Assessment of Blood Pressure Using Only a Smartphone and Machine Learning Techniques: A Systematic Review

Regular monitoring of blood pressure (BP) allows for early detection of hypertension and symptoms related to cardiovascular disease. Measuring BP with a cuff requires equipment that is not always readily available and it may be impractical for some patients. Smartphones are an integral part of the lives of most people; thus, detecting and monitoring hypertension with a smartphone is likely to increase the ability to monitor BP due to the convenience of use for many patients. Smartphones lend themselves to assessing cardiovascular health because their built-in sensors and cameras provide a means of detecting arterial pulsations. To this end, several image processing and machine learning (ML) techniques for predicting BP using a smartphone have been developed. Several ML models that utilize smartphones are discussed in this literature review. Of the 53 papers identified, seven publications were evaluated. The performance of the ML models was assessed based on their accuracy for classification, the mean error measure, and the standard deviation of error for regression. It was found that artificial neural networks and support vector machines were often used. Because a variety of influencing factors determines the performance of an ML model, no clear preference could be determined. The number of input features ranged from five to 233, with the most commonly used being demographic data and the features extracted from photoplethysmogram signals. Each study had a different number of participants, ranging from 17 to 5,992. Comparisons of the cuff-based measures were mostly used to validate the results. Some of these ML models are already used to detect hypertension and BP but, to satisfy possible regulatory demands, improved reliability is needed under a wider range of conditions, including controlled and uncontrolled environments. A discussion of the advantages of various ML techniques and the selected features is offered at the end of this systematic review

Blood pressure estimation with complexity features from electrocardiogram and photoplethysmogram signals

A novel method for the continual, cuff-less estimation of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) values based on signal complexity analysis of the photoplethysmogram (PPG) and the electrocardiogram (ECG) is reported. The proposed framework estimates the blood pressure (BP) values obtained from signals generated from 14 volunteers subjected to a series of exercise routines. Herein, the physiological signals were first pre-processed, followed by the extraction of complexity features from both the PPG and ECG. Subsequently the complexity features were used in regression models (artificial neural network (ANN), support vector machine (SVM) and LASSO) to predict the BP. The performance of the approach was evaluated by calculating the mean absolute error and the standard deviation of the predicted results and compared with the recommendations made by the British Hypertension Society (BHS) and Association for the Advancement of Medical Instrumentation. Complexity features from the ECG and PPG were investigated independently, along with the combined dataset. It was observed that the complexity features obtained from the combination of ECG and PPG signals resulted to an improved estimation accuracy for the BP. The most accurate DBP result of 5.15 ± 6.46 mmHg was obtained from ANN model, and SVM generated the most accurate prediction for the SBP which was estimated as 7.33 ± 9.53 mmHg. Results for DBP fall within recommended performance of the BHS but SBP is outside the range. Although initial results are promising, further improvements are required before the potential of this approach is fully realised

Pervasive blood pressure monitoring using Photoplethysmogram (PPG) Sensor

Preventive healthcare requires continuous monitoring of the blood pressure (BP) of patients, which is not feasible using conventional methods. Photoplethysmogram (PPG) signals can be effectively used for this purpose as there is a physiological relation between the pulse width and BP and can be easily acquired using a wearable PPG sensor. However, developing real-time algorithms for wearable technology is a significant challenge due to various conflicting requirements such as high accuracy, computationally constrained devices, and limited power supply. In this paper, we propose a novel feature set for continuous, real-time identification of abnormal BP. This feature set is obtained by identifying the peaks and valleys in a PPG signal (using a peak detection algorithm), followed by the calculation of rising time, falling time and peak-to-peak distance. The histograms of these times are calculated to form a feature set that can be used for classification of PPG signals into one of the two classes: normal or abnormal BP. No public dataset is available for such study and therefore a prototype is developed to collect PPG signals alongside BP measurements. The proposed feature set shows very good performance with an overall accuracy of approximately 95\%. Although the proposed feature set is effective, the significance of individual features varies greatly (validated using significance testing) which led us to perform weighted voting of features for classification by performing autoregressive modeling. Our experiments show that the simplest linear classifiers produce very good results indicating the strength of the proposed feature set. The weighted voting improves the results significantly, producing an overall accuracy of about 98%. Conclusively, the PPG signals can be effectively used to identify BP, and the proposed feature set is efficient and computationally feasible for implementation on standalone devices.N/

Photoplethysmography temporal marker-based machine learning classifier for anesthesia drug detection

Anesthesia drug overdose hazards and lack of gold standards in anesthesia monitoring lead to an urgent need for accurate anesthesia drug detection. To investigate the PPG waveform features affected by anesthesia drugs and develop a machine-learning classifier with high anesthesia drug sensitivity. This study used 64 anesthesia and non-anesthesia patient data (32 cases each), extracted from Queensland and MIMIC-II databases, respectively. The key waveform features (total area, rising time, width 75%, 50%, and 25%) were extracted from 16,310 signal recordings (5-s duration). Discriminant analysis, support vector machine (SVM), and K-nearest neighbor (KNN) were evaluated by splitting the dataset into halve training (11 patients, 8570 segments) and halve testing dataset (11 patients, 7740 segments). Significant differences exist between PPG waveform features of anesthesia and non-anesthesia groups (p  0.05). The KNN classifier achieved 91.7% (AUC = 0.95) anesthesia detection accuracy with the highest sensitivity (0.88) and specificity (0.90) as compared to other classifiers. Kohen’s kappa also shows almost perfect agreement (0.79) with the KNN classifier. The KNN classifier trained with significant PPG features has the potential to be used as a reliable, non-invasive, and low-cost method for the detection of anesthesia drugs for depth analysis during surgical operations and postoperative monitoring. GRAPHICAL ABSTRACT: [Image: see text

Personal Healthcare Agents for Monitoring and Predicting Stress and Hypertension from Biosignals

We live in exciting times. The fast paced growth in mobile computers has put powerful computational devices in the palm of our hands. Blazing fast connectivity has made human-human, human-machine, and machine-machine communication effortless. Wearable devices and the internet of things have made monitoring every aspect of our lives easier. This has given rise to the domain of quantified self where we can continuous record and quantify the various signals generated in everyday life. Sensors on smartphones can continuously record our location and motion profile. Sensors on wearable devices can track changes in our bodies’ physiological responses. This monitoring also has the capability to revolutionise the health care domain by creating more informed and involved patients. This has the potential to shift care-management from a physician-centric approach to a patient-centric approach allowing individuals to create more empowered patients and individuals who are in better control of their health. However, the data deluge from all these sources can sometimes be overwhelming. There is a need for intelligent technology that can help us navigate the data and take informed decisions. The goal of this work is to develop a mobile, personal intelligent agent platform that can become a digital companion to live with the user. It can monitor the covert and overt signal streams of the user, identify activity and stress levels to help the users’ make healthy choices regarding their lives. This thesis particularly targets patients suffering from or at-risk of essential hypertension since its a difficult condition to detect and manage. This thesis delivers the following contributions: 1) An intelligent personal agent platform for on-the-go continuous monitoring of covert and overt signals. 2) A machine learning algorithm for accurate recognition of activities using smartphone signals recorded from in-the-wild scenarios. 3) A machine learning pipeline to combine various physiological signal streams, motion profiles, and user annotations for on-the-go stress recognition. 4) We design and train a complete signal processing and classification system for hypertension prediction. 5) Through a small pilot study we demonstrate that this system can distinguish between hypertensive and normotensive subjects with high accuracy

Continuous physical activity recording - Consumer-based activity trackers in epidemiological studies

Physical activity is an important modifiable lifestyle factor that can improve general health and reduce the risk of disease. Currently, collecting data on physical activity in epidemiological studies are generally limited to long-term but self-reported and inaccurate physical activity questionnaires and/or using short-term but objective and more accurate accelerometers. Consumer-based activity trackers are designed for long-term objective data collection and can therefore potentially be used to close this gap. The objective of this dissertation was therefore to explore and develop new methods for collecting data on physical activity in epidemiological studies using consumer-based activity trackers. The four included papers apply different methods to explore the objective from multiple angles. Results includes an overview of how activity tracker sensor support has changed over time, recommendations when choosing an activity tracker model for future physical activity research, recommendations for increasing activity tracker wear time among participants in clinical studies, as well as knowledge about activity tracker validity and physical activity trends during the Norwegian COVID-19 lockdown in 2020. Finally, the dissertation describes a system for automatic and continuous data collection using consumer-based activity trackers from multiple providers. We show the usability of this system by accessing and analysing historic activity tracker data from participants who wore a tracker before-, during-, and after the COVID-19 lockdown period. The proposed system can be a valuable addition to existing methods for physical activity assessment by contributing to closing the above-mentioned method gap

Every sign of life

Thesis (Ph. D.)--Massachusetts Institute of Technology, School of Architecture and Planning, Program in Media Arts and Sciences, 2003.MIT Institute Archives copy: pages 151-[182] bound in reverse order.Includes bibliographical references (p. 142-150).Every Sign of Life introduces an approach to and motivational schema for personal health monitoring. It is an exploration of how to make information collected by personal health-monitoring devices fun and engaging, and consequently more useful to the non-specialist. In contrast to the common methodology of adding game elements to established biofeedback systems, the Every Sign of Life approach is to design and build games that use biosensor information to effect the game environment. This work tests the hypothesis that fun (the joy of learning, achieving, competing, etc.) is a way to achieve the goal of self-efficacy; to induce people to take care of their own health by altering their habits and lifestyles. One result is a basic architecture for personal health-monitoring systems that has led to an approach to the design of sensor peripherals and wearable computer components called "Extremity Computing." This approach is used to redefine biosensor monitoring from periodic to continuous (ultimately saving data over a lifetime). Another result is an approach to adding implicit biofeedback to computer games. This has led to a new genre of games called "Bio-Analytical Games" that straddles the boundary between sports and computer games. A series of studies of how to present health information to children and adults have demonstrated the ability of consumers to use bioinformatics without involving professionals.by Vadim Gerasimov.Ph.D

Algorithms for time series clustering applied to biomedical signals

Thesis submitted in the fulfillment of the requirements for the Degree of Master in Biomedical EngineeringThe increasing number of biomedical systems and applications for human body understanding creates a need for information extraction tools to use in biosignals. It’s important to comprehend the changes in the biosignal’s morphology over time, as they often contain critical information on the condition of the subject or the status of the experiment. The creation of tools that automatically analyze and extract relevant attributes from biosignals, providing important information to the user, has a significant value in the biosignal’s processing field. The present dissertation introduces new algorithms for time series clustering, where we are able to separate and organize unlabeled data into different groups whose signals are similar to each other. Signal processing algorithms were developed for the detection of a meanwave, which represents the signal’s morphology and behavior. The algorithm designed computes the meanwave by separating and averaging all cycles of a cyclic continuous signal. To increase the quality of information given by the meanwave, a set of wave-alignment techniques was also developed and its relevance was evaluated in a real database. To evaluate our algorithm’s applicability in time series clustering, a distance metric created with the information of the automatic meanwave was designed and its measurements were given as input to a K-Means clustering algorithm. With that purpose, we collected a series of data with two different modes in it. The produced algorithm successfully separates two modes in the collected data with 99.3% of efficiency. The results of this clustering procedure were compared to a mechanism widely used in this area, which models the data and uses the distance between its cepstral coefficients to measure the similarity between the time series.The algorithms were also validated in different study projects. These projects show the variety of contexts in which our algorithms have high applicability and are suitable answers to overcome the problems of exhaustive signal analysis and expert intervention. The algorithms produced are signal-independent, and therefore can be applied to any type of signal providing it is a cyclic signal. The fact that this approach doesn’t require any prior information and the preliminary good performance make these algorithms powerful tools for biosignals analysis and classification

The design and evaluation of discrete wearable medical devices for vital signs monitoring

The observation, recording and appraisal of an individual’s vital signs, namely temperature, heart rate, blood pressure, respiratory rate and blood oxygen saturation (SpO2), are key components in the assessment of their health and wellbeing. Measurements provide valuable diagnostic data, facilitating clinical diagnosis, management and monitoring. Respiratory rate sensing is perhaps the most under-utilised of all the vital signs, being routinely assessed by observation or estimated algorithmically from respiratory-induced beat-to-beat variation in heart rate. Moreover there is an unmet need for wearable devices that can measure all or most of the vital signs. This project therefore aims to a) develop a device that can measure respiratory rate and b) develop a wearable device that can measure all or most of the vital signs. An accelerometer-based clavicular respiratory motion sensor was developed and compared with a similar thoracic motion sensor and reference using exhalatory flow. Pilot study results established that the clavicle sensor accurately tracked the reference in monitoring respiratory rate and outperformed the thoracic device. An Ear-worn Patient Monitoring System (EPMS) was also developed, providing a discrete telemonitoring device capable of rapidly measuring tympanic temperature, heart rate, SpO2 and activity level. The results of a comparative pilot study against reference instruments revealed that heart rate matched the reference for accuracy, while temperature under read (< 1°C) and SpO2 was inconsistent with poor correlation. In conclusion, both of the prototype devices require further development. The respiratory sensor would benefit from product engineering and larger scale testing to fully exploit the technology, but could find use in both hospital and community-based The design and evaluation of discrete wearable medical devices for vital signs monitoring DG Pitts ii Cranfield University monitoring. The EPMS has potential for clinical and community use, having demonstrated its capability of rapidly capturing and wirelessly transmitting vital signs readings. Further development is nevertheless required to improve the thermometer probe and resolve outstanding issues with SpO2 readings

Long-term monitoring of respiratory metrics using wearable devices

Recently, there has been an increased interest in monitoring health using wearable sensors technologies however, few have focused on breathing. The utility of constant monitoring of breathing is currently not well understood, both for general health as well as respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD) that have significant prevalence in society. Having a wearable device that could measure respiratory metrics continuously and non-invasively with high adherence would allow us to investigate the significance of ambulatory breathing monitoring in health and disease management. The purpose of this thesis was to determine if it was feasible to continuously monitor respiratory metrics. To do this, we identified pulse oximetry to provide the best balance between use of mature signal processing methods, commercial availability, power efficiency, monitoring site and perceived wearability. Through a survey, it was found users would monitor their breathing, irrespective of their health status using a smart watch. Then it was found that reducing the duty cycle and power consumption adversely affected the reliability to capture accurate respiratory rate measurements through pulse oximetry. To account for the decreased accuracy of PPG derived respiratory rate at higher rates, a long short-term memory (LSTM) network and a U-Net were proposed, characterised and implemented. In addition to respiratory rate, inspiration time, expiration time, inter-breath intervals and the Inspiration:Expiration ratio were also predicted. Finally, the accuracy of these predictions was validated using pilot data from 11 healthy participants and 11 asthma participants. While percentage bias was low, the 95\% limits of agreement was high. While there is likely going to be enthusiastic uptake in wearable device use, it remains unseen whether clinical utility can be achieved, in particular the ability to forecast respiratory status. Further, the issues of sensor noise and algorithm performance during activity was not calculated. However, this body of work has investigated and developed the use of pulse oximetry, classical signal processing and machine learning methodologies to extract respiratory metrics to lay a foundation for both the hardware and software requirements in future clinical research