obstructive sleep apnoea (OSA) affects an estimated 936 million people worldwide, yet only 15% receive a definitive diagnosis. Diagnosis of OSA poses challenges due to the dynamic nature of physiological signals such as oxygen saturation (SpO2) and heart rate variability (HRV). Linear analysis methods may not fully capture the irregularities present in these signals. The application of entropy of routine physiological signals offers a promising method to better measure variabilities in dynamic biological data. This review aims to explore entropy changes in physiological signals among individuals with OSA.Approach.Keyword and title searches were performed on Medline, Embase, Scopus, and CINAHL databases. Studies had to analyse physiological signals in OSA using entropy. Quality assessment used the Newcastle-Ottawa Scale. Evidence was qualitatively synthesised, considering entropy signals, entropy type, and time-series length.Main results.Twenty-two studies were included. Multiple physiological signals related to OSA, including SpO2, HRV, and the oxygen desaturation index (ODI), have been investigated using entropy. Results revealed a significant decrease in HRV entropy in those with OSA compared to control groups. Conversely, SpO2and ODI entropy values were increased in OSA. Despite variations in entropy types, time scales, and data extraction devices, studies using receiver operating characteristic curves demonstrated a high discriminative accuracy (>80% AUC) in distinguishing OSA patients from control groups.Significance. This review highlights the potential of SpO2entropy analysis in developing new diagnostic indices for patients with OSA. Further investigation is needed before applying this technique clinically.

Physiological network approach to prognosis in cirrhosis: A shifting paradigm

Decompensated liver disease is complicated by multi-organ failure and poor prognosis. The prognosis of patients with liver failure often dictates clinical management. Current prognostic models have focused on biomarkers considered as individual isolated units. Network physiology assesses the interactions among multiple physiological systems in health and disease irrespective of anatomical connectivity and defines the influence or dependence of one organ system on another. Indeed, recent applications of network mapping methods to patient data have shown improved prediction of response to therapy or prognosis in cirrhosis. Initially, different physical markers have been used to assess physiological coupling in cirrhosis including heart rate variability, heart rate turbulence, and skin temperature variability measures. Further, the parenclitic network analysis was recently applied showing that organ systems connectivity is impaired in patients with decompensated cirrhosis and can predict mortality in cirrhosis independent of current prognostic models while also providing valuable insights into the associated pathological pathways. Moreover, network mapping also predicts response to intravenous albumin in patients hospitalized with decompensated cirrhosis. Thus, this review highlights the importance of evaluating decompensated cirrhosis through the network physiologic prism. It emphasizes the limitations of current prognostic models and the values of network physiologic techniques in cirrhosis.

Complexity reduction of oxygen saturation variability signals in COVID-19 patients: Implications for cardiorespiratory control

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a respiratory illness that leads to severe acute respiratory syndrome and various cardiorespiratory complications, contributing to morbidity and mortality. Entropy analysis has demonstrated its ability to monitor physiological states and system dynamics during health and disease. The main objective of the study is to extract information about cardiorespiratory control by conducting a complexity analysis of OSV signals using scale-based entropy measures following a two-month timeframe after recovery.

METHODS

This prospective study collected data from subjects meeting specific criteria, using a Beurer PO-80 pulse oximeter to measure oxygen saturation (SpO2) and pulse rate. Excluding individuals with a history of pulmonary/cardiovascular issues, the study analyzed 88 recordings from 44 subjects (26 men, 18 women, mean age 45.34 ± 14.40) during COVID-19 and two months post-recovery. Data preprocessing and scale-based entropy analysis were applied to assess OSV signals.

RESULTS

The study found a significant difference in mean OSV during illness (95.08 ± 0.15) compared to post-recovery (95.59 ± 1.03), indicating reduced cardiorespiratory dynamism during COVID-19. Multiscale entropy analyses (MSE, MPE, MFE) confirmed lower entropy values during illness across all time scales, particularly at higher scales. Notably, the maximum distinction between illness and recovery phases was seen at specific time scales and similarity criteria for each entropy measure, showing statistically significant differences.

CONCLUSIONS

The study demonstrates that the loss of complexity in OSV signals, quantified using scale-based entropy measures, has the potential to detect malfunctioning of cardiorespiratory control in COVID-19 patients. This finding suggests that OSV signals could serve as a valuable indicator for assessing the cardiorespiratory status of COVID-19 patients and monitoring their recovery progress.

Scale based entropy measures and deep learning methods for analyzing the dynamical characteristics of cardiorespiratory control system in COVID-19 subjects during and after recovery

COVID-19, known as Coronavirus Disease 2019 primarily targets the respiratory system and can impact the cardiovascular system, leading to a range of cardiorespiratory complications. The current forefront in analyzing the dynamical characteristics of physiological systems and aiding clinical decision-making involves the integration of entropy-based complexity techniques with artificial intelligence. Entropy-based measures offer promising prospects for identifying disturbances in cardiorespiratory control system (CRCS) among COVID-19 patients by assessing the oxygen saturation variability (OSV) signals. In this investigation, we employ scale-based entropy (SBE) methods, including multiscale entropy (MSE), multiscale permutation entropy (MPE), and multiscale fuzzy entropy (MFE), to characterize the dynamical characteristics of OSV signals. These measurements serve as features for the application of traditional machine learning (ML) and deep learning (DL) approaches in the context of classifying OSV signals from COVID-19 patients during their illness and subsequent recovery. We use the Beurer PO-80 pulse oximeter which non-invasively acquired OSV and pulse rate data from COVID-19 infected patients during the active infection phase and after a two-month recovery period. The dataset comprises of 88 recordings collected from 44 subjects(26 men and 18 women), both during their COVID-19 illness and two months post-recovery. Prior to analysis, data preprocessing is performed to remove artifacts and outliers. The application of SBE measures to OSV signals unveils a reduction in signal complexity during the course of COVID-19. Leveraging these SBE measures as feature sets, we employ two DL techniques, namely the radial basis function network (RBFN) and RBFN with dynamic delay algorithm (RBFNDDA), for the classification of OSV data collected during and after COVID-19 recovery. To evaluate the classification performance, we employ standard metrics such as sensitivity, specificity, false positive rate (FPR), and the area under the receiver operator characteristic curve (AUC). Among the three scale-based entropy measures, MFE outperformed MSE and MPE by achieving the highest classification performance using RBFN with 13 best features having sensitivity (0.84), FPR (0.30), specificity (0.70) and AUC (0.77). The outcomes of our study demonstrate that SBE measures combined with DL methods offer a valuable approach for categorizing OSV signals obtained during and after COVID-19, ultimately aiding in the detection of CRCS dysfunction.

A high altitude respiration and SpO2 dataset for assessing the human response to hypoxia

This report presents the Harespod dataset, an open dataset for high altitude hypoxia research, which includes respiration and SpO2 data. The dataset was collected from 15 college students aged 23-31 in a hypobaric oxygen chamber, during simulated altitude changes and induced hypoxia. Real-time physiological data, such as oxygen saturation waveforms, oxygen saturation, respiratory waveforms, heart rate, and pulse rate, were obtained at 100 Hz. Approximately 12 hours of valid data were collected from all participants. Researchers can easily identify the altitude corresponding to physiological signals based on their inherent patterns. Time markers were also recorded during altitude changes to facilitate realistic annotation of physiological signals and analysis of time-difference-of-arrival between various physiological signals for the same altitude change event. In high altitude scenarios, this dataset can be used to enhance the detection of human hypoxia states, predict respiratory waveforms, and develop related hardware devices. It will serve as a valuable and standardized resource for researchers in the field of high altitude hypoxia research, enabling comprehensive analysis and comparison.

Studying Dynamical Characteristics of Oxygen Saturation Variability Signals Using Haar Wavelet

An aim of the analysis of biomedical signals such as heart rate variability signals, brain signals, oxygen saturation variability (OSV) signals, etc., is for the design and development of tools to extract information about the underlying complexity of physiological systems, to detect physiological states, monitor health conditions over time, or predict pathological conditions. Entropy-based complexity measures are commonly used to quantify the complexity of biomedical signals; however novel complexity measures need to be explored in the context of biomedical signal classification. In this work, we present a novel technique that used Haar wavelets to analyze the complexity of OSV signals of subjects during COVID-19 infection and after recovery. The data used to evaluate the performance of the proposed algorithms comprised recordings of OSV signals from 44 COVID-19 patients during illness and after recovery. The performance of the proposed technique was compared with four, scale-based entropy measures: multiscale entropy (MSE); multiscale permutation entropy (MPE); multiscale fuzzy entropy (MFE); multiscale amplitude-aware permutation entropy (MAMPE). Preliminary results of the pilot study revealed that the proposed algorithm outperformed MSE, MPE, MFE, and MMAPE in terms of better accuracy and time efficiency for separating during and after recovery the OSV signals of COVID-19 subjects. Further studies are needed to evaluate the potential of the proposed algorithm for large datasets and in the context of other biomedical signal classifications.

Becalm: Intelligent Monitoring of Respiratory Patients

The Becalm project is an open and low-cost solution for the remote monitoring of respiratory support therapies like the ones used in COVID-19 patients. Becalm combines a decision-making system based on Case-Based Reasoning with a low-cost, non-invasive mask that enables the remote monitoring, detection, and explanation of risk situations for respiratory patients. This paper first describes the mask and the sensors that allow remote monitoring. Then, it describes the intelligent decision-making system that detects anomalies and raises early warnings. This detection is based on the comparison of cases that represent patients using a set of static variables plus the dynamic vector of the patient time series from sensors. Finally, personalized visual reports are created to explain the causes of the warning, data patterns, and patient context to the healthcare professional. To evaluate the case-based early-warning system, we use a synthetic data generator that simulates patients' clinical evolution from the physiological features and factors described in healthcare literature. This generation process has been verified with a real dataset and allows the validation of the reasoning system with noisy and incomplete data, threshold values, and life/death situations. The evaluation demonstrates promising results and good accuracy (0.91) for the proposed low-cost solution to monitor respiratory patients.

Descriptive characteristics of continuous oximetry measurement in moderate to severe covid-19 patients

Non-invasive oxygen saturation (SpO2) is a central vital sign used to shape the management of COVID-19 patients. Yet, there have been no report quantitatively describing SpO2 dynamics and patterns in COVID-19 patients using continuous SpO2 recordings. We performed a retrospective observational analysis of the clinical information and 27 K hours of continuous SpO2 high-resolution (1 Hz) recordings of 367 critical and non-critical COVID-19 patients hospitalised at the Rambam Health Care Campus, Haifa, Israel. An absolute SpO2 threshold of 93% most efficiently discriminated between critical and non-critical patients, regardless of oxygen support. Oximetry-derived digital biomarker (OBMs) computed per 1 h monitoring window showed significant differences between groups, notably the cumulative time below 93% SpO2 (CT93). Patients with CT93 above 60% during the first hour of monitoring, were more likely to require oxygen support. Mechanical ventilation exhibited a strong effect on SpO2 dynamics by significantly reducing the frequency and depth of desaturations. OBMs related to periodicity and hypoxic burden were markedly affected, up to several hours before the initiation of the mechanical ventilation. In summary, OBMs, traditionally used in the field of sleep medicine research, are informative for continuous assessment of disease severity and response to respiratory support of hospitalised COVID-19 patients. In conclusion, OBMs may improve risk stratification and therapy management of critical care patients with respiratory impairment.

The complexity analysis of cerebral oxygen saturation during pneumoperitoneum and Trendelenburg position: a retrospective cohort study

BACKGROUND

The human brain is a highly complex and nonlinear system, nonlinear complexity measures such as approximate entropy (ApEn) and sample entropy (SampEn) can better reveal characteristics of brain dynamics. However, no studies report complexity of perioperative physiological signals to reveal how brain complexity associates with age, varies along with the development of surgery and postoperative neurological complications.

AIM

This study examined the complexity of intraoperative regional cerebral oxygen saturation (rSO₂), aiming to reveal brain dynamics during surgery.

METHODS

This retrospective cohort study enrolled patients who scheduled for robot-assisted urological surgery. Intraoperative rSO₂ was continuously monitored throughout the surgery. Postoperative delirium (POD) was diagnosed by the Confusion Assessment Method. ApEn and SampEn were used to characterize the complexity of rSO₂. Pearson correlation coefficients were used to measure the correlation between complexity of rSO₂ and age. The association between complexity of rSO₂ and POD was examined using T tests.

RESULTS

A total of 68 patients (mean [SD] age, 63.0 (12.0) years; 47 (69.1%) males) were include in this analysis. There was a significant reverse relationship between the complexity of rSO₂ and age (The correlation coefficients range between - 0.32 and - 0.28, all p < 0.05). Patients  ≥ 75 years showed significantly lower complexity of rSO₂ than the other two groups. Older age remained an independent factor influencing complexity of rSO₂ after adjusting for a number of covariates. Six patients (8.8%) developed POD, and POD patients had lower complexity of rSO₂ compared with non-POD patients.

CONCLUSIONS

The complexity of rSO₂ may serve as a new candidate marker of aging and POD prediction.

Reduced oxygen saturation entropy is associated with poor prognosis in critically ill patients with sepsis

Recent studies have found that oxygen saturation (SpO2 ) variability analysis has potential for noninvasive assessment of the functional connectivity of cardiorespiratory control systems during hypoxia. Patients with sepsis have suboptimal tissue oxygenation and impaired organ system connectivity. Our objective with this report was to highlight the potential use for SpO2 variability analysis in predicting intensive care survival in patients with sepsis. MIMIC-III clinical data of 164 adults meeting Sepsis-3 criteria and with 30 min of SpO2 and respiratory rate data were analyzed. The complexity of SpO2 signals was measured through various entropy calculations such as sample entropy and multiscale entropy analysis. The sequential organ failure assessment (SOFA) score was calculated to assess the severity of sepsis and multiorgan failure. While the standard deviation of SpO2 signals was comparable in the non-survivor and survivor groups, non-survivors had significantly lower SpO2 entropy than those who survived their ICU stay (0.107 ± 0.084 vs. 0.070 ± 0.083, p < 0.05). According to Cox regression analysis, higher SpO2 entropy was a predictor of survival in patients with sepsis. Multivariate analysis also showed that the prognostic value of SpO2 entropy was independent of other covariates such as age, SOFA score, mean SpO2 , and ventilation status. When SpO2 entropy was combined with mean SpO2 , the composite had a significantly higher performance in prediction of survival. Analysis of SpO2 entropy can predict patient outcome, and when combined with SpO2 mean, can provide improved prognostic information. The prognostic power is on par with the SOFA score. This analysis can easily be incorporated into current ICU practice and has potential for noninvasive assessment of critically ill patients.

Acute oxygen desaturation characterizes pulmonary aspiration in patients with gastroesophageal reflux disease and laryngopharyngeal reflux

The aim of this study was to characterise pulmonary aspiration of refluxate in patients with gastroesophageal reflux disease (GORD) and laryngopharyngeal reflux (LPR) by continuous pulse oximetry (SpO2) during the supine phase of a scintigraphic reflux study. Variables assessed for significance included age, hiatus hernia, frequency, amplitude of reflux and clearance of reflux from the oesophagus/pharynx. The patients included in this study had established GORD and LPR by clinical history. All patients underwent fused three- dimensional scintigraphic/ X-ray computed tomography (CT) and simultaneous continuous pulse oximetry when supine for 30 minutes. A total of 265 patients (40.4% M, 59.6% F) were studied. Mean age of aspirators was 57.0 years and non-aspirators was 53.5 years. Seven patients had baseline oxygen saturation <95%, with 6/7 showing aspiration by scintigraphy. The remainder had mean baseline saturation of 97.7%. Continuous SpO2 monitoring showed a significant fall in pulmonary aspirators after 20 min of supine acquisition with significant variability. Analysis revealed a cyclic event every 1.5 min in aspirators only. Panel regression analysis showed a significant effect of age, hiatus hernia, pulse rate and reflux frequency on the fall in SpO2. Pulmonary aspiration in patients with LPR and GORD is characterised by acute oxygen desaturation. Variables affecting oxygen desaturation were age, hiatus hernia, pulse rate and reflux frequency. A cyclic event was observed every 1.5 min in aspirators and may be due to reflex homeostatic mechanism attempting to correct perceived hypoxia.

Pulse oximetry in paediatric dentistry

Pulse oximetry is a technique used to measure the levels of blood oxygen saturation. Because this technique is regarded as non-invasive, easy to apply, and accurate technology, the number of possible applications in general dentistry practice has been gradually increasing. The aim of the present study was to summarise the contemporary research literature concerning the use of pulse oximetry in paediatric dentistry. We made a critical evaluation of the clinical applications of pulse oximetry and the advantages and disadvantages of this technique. Knowledge of innovative methods and techniques for treatment and diagnostics by paediatric dentists is a valuable advantage in dealing with the functional problems in attending dental patients. The expository analysis allows reviewing the succession of this diagnostic approach.

The Current and Future Role of Technology in Respiratory Care

Over the past few decades, technology and improvements in artificial intelligence have dramatically changed major sectors of our day-to-day lives, including the field of healthcare. E-health includes a wide range of subdomains, such as wearables, smart-inhalers, portable electronic spirometers, digital stethoscopes, and clinical decision support systems. E-health has been consistently shown to enhance the quality of care, improve adherence to therapy, and allow early detection of worsening in chronic pulmonary diseases. The present review addresses the current and potential future role of major e-health tools and approaches in respiratory medicine, with the aim of providing readers with trustful and updated evidence to increase their awareness of the topic, and to allow them to optimally benefit from the latest innovation technology. Collected literature evidence shows that the potential of technology tools in respiratory medicine mainly relies on three fundamental interactions: between clinicians, between clinician and patient, and between patient and health technology. However, it would be desirable to establish widely agreed and adopted standards for conducting trials and reporting results in this area, as well as to take into proper consideration potentially relevant pitfalls related to privacy protection and compliance with regulatory procedures.

Application of oxygen saturation variability analysis for the detection of exacerbation in individuals with COPD: A proof-of-concept study

BACKGROUND

Individuals with chronic obstructive pulmonary disease (COPD) commonly experience exacerbations, which may require hospital admission. Early detection of exacerbations, and therefore early treatment, could be crucial in preventing admission and improving outcomes. Our previous research has demonstrated that the pattern analysis of peripheral oxygen saturation (Sp O2 ) fluctuations provides novel insights into the engagement of the respiratory control system in response to physiological stress (hypoxia). Therefore, this pilot study tested the hypothesis that the pattern of Sp O2 variations in overnight recordings of individuals with COPD would distinguish between stable and exacerbation phases of the disease.

METHODS

Overnight pulse oximetry data from 11 individuals with COPD, who exhibited exacerbation after a period of stable disease, were examined. Stable phase recordings were conducted overnight and one night prior to exacerbation recordings were also analyzed. Pattern analysis of Sp O2 variations was carried examined using sample entropy (for assessment of irregularity), the multiscale entropy (complexity), and detrended fluctuation analysis (self-similarity).

RESULTS

Sp O2 variations displayed a complex pattern in both stable and exacerbation phases of COPD. During an exacerbation, Sp O2 entropy increased (p = 0.029) and long-term fractal-like exponent (α2) decreased (p = 0.002) while the mean and standard deviation of Sp O2 time series remained unchanged. Through ROC analyses, Sp O2 entropy and α2 were both able to classify the COPD phases into either stable or exacerbation phase. With the best positive predictor value (PPV) for sample entropy (PPV = 70%) and a cut-off value of 0.454. While the best negative predictor value (NPV) was α2 (NPV = 78%) with a cut-off value of 1.00.

CONCLUSION

Alterations in Sp O2 entropy and the fractal-like exponent have the potential to detect exacerbations in COPD. Further research is warranted to examine if Sp O2 variability analysis could be used as a novel objective method of detecting exacerbations.

Which criteria is a better predictor of ICU admission in trauma patients? An artificial neural network approach

PURPOSE

One of the most critical concerns in the intensive care unit (ICU) section is identifying the best criteria for entering patients to this part. This study aimed to predict the best compatible criteria for entering trauma patients in the ICU section.

METHOD

The present study was a historical cohort study. The data were collected from 2448 trauma patients referring to Shahid Rajaee Hospital between January 2015 and January 2017 in Shiraz, Iran. The artificial neural network (ANN) models with cross-validation and logistic regression (LR) with a backward method was used for data analysis. The final analysis was performed on a total of 958 patients who were transferred to the ICU section.

RESULTS

Based on the present results, the motor component of the GCS score at each cutoff point had the highest importance. The results also showed better performance for the AUC and accuracy rate for ANN compared with LR.

CONCLUSION

The most critical indicators in predicting the optimal use of ICU services in this study were the Motor component of the GCS. Results revealed that the ANN had a better performance than the LR in predicting the main outcomes of the traumatic patients in both the accuracy and AUC index. Trauma section surgeons and ICU specialists will benefit from this study's results and can assist them in making decisions to predict the patient outcomes before entering the ICU.

COVID-19-The impact of variable and "low normal" pulse oximetry scores on Oximetry@Home services and clinical pathways: Confounding variables?

COVID‐19 Oximetry@Home services have been commissioned nationally. This allows higher‐risk patients with mild COVID‐19 symptoms to remain at home, being supplied with a Pulse Oximeter to measure their oxygen saturation (SpO₂) two to three times daily for two weeks. Patients record their readings manually or electronically which are monitored by a clinical team. Clinical decisions, using an algorithm, are based on SpO₂ readings in a narrow range with 1–2 point changes potentially affecting care. In this article, we discussed the problem that multiple factors affect SpO₂ readings, and that some “normal” individuals will have “low‐normal” scores at the threshold of clinical management, without any known respiratory problem. We discuss the potential magnitude of this problem based on the associated literature and consider how this will have an impact on the use of the Oximetry@home services, potentially partially confounding their purpose; to reduce face‐to‐face medical care.

More random motor activity fluctuations predict incident frailty, disability, and mortality

Mobile healthcare increasingly relies on analytical tools that can extract meaningful information from ambulatory physiological recordings. We tested whether a nonlinear tool of fractal physiology could predict long-term health consequences in a large, elderly cohort. Fractal physiology is an emerging field that aims to study how fractal temporal structures in physiological fluctuations generated by complex physiological networks can provide important information about system adaptability. We assessed fractal temporal correlations in the spontaneous fluctuations of ambulatory motor activity of 1275 older participants at baseline, with a follow-up period of up to 13 years. We found that people with reduced temporal correlations (more random activity fluctuations) at baseline had increased risk of frailty, disability, and all-cause death during follow-up. Specifically, for 1-SD decrease in the temporal activity correlations of this studied cohort, the risk of frailty increased by 31%, the risk of disability increased by 15 to 25%, and the risk of death increased by 26%. These incidences occurred on average 4.7 years (frailty), 3 to 4.2 years (disability), and 5.8 years (death) after baseline. These observations were independent of age, sex, education, chronic health conditions, depressive symptoms, cognition, motor function, and total daily activity. The temporal structures in daily motor activity fluctuations may contain unique prognostic information regarding wellness and health in the elderly population.

Effects of Normobaric Hypoxia on Oxygen Saturation Variability

Background: The study is the first to evaluate the effects of graded normobaric hypoxia on SpO₂ variability in healthy individuals. Materials and Methods: Twelve healthy males (mean [standard deviation] age 22 [4] years) were exposed to four simulated environments (fraction of inspired oxygen [F_IO₂]: 0.12, 0.145, 0.17, and 0.21) for 45 minutes, in a balanced crossover design. Results: Sample entropy, a tool that quantifies the irregularity of pulse oximetry fluctuations, was used as a measure of SpO₂ variability. SpO₂ entropy increased as the F_IO₂ decreased, and there was a strong significant negative correlation between mean SpO₂ and its entropy during hypoxic exposure (r = -0.841 to -0.896, p < 0.001). In addition, SpO₂ sample entropy, but not mean SpO₂, was correlated (r = 0.630-0.760, p < 0.05) with dyspnea in F_IO₂ 0.17, 0.145, and 0.12 and importantly, SpO₂ sample entropy at F_IO₂ 0.17 was correlated with dyspnea at F_IO₂ 0.145 (r = 0.811, p < 0.01). Conclusions: These findings suggest that SpO₂ variability analysis may have the potential to be used in a clinical setting as a noninvasive measure to identify the negative sequelae of hypoxemia.

Clinical Decision Support for Early Detection of Prediabetes and Type 2 Diabetes Mellitus Using Wearable Technology

Worldwide spending on long-term and chronic care conditions is increasing to a point that requires immediate interventions and advancements to reduce the burden of the healthcare cost. This research is focused on early detection of prediabetes and type 2 diabetes mellitus (T2DM) using wearable technology. An artificial intelligence model was developed based on adaptive-neuro fuzzy interference to detect prediabetes and T2DM via individualized monitoring. The key contributing factors to the proposed model include heart rate, heart rate variability, breathing rate, breathing volume, and activity data (steps, cadence and calories). The data was collected using an advanced wearable body vest. The real-time data was combined with manual recordings of blood glucose, height, weight, age and sex. The model analyzed the data alongside a clinical knowledge-base. Fuzzy rules were used to establish baseline values via existing interventions, clinical guidelines and protocols. The proposed model was tested and validated using Kappa analysis and achieved an overall agreement of 91%.

Entropy Analysis of High-Definition Transcranial Electric Stimulation Effects on EEG Dynamics

A foundation of medical research is time series analysis—the behavior of variables of interest with respect to time. Time series data are often analyzed using the mean, with statistical tests applied to mean differences, and has the assumption that data are stationary. Although widely practiced, this method has limitations. Here we present an alternative statistical approach with sample analysis that provides a summary statistic accounting for the non-stationary nature of time series data. This work discusses the use of entropy as a measurement of the complexity of time series, in the context of Neuroscience, due to the non-stationary characteristic of the data. To elucidate our argument, we conducted entropy analysis on a sample of electroencephalographic (EEG) data from an interventional study using non-invasive electrical brain stimulation. We demonstrated that entropy analysis could identify intervention-related change in EEG data, supporting that entropy can be a useful “summary” statistic in non-linear dynamical systems.

Wearable Finger Pulse Oximetry for Continuous Oxygen Saturation Measurements During Daily Home Routines of Patients With Chronic Obstructive Pulmonary Disease (COPD) Over One Week: Observational Study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) patients can suffer from low blood oxygen concentrations. Peripheral blood oxygen saturation (SpO2), as assessed by pulse oximetry, is commonly measured during the day using a spot check, or continuously during one or two nights to estimate nocturnal desaturation. Sampling at this frequency may overlook natural fluctuations in SpO2.

OBJECTIVE

This study used wearable finger pulse oximeters to continuously measure SpO2 during daily home routines of COPD patients and assess natural SpO2 fluctuations.

METHODS

A total of 20 COPD patients wore a WristOx2 pulse oximeter for 1 week to collect continuous SpO2 measurements. A SenseWear Armband simultaneously collected actigraphy measurements to provide contextual information. SpO2 time series were preprocessed and data quality was assessed afterward. Mean SpO2, SpO2 SD, and cumulative time spent with SpO2 below 90% (CT90) were calculated for every (1) day, (2) day in rest, and (3) night to assess SpO2 fluctuations.

RESULTS

A high percentage of valid SpO2 data (daytime: 93.27%; nocturnal: 99.31%) could be obtained during a 7-day monitoring period, except during moderate-to-vigorous physical activity (MVPA) (67.86%). Mean nocturnal SpO2 (89.9%, SD 3.4) was lower than mean daytime SpO2 in rest (92.1%, SD 2.9; P<.001). On average, SpO2 in rest ranged over 10.8% (SD 4.4) within one day. Highly varying CT90 values between different nights led to 50% (10/20) of the included patients changing categories between desaturator and nondesaturator over the course of 1 week.

CONCLUSIONS

Continuous SpO2 measurements with wearable finger pulse oximeters identified significant SpO2 fluctuations between and within multiple days and nights of patients with COPD. Continuous SpO2 measurements during daily home routines of patients with COPD generally had high amounts of valid data, except for motion artifacts during MVPA. The identified fluctuations can have implications for telemonitoring applications that are based on daily SpO2 spot checks. CT90 values can vary greatly from night to night in patients with a nocturnal mean SpO2 around 90%, indicating that these patients cannot be consistently categorized as desaturators or nondesaturators. We recommend using wearable sensors for continuous SpO2 measurements over longer time periods to determine the clinical relevance of the identified SpO2 fluctuations.

Which heart rate variability index is an independent predictor of mortality in cirrhosis?

BACKGROUND

Liver cirrhosis is associated with reduced heart rate variability (HRV), which indicates impaired integrity of cardiovascular control in this patient population. There are several different indices for HRV quantification. The present study was designed to: 1) determine which of the HRV indices is best at predicting mortality in patients with cirrhosis; 2) verify if such ability to predict mortality is independent of the severity of hepatic failure.

METHODS

Ten minutes electrocardiogram was recorded in 74 patients with cirrhosis. Heart rate fluctuations were quantified using statistical, geometrical and non-linear analysis. The patients were followed-up for 18months and information was collected on the occurrence of death/liver transplantation.

RESULTS

During the follow-up period, 24 patients (32%) died or were transplanted for hepatic decompensation. Cox's regression analysis showed that SDNN (total HRV), cSDNN (corrected SDNN), SD1 (short-term HRV), SD2 (long-terms HRV) and spectral indices could predict survival in these patients. However, only SD2 and cSDNN were shown to be independent of MELD in predicting survival. The prognostic value of HRV indices was independent of age, gender, use of beta blockers, and the aetiology of liver disease.

CONCLUSION

Two HRV indices were identified that could predict mortality in patients with cirrhosis, independently of MELD. These indices are potentially useful tools for survival prediction.