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Abstract Pulse rate (PR) and respiratory rate (RR) are two of the most important vital signs. Monitoring them would benefit from easy-to-use technologies. Hence, wearable devices would, in principle, be ideal candidates for such systems. The neck, although highly susceptible to artifacts, presents an attractive location for a diverse pool of physiological biomarkers monitoring purposes such as airflow sensing in a non-obstructive manner. This paper presents a methodology for PR and RR estimation using photoplethysmography (PPG) and accelerometry (Acc) sensors placed on the neck. Neck PPG and Acc signals were recorded from 22 healthy participants for RR estimation, where the resting subjects performed guided breathing following a visual metronome. Neck PPG signals were obtained from 16 healthy participants who breathed through an altitude generator machine in order to acquire a wider range of PR readings while at rest. The proposed methodology was able to provide rate estimates via a combination of recursive FFT-based dominance scoring coupled with an exponentially weighted moving average (EWMA)-driven aggregation scheme. The recursion aimed at bypassing sudden intra-window amplitude deviations caused by momentary artifacts, while the EWMA-based aggregation was utilized for handling inter-window artifact-induced deviations. To further improve estimation stability and confidence, estimates were calculated in the form of rate bands taking into account the relevant clinically acceptable error margins, and results when considering rate values and rate bands are presented and discussed. The framework was able to achieve an overall pulse rate value accuracy of $$93.67\pm 7.64$$ 93.67 ± 7.64 % within the clinically acceptable ± 5 BPM with reference to the gold-standard reference devices while providing an overall respiratory rate value accuracy within the clinically appropriate ± 3 BrPM of $$94.94\pm 3.56$$ 94.94 ± 3.56 % with reference to the guiding visual metronome, and $$88.4\pm 7.63$$ 88.4 ± 7.63 % with respect to the gold-standard reference device. The proposed methodology achieves acceptable PR and RR estimation capabilities, even when signals are acquired from an unusual location such as the neck. This work introduces novel ideas that can lead to the development of medical device outputs for PR and RR monitoring, especially capitalizing on the advantages of the neck as a multi-modal physiological monitoring location.

Photoplethysmogram is a noninvasive technique used to detect volumetric changes in the blood. Cardiovascular diseases, related to heart and blood supply problems, are one of the largest causes of death in the world. Our study explored the possibility of classifying different cardiovascular diseases using photoplethysmogram signals for quick diagnosis. Using the support vector machine technique, the classification is done at the software level, while Xilinx Zynq 7000 field-programmable gate array (FPGA) chip is utilized for hardware design. The overall accuracy for detecting cerebral infarction and cerebrovascular disease is 93.48% and 96.43%, respectively, using eleven features. In addition, diabetes which is linked to cardiovascular diseases is classified, and an accuracy of 88.46% is achieved. Considering the PPG signal with a higher signal quality index, the overall accuracy for all the diseases can be further increased. The resource and power utilization of the implemented system is analyzed, which shows that 0.693 W power is required. The developed prototype can be further extended as a point-of-care system for cardiovascular disease detection. [ABSTRACT FROM AUTHOR]

Background and objective: Photoplethysmography (PPG) signals provide a non-invasive method for monitoring cardiovascular health, including blood pressure levels, which are critical for the early detection and management of hypertension. This study leverages wavelet transformation and special purpose deep learning model, enhanced by signal processing and normalization, to classify blood pressure stages from PPG signals. The primary objective is to advance non-invasive hypertension monitoring, improving the accuracy and efficiency of these assessments. Methods: The study employed continuous wavelet transform (CWT) to prepare PPG signals for analysis using a special purpose PPG-NET designed by applying advanced deep-learning models. PPG-NET was verified by applying several pre-trained models, including Inception, MobileNetV2, InceptionResNetV2, and others to the PPG data. Rigorously five-fold cross-validated models were conducted to obtain the models' performance to ensure robustness and repeatability of results. Results: The PPG-NET model demonstrated superior performance, achieving a perfect accuracy of 100 % in classifying the four stages of hypertension—normal, prehypertension, stage 1, and stage 2. The evaluation metrics reported include precision, sensitivity, and specificity, with the PPG-NET model achieving 100 % across all metrics. Other models showed varying levels of accuracy, with InceptionV3 also reaching 91.5 %, while some, like VGG-19, underperformed significantly. Conclusions: Integrating CWT and PPG-NET offers a promising avenue for enhancing non-invasive blood pressure monitoring. The PPG-NET model, in particular, showed potential for clinical application due to its high accuracy and reliability. This study showed the effectiveness of combining advanced computational techniques with traditional PPG analysis, potentially leading to more personalized and accessible hypertension management strategies.

Electrocardiography (ECG) is generally used in clinical practice for cardiovascular diagnosis and for monitoring cardiovascular status. It is considered to be the gold standard for diagnosing cardiovascular diseases and assessing cardiovascular status. However, it is not always easy to obtain. Unlike ECG devices, photoplethysmography (PPG) devices can be placed on body parts such as the earlobes, fingertips, and wrists, making them more comfortable and easier to obtain. Several methods for reconstructing ECG signals using PPG signals have been proposed, but some of these methods are subject-specific models. These models cannot be applied to multiple subjects and have limitations. This study proposes a neural network model based on UNet and bidirectional long short-term memory (BiLSTM) networks as a group model for reconstructing ECG from PPG. The model was verified using 125 records from the MIMIC III matched subset. The experimental results demonstrated that the proposed model was, on average, able to achieve a Pearson's correlation coefficient, root mean square error, percentage root mean square difference, and Fréchet distance of 0.861, 0.077, 5.302, and 0.278, respectively. This research can use the correlation between PPG and ECG to reconstruct a better ECG signal from PPG, which is crucial for diagnosing cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Wearable health devices (WHDs) are rapidly gaining ground in the biomedical field due to their ability to monitor the individual physiological state in everyday life scenarios, while providing a comfortable wear experience. This study introduces a novel wearable biomedical device capable of synchronously acquiring electrocardiographic (ECG), photoplethysmographic (PPG), galvanic skin response (GSR) and motion signals. The device has been specifically designed to be worn on a finger, enabling the acquisition of all biosignals directly on the fingertips, offering the significant advantage of being very comfortable and easy to be employed by the users. The simultaneous acquisition of different biosignals allows the extraction of important physiological indices, such as heart rate (HR) and its variability (HRV), pulse arrival time (PAT), GSR level, blood oxygenation level (SpO2), and respiratory rate, as well as motion detection, enabling the assessment of physiological states, together with the detection of potential physical and mental stress conditions. Preliminary measurements have been conducted on healthy subjects using a measurement protocol consisting of resting states (i.e., SUPINE and SIT) alternated with physiological stress conditions (i.e., STAND and WALK). Statistical analyses have been carried out among the distributions of the physiological indices extracted in time, frequency, and information domains, evaluated under different physiological conditions. The results of our analyses demonstrate the capability of the device to detect changes between rest and stress conditions, thereby encouraging its use for assessing individuals' physiological state. Furthermore, the possibility of performing synchronous acquisitions of PPG and ECG signals has allowed us to compare HRV and pulse rate variability (PRV) indices, so as to corroborate the reliability of PRV analysis under stationary physical conditions. Finally, the study confirms the already known limitations of wearable devices during physical activities, suggesting the use of algorithms for motion artifact correction. [ABSTRACT FROM AUTHOR]

The non-invasive Blood Pressure Estimation (BPE) utilizing the technology of photoplethysmography (PPG) gains significant interest because PPG could be extensively employed to wearable sensors. Here, a method for estimating Systolic Blood pressure (SBP), as well as Diastolic Blood pressure (DBP), grounded only on a PPG signal utilizing the Image Denoising Algorithms (IDA) algorithms is proposed. Also, a classification methodology to execute the risk analysis (RA) of the BP patients utilizing Moore–Penrose Pseudo-Inverse Matrix-Deep Learning Neural Network (MPPIW-DLNN) is proposed. The preprocessing is then done on the input PPG signal utilizing the Modified–Chebyshev Filter (CF) to eradicate the unwanted information existent in the signal. Afterward, the BPE is done utilizing IDA, which categorizes those components into (i) SBP and (ii) DBP. The MPPIW-DLNN provides the results of four sorts of risk classes like (i) stroke, (ii) heart failure (HF), (iii) heart attack (HA), and (iv) aneurysm identified from the inputted PPG signal. [ABSTRACT FROM AUTHOR]

One of the most significant indicators of heart and cardiovascular health is blood pressure (BP). Blood pressure (BP) has gained great attention in the last decade. Uncontrolled high blood pressure increases the risk of serious health problems, including heart attack and stroke. Recently, machine/deep learning has been leveraged for learning a BP from photoplethysmography (PPG) signals. Hence, continuous BP monitoring can be introduced, based on simple wearable contact sensors or even remotely sensed from a proper camera away from the clinical setup. However, the available training dataset imposes many limitations besides the other difficulties related to the PPG time series as high-dimensional data. This work presents beat-by-beat continuous PPG-based BP monitoring while accounting for the aforementioned limitations. For a better exploration of beats' features, we propose to use wavelet scattering transform as a better descriptive domain to cope with the limitation of the training dataset and to help the deep learning network accurately learn the relationship between the morphological shapes of PPG beats and the BP. A long short-term memory (LSTM) network is utilized to demonstrate the superiority of the wavelet scattering transform over other domains. The learning scenarios are carried out on a beat basis where the input corresponding PPG beat is used for predicting BP in two scenarios; (1) Beat-by-beat arterial blood pressure (ABP) estimation, and (2) Beat-by-beat estimation of the systolic and diastolic blood pressure values. Different transformations are used to extract the features of the PPG beats in different domains including time, discrete cosine transform (DCT), discrete wavelet transform (DWT), and wavelet scattering transform (WST) domains. The simulation results show that using the WST domain outperforms the other domains in the sense of root mean square error (RMSE) and mean absolute error (MAE) for both of the suggested two scenarios. [ABSTRACT FROM AUTHOR]

Emotion is a complicated state of mind, which normally reflects human perceptions and attitudes. Proper recognition of emotional states and its quality plays crucial role for the detection of critical diseases and subsequent treatment procedures. Generally, multi-lead, complicated Electroencephalogram (EEG) based analysis predominate the characterization of emotion detection. Nowadays, user-friendly, rich-cardiac-information and wearable characteristics of the photoplethysmogram (PPG) signal are also being used to identify the emotional states. However, a majority of the reported emotion detection techniques mostly uses PPG signal in multimodality approach. In this paper, a simple methodology is proposed to identify multiple emotional states via the analysis of the PPG signal alone. Normally, emotion induced alteration in the heart rate causes variation in the blood ejection rate and a subsequent deviation in the balance of the systolic and the diastolic phases. Consequently, a specific time-domain characteristic is identified to quantify such imbalance and its variability is then used as a feature to discriminate between the five most prominent emotional states via a threshold-based classification technique. The algorithm presents superior performance while evaluated on the PPG data collected from the standard DEAP dataset with an average detection accuracy of 97.78%. Compared to existing literatures, the superior results establish the effectiveness of the proposed algorithm for the detection of multiple emotional states using PPG signal only. Moreover, the use of a single PPG feature and the application of a simple threshold-based classification technique also justify its promises for implementation in real-life, healthcare applications. [ABSTRACT FROM AUTHOR]

We present the design, implementation, and results of an algorithm for respiratory rate (RR) estimation using respiratory-induced frequency, intensity, and amplitude variation calculated from the infrared (IR) channel of the SEN-15219 board for photoplethysmography (PPG) acquisition. First, the algorithm was developed in Python (on a PC) using synthetic signals and publicly available respiration and PPG data. We also include a graphical user interface to process data from sensors and display vital signs. Later, we ported the algorithm to an MSP432P401R microcontroller to complete our wearable prototype. Results are promissory and show that RR estimation can be performed on the selected platform with our proposed Fourier Product (FP) method, which results in a Mean Absolute Error of 4.1 using 16-s windows of IR-PPG signals. [ABSTRACT FROM AUTHOR]

Summary: Background: Dengue epidemics impose considerable strain on healthcare resources. Real-time continuous and non-invasive monitoring of patients admitted to the hospital could lead to improved care and outcomes. We evaluated the performance of a commercially available wearable (SmartCare) utilising photoplethysmography (PPG) to stratify clinical risk for a cohort of hospitalised patients with dengue in Vietnam. Methods: We performed a prospective observational study for adult and paediatric patients with a clinical diagnosis of dengue at the Hospital for Tropical Disease, Ho Chi Minh City, Vietnam. Patients underwent PPG monitoring early during admission alongside standard clinical care. PPG waveforms were analysed using machine learning models. Adult patients were classified between 3 severity classes: i) uncomplicated (ward-based), ii) moderate-severe (emergency department-based), and iii) severe (ICU-based). Data from paediatric patients were split into 2 classes: i) severe (during ICU stay) and ii) follow-up (14–21 days after the illness onset). Model performances were evaluated using standard classification metrics and 5-fold stratified cross-validation. Findings: We included PPG and clinical data from 132 adults and 15 paediatric patients with a median age of 28 (IQR, 21–35) and 12 (IQR, 9–13) years respectively. 1781 h of PPG data were available for analysis. The best performing convolutional neural network models (CNN) achieved a precision of 0.785 and recall of 0.771 in classifying adult patients according to severity class and a precision of 0.891 and recall of 0.891 in classifying between disease and post-disease state in paediatric patients. Interpretation: We demonstrate that the use of a low-cost wearable provided clinically actionable data to differentiate between patients with dengue of varying severity. Continuous monitoring and connectivity to early warning systems could significantly benefit clinical care in dengue, particularly within an endemic setting. Work is currently underway to implement these models for dynamic risk predictions and assist in individualised patient care. Funding: EPSRC Centre for Doctoral Training in High-Performance Embedded and Distributed Systems (HiPEDS) (Grant: EP/L016796/1) and the Wellcome Trust (Grants: 215010/Z/18/Z and 215688/Z/19/Z).

Currently, blood pressure assessment is on the verge of shifting from classical cuff-based measurements to continuous estimation using smart devices based on the absorption and reflection characteristics of light in tissue. This type of blood pressure estimation has been known for a long time and depends on calibration with conventional blood pressure measurement systems. Products from well-known manufacturers in this market already perform calibration with automatic cuffs using an oscillometric estimation. The main aim is to show that classical oscillometric blood pressure estimation is not suitable for calibration, which allows a burden-free and continuous estimation by today’s approaches. This study identifies the reason and also the solution for this in the second-order blood pressure variation. The current approach to oscillometric estimation of blood pressure has an uncorrectable systematic error of the order of the second-order blood pressure variation. Therefore the current method has too much error to be used as a basis for calibration to allow continuous estimation of blood pressure based on another vital parameter. It is shown that when using a measurement of the second-order blood pressure variation as basis for such calibration this problem can be solved.

The current study presents a novel, non-invasive method for estimating both systolic and diastolic blood pressure by combining photoplethysmogram (PPG) signals with physiological data, such as sex, age, weight, height, heart rate, and BMI, using two Gated Recurrent Units (GRUs) models. The first model processes dynamic patterns in PPG signals, while the second model incorporates physiological parameters. Both models are connected through a series of dense layers. To prepare the datasets for the GRU framework, rigorous preprocessing was conducted. This resulted in a robust architecture capable of accurately predicting systolic and diastolic blood pressure. The proposed method achieved a Mean Absolute Error (MAE) of 1.458 for systolic and 1.164 for diastolic blood pressure. These findings demonstrate the potential of this approach for continual and non-intrusive blood pressure monitoring in wearable health technology. The study’s results also make a significant contribution to the field of medical monitoring technology. The proposed solution addresses a major limitation in traditional blood pressure measurement practices and paves the way for advancements in personalized health monitoring, particularly for managing hypertension and cardiovascular conditions.

Patients with hyperglycemia require routine glucose monitoring to effectively treat their condition. We have developed a lightweight wristband device to capture Photoplethysmography (PPG) signals. We collected PPG signals, demographic information, and blood pressure data from 139 diabetic (49.65%) and non-diabetic (50.35%) subjects. Blood glucose was estimated, and diabetic severity (normal, warning, and dangerous) was stratified using Mel frequency cepstral coefficients, time, frequency, and statistical features from PPG and their derivative signals along with physiological parameters. Bagged Ensemble Trees outperform other algorithms in estimating blood glucose level with a correlation coefficient of 0.90. The proposed model’s prediction was all in Zone A and B in the Clarke Error Grid analysis. The predictions are thus clinically acceptable. Furthermore, K-nearest neighbor model classified the severity levels with an accuracy of 98.12%. Furthermore, the proposed models were deployed in Amazon Web Server. The wristband is connected to an Android mobile application to collect real-time data and update the estimated glucose and diabetic severity every 10-seconds, which will allow the users to gain better control of their diabetic health.

One of the most significant indicators of heart and cardiovascular health is blood pressure (BP). Blood pressure (BP) has gained great attention in the last decade. Uncontrolled high blood pressure increases the risk of serious health problems, including heart attack and stroke. Recently, machine/deep learning has been leveraged for learning a BP from photoplethysmography (PPG) signals. Hence, continuous BP monitoring can be introduced, based on simple wearable contact sensors or even remotely sensed from a proper camera away from the clinical setup. However, the available training dataset imposes many limitations besides the other difficulties related to the PPG time series as high-dimensional data. This work presents beat-by-beat continuous PPG-based BP monitoring while accounting for the aforementioned limitations. For a better exploration of beats’ features, we propose to use wavelet scattering transform as a better descriptive domain to cope with the limitation of the training dataset and to help the deep learning network accurately learn the relationship between the morphological shapes of PPG beats and the BP. A long short-term memory (LSTM) network is utilized to demonstrate the superiority of the wavelet scattering transform over other domains. The learning scenarios are carried out on a beat basis where the input corresponding PPG beat is used for predicting BP in two scenarios; (1) Beat-by-beat arterial blood pressure (ABP) estimation, and (2) Beat-by-beat estimation of the systolic and diastolic blood pressure values. Different transformations are used to extract the features of the PPG beats in different domains including time, discrete cosine transform (DCT), discrete wavelet transform (DWT), and wavelet scattering transform (WST) domains. The simulation results show that using the WST domain outperforms the other domains in the sense of root mean square error (RMSE) and mean absolute error (MAE) for both of the suggested two scenarios.

In health care applications, an evolution of electronics has made drastic advancements. There are some problems created due to this advancement. To estimate the coronary heart rate, till date some problems have been confronted. To overcome these issues, remote photoplethysmography (RPPG) technology is used to determine the heart rate (HR) and respiratory rate (RR) by using normal web cameras, without any additional hardware. Here, a high resolution camera detects the face using a face detector by means of image processing techniques. Hardware part is only used to display the heart rate and respiratory rate using sensors. The performance analysis demonstrates the practicality of the patients. Experimental results of heart rate measurement show that the proposed dynamic ROI method for RIPPG can effectively improve the RIPPG signal quality, compared with the state-of-the-art ROI methods for RIPPG. Objective performance tests show strong correlation with the ground truth values for the estimated heart rate and variation. [ABSTRACT FROM AUTHOR]

Access to accurate and precise monitoring systems for cardiac arrhythmia could contribute significantly to preventing damage and subsequent heart disorders. The present research concentrates on using photoplethysmography (PPG) and arterial blood pressure (ABP) with deep convolutional neural networks (CNN) for the classification and detection of fetal cardiac arrhythmia or premature ventricular contractions (PMVCs). The framework for the study entails (Icentia 11k) a public dataset of ECG signals consisting of different cardiac abnormalities. Following this, the weights obtained from the Icentia 11k dataset are transferred to the proposed CNN. Finally, fine-tuning was carried out to improve the accuracy of classification. Results obtained showcase the capacity of the proposed method to detect and classify PMVCs into three types: Normal, P1, and P2 with an accuracy of 99.9%, 99.8%, and 99.5%. [ABSTRACT FROM AUTHOR]

The body’s ability to balance oxygen supply and demand can be compromised in conditions such as shock, sepsis, and heart failure. Thus, measuring venous oxygen saturation (SvO2) simultaneously with the well-established peripheral arterial oxygen saturation can help in the clinical management of these conditions. Some authors have suggested a non-invasive SvO2 estimation method that acquires venous blood volume variations generated through the calf muscle pump using photoplethysmography (PPG): the Venous Muscle Pump Test (VMPT). However, the technique presents significant variability in the rhythm and speed of the foot dorsal flexions needed for the VMPT and cannot be performed on unconscious subjects and those with reduced mobility. This study proposes using functional electrical stimulation (FES) to stimulate the calf muscle and generate rhythmic and reproducible muscle contractions. A human proof-of-concept study was conducted with three healthy young male participants. The PPG signals achieved through the VMPT with conventionally active and FES-induced movements were compared. We found that FES-induced movement produced reproducible venous blood volume variations comparable to the ones induced by the active movement. However, it also leads to lower venous refilling time and lower muscle power. Although further individualized tuning of the stimulation parameters is needed to achieve more conclusive results, FES-induced movement proves to be a promising alternative to the conventional VMPT technique to measure venous oxygen saturation and assess venous insufficiency in specific clinical situations.

Non-invasive techniques have become increasingly vital in modern medicine, providing valuable diagnostic information without invasive procedures. These techniques encompass a diverse range of procedures, including imaging scans, blood tests, urine tests, and genetic testing, enabling the investigation of various conditions without device insertion. In contrast to conventional invasive methods, non-invasive diagnostics have numerous advantages, including reduced complications, shorter recovery times, improved patient comfort, and lower costs. As a result, the exploration of alternative diagnostic approaches has become imperative. This article provides a comprehensive overview of advances, challenges, and opportunities in the realm of non-invasive diagnostic techniques. It delves into a detailed exploration of non-invasive techniques, including photoplethysmography (PPG), electroencephalography (EEG), electromyography (EMG), electrocardiography (ECG), computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), and electrical impedance tomography (EIT) discussing their origin, underlying principles, instrumentation, and applications in various medical fields. Furthermore, the advantages and limitations of various Surface Measurement and Imaging Modalities techniques are thoroughly compared and analysed. The article also addresses these challenges and highlights emerging technologies and methodologies that offer solutions. More importantly, we propose several promising directions for future research and development of non-invasive diagnostic techniques.

Blood pressure (BP) is an important vital sign of the human body. The traditional cuff measurement methods are mainly intermittent, which cannot meet the clinical practice well. Continuous measurements of BP are of great significance for monitoring vital signs of patients. In order to achieve BP estimation in a continuous, cuffless and non-invasive way, this paper proposes a BP estimation model based on mixed attention gating U-Net (MAGU), which can effectively improve the accuracy and efficiency of BP estimation. The photoplethysmography signal is fed into the improved U-Net to extract features. A mixed attention gating mechanism is added between up-sampling and down-sampling, as well as the residual blocks are added in down-sampling to prevent the vanishing gradient, so as to improve the feature extraction efficiency in the deep network. The performance of the MAGU is validated against those state-of-the-art results on the MIMIC-II public dataset. The mean absolute error and standard deviation of systolic blood pressure predicted by the proposed method are 3.49 mmHg and 4.13 mmHg respectively, and those of diastolic blood pressure (DBP) are 2.11 mmHg and 2.49 mmHg. The comparison shows that the proposed method outperforms those state-of-the-art methods. [ABSTRACT FROM AUTHOR]

Wearable health devices (WHDs) are rapidly gaining ground in the biomedical field due to their ability to monitor the individual physiological state in everyday life scenarios, while providing a comfortable wear experience. This study introduces a novel wearable biomedical device capable of synchronously acquiring electrocardiographic (ECG), photoplethysmographic (PPG), galvanic skin response (GSR) and motion signals. The device has been specifically designed to be worn on a finger, enabling the acquisition of all biosignals directly on the fingertips, offering the significant advantage of being very comfortable and easy to be employed by the users. The simultaneous acquisition of different biosignals allows the extraction of important physiological indices, such as heart rate (HR) and its variability (HRV), pulse arrival time (PAT), GSR level, blood oxygenation level (SpO2), and respiratory rate, as well as motion detection, enabling the assessment of physiological states, together with the detection of potential physical and mental stress conditions. Preliminary measurements have been conducted on healthy subjects using a measurement protocol consisting of resting states (i.e., SUPINE and SIT) alternated with physiological stress conditions (i.e., STAND and WALK). Statistical analyses have been carried out among the distributions of the physiological indices extracted in time, frequency, and information domains, evaluated under different physiological conditions. The results of our analyses demonstrate the capability of the device to detect changes between rest and stress conditions, thereby encouraging its use for assessing individuals’ physiological state. Furthermore, the possibility of performing synchronous acquisitions of PPG and ECG signals has allowed us to compare HRV and pulse rate variability (PRV) indices, so as to corroborate the reliability of PRV analysis under stationary physical conditions. Finally, the study confirms the already known limitations of wearable devices during physical activities, suggesting the use of algorithms for motion artifact correction.

Fatigue is a prevalent subjective sensation, affecting both office workers and a significant global population. In Taiwan alone, over 2.6 million individuals—around 30% of office workers—experience chronic fatigue. However, fatigue transcends workplaces, impacting people worldwide and potentially leading to health issues and accidents. Gaining insight into one's fatigue status over time empowers effective management and risk reduction associated with other ailments. Utilizing photoplethysmography (PPG) signals brings advantages due to their easy acquisition and physiological insights. This study crafts a specialized preprocessing and peak detection methodology for PPG signals. A novel fatigue index stems from PPG signals, focusing on the dicrotic peak's position. This index replaces subjective data from the brief fatigue index (BFI)-Taiwan questionnaire and heart rate variability (HRV) indices derived from PPG signals for assessing fatigue levels. Correlation analysis, involving sixteen healthy adults, highlights a robust correlation (R > 0.53) between the new fatigue index and specific BFI questions, gauging subjective fatigue over the last 24 h. Drawing from these insights, the study computes an average of the identified questions to formulate the evaluated fatigue score, utilizing the newfound fatigue index. The implementation of linear regression establishes a robust fatigue assessment system. The results reveal an impressive 91% correlation coefficient between projected fatigue levels and subjective fatigue experiences. This underscores the remarkable accuracy of the proposed fatigue prediction in evaluating subjective fatigue. This study further operationalized the proposed PPG processing, peak detection method, and fatigue index using C# in a computer environment alongside a PPG device, thereby offering real-time fatigue indices to users. Timely reminders are employed to prompt users to take notice when their index exceeds a predefined threshold, fostering greater attention to their physical well-being. [ABSTRACT FROM AUTHOR]

Background: Pulse transit time (PTT) is a key parameter in cuffless blood pressure measurement based on photoplethysmography (PPG) signals. In wearable PPG sensors, raw PPG signals are filtered, which can change the timing of PPG waveform feature points, leading to inaccurate PTT estimation. There is a lack of comprehensive investigation of filtering-induced PTT changes in subjects with different ages. Objective: This study aimed to quantitatively investigate the effects of aging and PTT definition on the infinite impulse response (IIR) filtering-induced PTT changes. Methods: One hundred healthy subjects in five different ranges of age (i.e., 20–29, 30–39, 40–49, 50–59, and over 60 years old, 20 subjects in each) were recruited. Electrocardiogram (ECG) and PPG signals were recorded simultaneously for 120 s. PTT was calculated from the R wave of ECG and PPG waveform features. Eight PTT definitions were developed from different PPG waveform feature points. The raw PPG signals were preprocessed then further low-pass filtered. The difference between PTTs derived from preprocessed and filtered PPG signals, and the relative difference, were calculated and compared among five age groups and eight PTT definitions using the analysis of variance (ANOVA) or Scheirer–Ray–Hare test with post hoc analysis. Linear regression analysis was used to investigate the relationship between age and filtering-induced PTT changes. Results: Filtering-induced PTT difference and the relative difference were significantly influenced by age and PTT definition (p < 0.001 for both). Aging effect on filtering-induced PTT changes was consecutive with a monotonous trend under all PTT definitions. The age groups with maximum and minimum filtering-induced PTT changes depended on the definition. In all subjects, the PTT defined by maximum peak of PPG had the minimum filtering-induced PTT changes (mean: 16.16 ms and 5.65% for PTT difference and relative difference). The changes of PTT defined by maximum first PPG derivative had the strongest linear relationship with age (R-squared: 0.47 and 0.46 for PTT difference relative difference). Conclusion: The filtering-induced PTT changes are significantly influenced by age and PTT definition. These factors deserve further consideration to improve the accuracy of PPG-based cuffless blood pressure measurement using wearable sensors. [ABSTRACT FROM AUTHOR]

Researchers commonly use continuous noninvasive blood-pressure measurement (cNIBP) based on photoplethysmography (PPG) signals to monitor blood pressure conveniently. However, the performance of the system still needs to be improved. Accuracy and precision in blood-pressure measurements are critical factors in diagnosing and managing patients' health conditions. Therefore, we propose a convolutional long short-term memory neural network (CNN–LSTM) with grid search ability, which provides a robust blood-pressure estimation system by extracting meaningful information from PPG signals and reducing the complexity of hyperparameter optimization in the proposed model. The multiparameter intelligent monitoring for intensive care III (MIMIC III) dataset obtained PPG and arterial-blood-pressure (ABP) signals. We obtained 75,226 signal segments, with 60,180 signals allocated for training data, 12,030 signals allocated for the validation set, and 15,045 signals allocated for the test data. During training, we applied five-fold cross-validation with a grid-search method to select the best model and determine the optimal hyperparameter settings. The optimized configuration of the CNN–LSTM layers consisted of five convolutional layers, one long short-term memory (LSTM) layer, and two fully connected layers for blood-pressure estimation. This study successfully achieved good accuracy in assessing both systolic blood pressure (SBP) and diastolic blood pressure (DBP) by calculating the standard deviation (SD) and the mean absolute error (MAE), resulting in values of 7.89 ± 3.79 and 5.34 ± 2.89 mmHg, respectively. The optimal configuration of the CNN–LSTM provided satisfactory performance according to the standards set by the British Hypertension Society (BHS), the Association for the Advancement of Medical Instrumentation (AAMI), and the Institute of Electrical and Electronics Engineers (IEEE) for blood-pressure monitoring devices. [ABSTRACT FROM AUTHOR]

Remote physiological monitoring has become increasingly important in improving quality of life, with remote photoplethysmography (RPPG) being a popular choice. This paper introduces an envelope–based method for RPPG channels to improve wave morphology of the collected signal based on the reference signal from finger PPG. Using a model consistent with physiological and optical principles, the authors divided the signal into linear superpositions, comprising pulse, constant, and disturbance components. The correlation coefficients were used to calculate a linear combination of Red–Green–Blue (RGB) channels to approximate the envelope shape of the reference PPG signal. Experiments with different light intensities and stability were designed to compare the envelope approximation ability and robustness of the proposed method with some common methods. Analysis of variance demonstrated the stable performance of the envelopment–based approach in most cases. Additionally, it improved the morphology of the Green (G) channel, including changing trends and directions, adjusting wave sizes, reducing noise, and reinforcing details of the single waveform. The envelope–based linear model approach has the ability to flexibly improve RPPG signals, which helps RPPG play a full role in many fields such as medicine. [ABSTRACT FROM AUTHOR]

Photoplethysmography (PPG) allows various statements about the physiological state. It supports multiple recording setups, i.e., application to various body sites and different acquisition modes, rendering the technique a versatile tool for various situations. Owing to anatomical, physiological and metrological factors, PPG signals differ with the actual setup. Research on such differences can deepen the understanding of prevailing physiological mechanisms and path the way towards improved or novel methods for PPG analysis. The presented work systematically investigates the impact of the cold pressor test (CPT), i.e., a painful stimulus, on the morphology of PPG signals considering different recording setups. Our investigation compares contact PPG recorded at the finger, contact PPG recorded at the earlobe and imaging PPG (iPPG), i.e., non-contact PPG, recorded at the face. The study bases on own experimental data from 39 healthy volunteers. We derived for each recording setup four common morphological PPG features from three intervals around CPT. For the same intervals, we derived blood pressure and heart rate as reference. To assess differences between the intervals, we used repeated measures ANOVA together with paired t-tests for each feature and we calculated Hedges’ g to quantify effect sizes. Our analyses show a distinct impact of CPT. As expected, blood pressure shows a highly significant and persistent increase. Independently of the recording setup, all PPG features show significant changes upon CPT as well. However, there are marked differences between recording setups. Effect sizes generally differ with the finger PPG showing the strongest response. Moreover, one feature (pulse width at half amplitude) shows an inverse behavior in finger PPG and head PPG (earlobe PPG and iPPG). In addition, iPPG features behave partially different from contact PPG features as they tend to return to baseline values while contact PPG features remain altered. Our findings underline the importance of recording setup and physiological as well as metrological differences that relate to the setups. The actual setup must be considered in order to properly interpret features and use PPG. The existence of differences between recording setups and a deepened knowledge on such differences might open up novel diagnostic methods in the future. Photoplethysmography (PPG) allows various statements about the physiological state. It supports multiple recording setups, i.e., application to various body sites and different acquisition modes, rendering the technique a versatile tool for various situations. Owing to anatomical, physiological and metrological factors, PPG signals differ with the actual setup. Research on such differences can deepen the understanding of prevailing physiological mechanisms and path the way towards improved or novel methods for PPG analysis. The presented work systematically investigates the impact of the cold pressor test (CPT), i.e., a painful stimulus, on the morphology of PPG signals considering different recording setups. Our investigation compares contact PPG recorded at the finger, contact PPG recorded at the earlobe and imaging PPG (iPPG), i.e., non-contact PPG, recorded at the face. The study bases on own experimental data from 39 healthy volunteers. We derived for each recording setup four common morphological PPG features from three intervals around CPT. For the same intervals, we derived blood pressure and heart rate as reference. To assess differences between the intervals, we used repeated measures ANOVA together with paired t-tests for each feature and we calculated Hedges’ g to quantify effect sizes. Our analyses show a distinct impact of CPT. As expected, blood pressure shows a highly significant and persistent increase. Independently of the recording setup, all PPG features show significant changes upon CPT as well. However, there are marked differences between recording setups. Effect sizes generally differ with the finger PPG showing the strongest response. Moreover, one feature (pulse width at half amplitude) shows an inverse behavior in finger PPG and head PPG (earlobe PPG and iPPG). In addition, iPPG features behave partially different from contact PPG features as they tend to return to baseline values while contact PPG features remain altered. Our findings underline the importance of recording setup and physiological as well as metrological differences that relate to the setups. The actual setup must be considered in order to properly interpret features and use PPG. The existence of differences between recording setups and a deepened knowledge on such differences might open up novel diagnostic methods in the future. [ABSTRACT FROM AUTHOR]

Photoplethysmography (PPG) signals have been widely used in evaluating cardiovascular biomarkers, however, there is a lack of in-depth understanding of the remote usage of this technology and its viability for underdeveloped countries. This study aims to quantitatively evaluate the performance of a low-cost wireless PPG device in detecting ultra-short-term time-domain pulse rate variability (PRV) parameters in different postures and breathing patterns. A total of 30 healthy subjects were recruited. ECG and PPG signals were simultaneously recorded in 3 min using miniaturized wearable sensors. Four heart rate variability (HRV) and PRV parameters were extracted from ECG and PPG signals, respectively, and compared using analysis of variance (ANOVA) or Scheirer–Ray–Hare test with post hoc analysis. In addition, the data loss was calculated as the percentage of missing sampling points. Posture did not present statistical differences across the PRV parameters but a statistical difference between indicators was found. Strong variation was found for the RMSSD indicator in the standing posture. The sitting position in both breathing patterns demonstrated the lowest data loss (1.0 ± 0.6 and 1.0 ± 0.7) and the lowest percentage of different factors for all indicators. The usage of commercial PPG and BLE devices can allow the reliable extraction of the PPG signal and PRV indicators in real time. [ABSTRACT FROM AUTHOR]

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Frequency estimation plays a critical role in vital sign monitoring. Methods based on Fourier transform and eigen-analysis are commonly adopted techniques for frequency estimation. Because of the nonstationary and time-varying characteristics of physiological processes, time-frequency analysis (TFA) is a feasible way to perform biomedical signal analysis. Among miscellaneous approaches, Hilbert–Huang transform (HHT) has been demonstrated to be a potential tool in biomedical applications. However, the problems of mode mixing, unnecessary redundant decomposition and boundary effect are the common deficits that occur during the procedure of empirical mode decomposition (EMD) or ensemble empirical mode decomposition (EEMD). The Gaussian average filtering decomposition (GAFD) technique has been shown to be appropriate in several biomedical scenarios and can be an alternative to EMD and EEMD. This research proposes the combination of GAFD and Hilbert transform that is termed the Hilbert–Gauss transform (HGT) to overcome the conventional drawbacks of HHT in TFA and frequency estimation. This new method is verified to be effective for the estimation of respiratory rate (RR) in finger photoplethysmography (PPG), wrist PPG and seismocardiogram (SCG). Compared with the ground truth values, the estimated RRs are evaluated to be of excellent reliability by intraclass correlation coefficient (ICC) and to be of high agreement by Bland–Altman analysis. [ABSTRACT FROM AUTHOR]

(1) Background: Traumatic brain injuries (TBI) result in high fatality and lifelong disability rates. Two of the primary biomarkers in assessing TBI are intracranial pressure (ICP) and brain oxygenation. Both are assessed using standalone techniques, out of which ICP can only be assessed utilizing invasive techniques. The motivation of this research is the development of a non-invasive optical multimodal monitoring technology for ICP and brain oxygenation which will enable the effective management of TBI patients. (2) Methods: a multiwavelength optical sensor was designed and manufactured so as to assess both parameters based on the pulsatile and non-pulsatile signals detected from cerebral backscatter light. The probe consists of four LEDs and three photodetectors that measure photoplethysmography (PPG) and near-infrared spectroscopy (NIRS) signals from cerebral tissue. (3) Results: The instrumentation system designed to acquire these optical signals is described in detail along with a rigorous technical evaluation of both the sensor and instrumentation. Bench testing demonstrated the right performance of the electronic circuits while a signal quality assessment showed good indices across all wavelengths, with the signals from the distal photodetector being of highest quality. The system performed well within specifications and recorded good-quality pulsations from a head phantom and provided non-pulsatile signals as expected. (4) Conclusions: This development paves the way for a multimodal non-invasive tool for the effective assessment of TBI patients. [ABSTRACT FROM AUTHOR]

Sleep apnea syndrome (SAS) is a common but underdiagnosed health problem related to impaired quality of life and increased cardiovascular risk. In order to solve the problem of complicated and expensive operation procedures for clinical diagnosis of sleep apnea, here we propose a small and low-cost wearable apnea diagnostic system. The system uses a photoplethysmography (PPG) optical sensor to collect human pulse wave signals and blood oxygen saturation synchronously. Then multiscale entropy and random forest algorithms are used to process the PPG signal for analysis and diagnosis of sleep apnea. The SAS determination is based on the comprehensive diagnosis of the PPG signal and blood oxygen saturation signal, and the blood oxygen is used to exclude the error induced by non-pathological factors. The performance of the system is compared with the Compumedics Grael PSG (Polysomnography) sleep monitoring system. This simple diagnostic system provides a feasible technical solution for portable and low-cost screening and diagnosis of SAS patients with a high accuracy of over 85%. [ABSTRACT FROM AUTHOR]

The increasing interest in innovative solutions for health and physiological monitoring has recently fostered the development of smaller biomedical devices. These devices are capable of recording an increasingly large number of biosignals simultaneously, while maximizing the user's comfort. In this study, we have designed and realized a novel wearable multisensor ring-shaped probe that enables synchronous, real-time acquisition of photoplethysmographic (PPG) and galvanic skin response (GSR) signals. The device integrates both the PPG and GSR sensors onto a single probe that can be easily placed on the finger, thereby minimizing the device footprint and overall size. The system enables the extraction of various physiological indices, including heart rate (HR) and its variability, oxygen saturation (SpO2), and GSR levels, as well as their dynamic changes over time, to facilitate the detection of different physiological states, e.g., rest and stress. After a preliminary SpO2 calibration procedure, measurements have been carried out in laboratory on healthy subjects to demonstrate the feasibility of using our system to detect rapid changes in HR, skin conductance, and SpO2 across various physiological conditions (i.e., rest, sudden stress-like situation and breath holding). The early findings encourage the use of the device in daily-life conditions for real-time monitoring of different physiological states. [ABSTRACT FROM AUTHOR]

Monitoring diabetes saves lives. To this end, we introduce a novel, unobtrusive, and readily deployable in-ear device for the continuous and non-invasive measurement of blood glucose levels (BGLs). The device is equipped with a low-cost commercially available pulse oximeter whose infrared wavelength (880 nm) is used for the acquisition of photoplethysmography (PPG). For rigor, we considered a full range of diabetic conditions (non-diabetic, pre-diabetic, type I diabetic, and type II diabetic). Recordings spanned nine different days, starting in the morning while fasting, up to a minimum of a two-hour period after eating a carbohydrate-rich breakfast. The BGLs from PPG were estimated using a suite of regression-based machine learning models, which were trained on characteristic features of PPG cycles pertaining to high and low BGLs. The analysis shows that, as desired, an average of 82% of the BGLs estimated from PPG lie in region A of the Clarke error grid (CEG) plot, with 100% of the estimated BGLs in the clinically acceptable CEG regions A and B. These results demonstrate the potential of the ear canal as a site for non-invasive blood glucose monitoring. [ABSTRACT FROM AUTHOR]

Background: Intracranial photoplethysmography (PPG) signals can be measured from extracranial sites using wearable sensors and may enable long-term noninvasive monitoring of intracranial pressure (ICP). However, it is still unknown if ICP changes can lead to waveform changes in intracranial PPG signals. Aim: To investigate the effect of ICP changes on the waveform of intracranial PPG signals of different cerebral perfusion territories. Methods: Based on lump-parameter Windkessel models, we developed a computational model consisting three interactive parts: cardiocerebral artery network, ICP model, and PPG model. We simulated ICP and PPG signals of three perfusion territories [anterior, middle, and posterior cerebral arteries (ACA, MCA, and PCA), all left side] in three ages (20, 40, and 60 years) and four intracranial capacitance conditions (normal, 20% decrease, 50% decrease, and 75% decrease). We calculated following PPG waveform features: maximum, minimum, mean, amplitude, min-to-max time, pulsatility index (PI), resistive index (RI), and max-to-mean ratio (MMR). Results: The simulated mean ICPs in normal condition were in the normal range (8.87–11.35 mm Hg), with larger PPG fluctuations in older subject and ACA/PCA territories. When intracranial capacitance decreased, the mean ICP increased above normal threshold (>20 mm Hg), with significant decreases in maximum, minimum, and mean; a minor decrease in amplitude; and no consistent change in min-to-max time, PI, RI, or MMR (maximal relative difference less than 2%) for PPG signals of all perfusion territories. There were significant effects of age and territory on all waveform features except age on mean. Conclusion: ICP values could significantly change the value-relevant (maximum, minimum, and amplitude) waveform features of PPG signals measured from different cerebral perfusion territories, with negligible effect on shape-relevant features (min-to-max time, PI, RI, and MMR). Age and measurement site could also significantly influence intracranial PPG waveform. [ABSTRACT FROM AUTHOR]

This study presents an ear-mounted photoplethysmography (PPG) system that is designed to detect mental stress. Mental stress is a prevalent condition that can negatively impact an individual's health and well-being. Early detection and treatment of mental stress are crucial for preventing related illnesses and maintaining overall wellness. The study used data from 14 participants that were collected in a controlled environment. The participants were subjected to stress-inducing tasks such as the Stroop color–word test and mathematical calculations. The raw PPG signal was then preprocessed and transformed into scalograms using continuous wavelet transform (CWT). A convolutional neural network classifier was then used to classify the transformed signals as stressed or non-stressed. The results of the study show that the PPG system achieved high levels of accuracy (92.04%) and F1-score (90.8%). Furthermore, by adding white Gaussian noise to the raw PPG signals, the results were improved even more, with an accuracy of 96.02% and an F1-score of 95.24%. The proposed ear-mounted device shows great promise as a reliable tool for the early detection and treatment of mental stress, potentially revolutionizing the field of mental health and well-being. [ABSTRACT FROM AUTHOR]