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Almarshad MA, Islam MS, Al-Ahmadi S, BaHammam AS. Diagnostic Features and Potential Applications of PPG Signal in Healthcare: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10030547. [PMID: 35327025 PMCID: PMC8950880 DOI: 10.3390/healthcare10030547] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023] Open
Abstract
Recent research indicates that Photoplethysmography (PPG) signals carry more information than oxygen saturation level (SpO2) and can be utilized for affordable, fast, and noninvasive healthcare applications. All these encourage the researchers to estimate its feasibility as an alternative to many expansive, time-wasting, and invasive methods. This systematic review discusses the current literature on diagnostic features of PPG signal and their applications that might present a potential venue to be adapted into many health and fitness aspects of human life. The research methodology is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020. To this aim, papers from 1981 to date are reviewed and categorized in terms of the healthcare application domain. Along with consolidated research areas, recent topics that are growing in popularity are also discovered. We also highlight the potential impact of using PPG signals on an individual’s quality of life and public health. The state-of-the-art studies suggest that in the years to come PPG wearables will become pervasive in many fields of medical practices, and the main domains include cardiology, respiratory, neurology, and fitness. Main operation challenges, including performance and robustness obstacles, are identified.
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Affiliation(s)
- Malak Abdullah Almarshad
- Computer Science Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia; (M.S.I.); (S.A.-A.)
- Computer Science Department, College of Computer and Information Sciences, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
- Correspondence:
| | - Md Saiful Islam
- Computer Science Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia; (M.S.I.); (S.A.-A.)
| | - Saad Al-Ahmadi
- Computer Science Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia; (M.S.I.); (S.A.-A.)
| | - Ahmed S. BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11324, Saudi Arabia;
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Seo JW, Choi J, Lee K, Kim JU. Age-Related Changes in the Characteristics of the Elderly Females Using the Signal Features of an Earlobe Photoplethysmogram. SENSORS 2021; 21:s21237782. [PMID: 34883786 PMCID: PMC8659530 DOI: 10.3390/s21237782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/31/2021] [Accepted: 11/18/2021] [Indexed: 12/02/2022]
Abstract
Non-invasive measurement of physiological parameters and indicators, specifically among the elderly, is of utmost importance for personal health monitoring. In this study, we focused on photoplethysmography (PPG), and developed a regression model that calculates variables from the second (SDPPG) and third (TDPPG) derivatives of the PPG pulse that can observe the inflection point of the pulse wave measured by a wearable PPG device. The PPG pulse at the earlobe was measured for 3 min in 84 elderly Korean women (age: 71.19 ± 6.97 years old). Based on the PPG-based cardiovascular function, we derived additional variables from TDPPG, in addition to the aging variable to predict the age. The Aging Index (AI) from SDPPG and Sum of TDPPG variables were calculated in the second and third differential forms of PPG. The variables that significantly correlated with age were c/a, Tac, AI of SDPPG, sum of TDPPG, and correlation coefficient ‘r’ of the model. In multiple linear regression analysis, the r value of the model was 0.308, and that using deep learning on the model was 0.839. Moreover, the possibility of improving the accuracy of the model using supervised deep learning techniques, rather than the addition of datasets, was confirmed.
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Affiliation(s)
- Jeong-Woo Seo
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon 34504, Korea;
| | - Jungmi Choi
- Human Anti-Aging Standards Research Institute, Uiryeong, Gyungnam 52151, Korea;
| | - Kunho Lee
- Gwangju Alzheimer’s Disease and Related Dementias (GARD) Cohort Research Center, Chosun University, Gwangju 61452, Korea;
- Department of Biomedical Science, Chosun University, Gwangju 61452, Korea
- Dementia Research Group, Korea Brain Research Institute, Daegu 41602, Korea
| | - Jaeuk U. Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon 34504, Korea;
- Korean Convergence Medicine, University of Science and Technology, Daejeon 34054, Korea
- Correspondence: ; Tel.: +82-42-868-9558
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Pluimakers VG, van Santen SS, Fiocco M, Bakker MCE, van der Lelij AJ, van den Heuvel-Eibrink MM, Neggers SJCMM. Can biomarkers be used to improve diagnosis and prediction of metabolic syndrome in childhood cancer survivors? A systematic review. Obes Rev 2021; 22:e13312. [PMID: 34258851 PMCID: PMC8596408 DOI: 10.1111/obr.13312] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 12/26/2022]
Abstract
Childhood cancer survivors (CCS) are at increased risk to develop metabolic syndrome (MetS), diabetes, and cardiovascular disease. Common criteria underestimate adiposity and possibly underdiagnose MetS, particularly after abdominal radiotherapy. A systematic literature review and meta-analysis on the diagnostic and predictive value of nine newer MetS related biomarkers (adiponectin, leptin, uric acid, hsCRP, TNF-alpha, IL-1, IL-6, apolipoprotein B (apoB), and lipoprotein(a) [lp(a)]) in survivors and adult non-cancer survivors was performed by searching PubMed and Embase. Evidence was summarized with GRADE after risk of bias evaluation (QUADAS-2/QUIPS). Eligible studies on promising biomarkers were pooled. We identified 175 general population and five CCS studies. In the general population, valuable predictive biomarkers are uric acid, adiponectin, hsCRP and apoB (high level of evidence), and leptin (moderate level of evidence). Valuable diagnostic biomarkers are hsCRP, adiponectin, uric acid, and leptin (low, low, moderate, and high level of evidence, respectively). Meta-analysis showed OR for hyperuricemia of 2.94 (age-/sex-adjusted), OR per unit uric acid increase of 1.086 (unadjusted), and AUC for hsCRP of 0.71 (unadjusted). Uric acid, adiponectin, hsCRP, leptin, and apoB can be alternative biomarkers in the screening setting for MetS in survivors, to enhance early identification of those at high risk of subsequent complications.
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Affiliation(s)
| | - Selveta S van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Medical Statistics, Department of Biomedical Data Science, Leiden UMC, Leiden, Netherlands.,Mathematical Institute, Leiden University, Leiden, Netherlands
| | - Marie-Christine E Bakker
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, University Medical Center Utrecht, Netherlands
| | - Aart J van der Lelij
- Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Sebastian J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
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Norchai P, Tharavanij T, Suwannahitatorn P, Charernboon T. Screening Test on Metabolic Syndrome Using Electro Interstitial Scan Instrument. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:237-243. [PMID: 32943950 PMCID: PMC7478373 DOI: 10.2147/mder.s268948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/14/2020] [Indexed: 11/23/2022] Open
Abstract
Background Metabolic syndrome is diagnosed using clinical and laboratory data. Electro interstitial scan (EIS) is a rapid and noninvasive screening. It measures and calculates the parameters to reflect hypertension, sympathetic activity, stiffness of the arteries, body fat composition, leptin and insulin resistance. Metabolic syndrome will be diagnosed if calculated score ≥10 CU. Purpose To evaluate the accuracy, validity and appropriate cut-off score to diagnose metabolic syndrome. Materials and Methods A cross-sectional study was conducted using the population-based approach. Metabolic syndrome was diagnosed according to the modified National Cholesterol Education Program (NCEP ATP III) and International Diabetes Federation (IDF) criteria. The appropriate cut-off score to diagnose metabolic syndrome by instrument was determined. Results A total of 253 participants were enrolled with mean age of 40.06±6.33 years, and 64.43% (163/253) were female. Metabolic syndrome was diagnosed among 123 (48.62%) and 104 (41.11%) patients according to the NCEP ATP III and IDF criteria, respectively. The diagnostic indices of metabolic syndrome score ≥10 CU had a sensitivity of 23.6% and 27.9%, a specificity of 100% and area under ROC of 0.62 and 0.64, according to the NCEP ATP III and IDF criteria, respectively. The best cut-off level of metabolic syndrome score was ≥9 CU with a sensitivity of 79.67% (95% CI, 71.5–86.4%) and 88.46% (95% CI, 80.7–93.9%), a specificity of 96.92% (95% CI, 92.3–99.2%) and 93.29% (95% CI, 88.0–96.7%) and area under ROC 0.89 (95% CI, 0.85–0.93) and 0.92 (95% CI, 0.88–0.95), respectively, according to the NCEP ATP III and IDF criteria. Conclusion Screening of metabolic syndrome using ES TECK in a Thai population demonstrated inadequate accuracy when using metabolic syndrome score ≥10 CU. We recommend using a metabolic syndrome score ≥9 CU to provide the best accuracy. This instrument is safe, fast and easy to use for metabolic syndrome screening.
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Affiliation(s)
- Phawit Norchai
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Thipaporn Tharavanij
- Endocrinology and Metabolism Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.,Diabetes and Metabolic Syndrome Research Unit, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.,Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.,Thammasat University-Center of Excellence for Diabetic Foot Care, Thammasat University Hospital, Pathumthani, Thailand
| | - Picha Suwannahitatorn
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, Thailand.,Biostatistics Unit, Office of Research Development Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Thammanard Charernboon
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.,Department of Psychiatry, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Zhang Y, Jiang Z, Qi L, Xu L, Sun X, Chu X, Liu Y, Zhang T, Greenwald SE. Evaluation of Cardiorespiratory Function During Cardiopulmonary Exercise Testing in Untreated Hypertensive and Healthy Subjects. Front Physiol 2018; 9:1590. [PMID: 30487751 PMCID: PMC6246679 DOI: 10.3389/fphys.2018.01590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/23/2018] [Indexed: 01/10/2023] Open
Abstract
Objective: This study aimed to compare differences in cardiorespiratory function between untreated hypertensive subjects (UHS) and healthy subjects (HS) during cardiopulmonary exercise testing (CPET). Additionally, it also aimed to explore the potential mechanisms of different exercise responses in cardiorespiratory function before, during and after CPET. Methods: Thirty subjects (15 UHS and 15 HS) were enrolled. Photoplethysmography (PPG), respiratory signal, and ECG were simultaneously collected while subjects were performing CPET. Fiducial points (a, b, c, d, e) were extracted from the second derivative of the PPG (SDPPG), and the ratios b/a, c/a, d/a, e/a, and (b-c-d-e)/a (named Aging Index, AGI) were calculated as markers of systolic and diastolic function. Additionally, respiratory rate was calculated and analyzed. Results:Before CPET, there were no significant differences in b/a, d/a, and AGI between two groups. However, after CPET, b/a (-0.9 ± 0.19 vs. -1.06 ± 0.19, p-value = 0.03) and AGI (-0.49 ± 0.75 vs. -1.15 ± 0.59, p-value = 0.011) of the UHS group were significantly higher than those of the HS. The d/a (-0.32 ± 0.24 vs. -0.14 ± 0.17, p-value = 0.024), and c/a (-0.33 ± 0.26 vs. -0.07 ± 0.19, p-value = 0.004) were significantly lower in UHS than those in HS. In contrast, before CPET, e/a (0.22 ± 0.11 vs. 0.32 ± 0.09, p-value = 0.007) in UHS was significantly lower than that in HS, while after CPET there was no significant difference between the two groups in this variable. In addition, during CPET, AGI (p-value = 0.003), and respiratory rate (p-value = 0.000) in UHS were significantly higher in comparison with before CPET. Conclusions: Different exercise responses showed the differences of cardiorespiratory function between UHS and HS. These differences not only can highlight the CV risk of UHS, but also can predict the appearance of arterial stiffness in UHS. Additionally, during CPET, significant differences in AGI, autonomic nervous function and respiratory activity assessed by respiratory rate were found between the two groups in comparison with before CPET.
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Affiliation(s)
- Yahui Zhang
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang City, China
| | - Zhihao Jiang
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang City, China
| | - Lin Qi
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang City, China
| | - Lisheng Xu
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang City, China
| | - Xingguo Sun
- Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Beijing, China
| | - Xinmei Chu
- Beijing Haidian Hospital, Peking University Third Hospital Haidian Campus, Beijing, China
| | - Yanling Liu
- Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Tianjing Zhang
- Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Beijing, China
| | - Stephen E Greenwald
- Blizard Institute, Barts, The London School of Medicine, Dentistry, Queen Mary University of London, London, United Kingdom
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Second derivative of the finger photoplethysmogram and cardiovascular mortality in middle-aged and elderly Japanese women. Hypertens Res 2016; 40:207-211. [PMID: 27682652 DOI: 10.1038/hr.2016.123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 01/12/2023]
Abstract
The second derivative of the digital photoplethysmogram (SDPTG) is an indicator of arterial stiffness. The ratio of the height of the d wave to the a wave of the SDPTG (d/a) is associated with functional peripheral vascular tension and represents aortic-blood pressure (BP) augmented by reflection waves from the periphery. This longitudinal study aimed to investigate the relationship between SDPTG and cardiovascular mortality in middle-aged and elderly Japanese women. From 1998 to 2008, we recruited 4373 women (50-79 years old at baseline) who underwent medical check-ups and SDPTG measurement. The SDPTG index (d/a) was calculated from the wave component height, and was divided into quartiles (Q) according to the d/a value. The median follow-up period was 9.0 years. The d/a value was negatively associated with age and BP, and positively associated with heart rate and body height. Using the Cox proportional hazards model, the hazard ratios for cardiovascular mortality for Q2, Q3 and Q4 were significantly higher than that of Q1. In multivariate analysis, the hazard ratio was 2.30 for Q3 (95% confidence interval (CI): 1.06-4.99, P<0.05) and 2.60 for Q4 (95% CI: 1.21-5.60, P<0.05), after adjustment for age, height, body mass index, BP levels, heart rate and other atherosclerosis-related factors. The hazard ratios of cardiovascular mortality for Q3 and Q4 were significantly higher compared with the reference (Q1). Thus, the SDPTG d/a is an independent predictor of cardiovascular mortality in middle-aged and elderly Japanese women.
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Yousef KQ, Rubins U, Mafawez A. Photoplethysmogram second derivative review: Analysis and applications. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/sre2015.6322] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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