Breathing Rate Estimation From the Electrocardiogram and Photoplethysmogram: A Review.

Breathing rate (BR) is a key physiological parameter used in a range of clinical settings. Despite its diagnostic and prognostic value, it is still widely measured by counting breaths manually. A plethora of algorithms have been proposed to estimate BR from the electrocardiogram (ECG) and pulse oximetry (photoplethysmogram, PPG) signals. These BR algorithms provide opportunity for automated, electronic, and unobtrusive measurement of BR in both healthcare and fitness monitoring. This paper presents a review of the literature on BR estimation from the ECG and PPG. First, the structure of BR algorithms and the mathematical techniques used at each stage are described. Second, the experimental methodologies that have been used to assess the performance of BR algorithms are reviewed, and a methodological framework for the assessment of BR algorithms is presented. Third, we outline the most pressing directions for future research, including the steps required to use BR algorithms in wearable sensors, remote video monitoring, and clinical practice

Consumer sleep monitors: is there a baby in the bathwater?

The rapid expansion of consumer sleep devices is outpacing the validation data necessary to assess the potential use of these devices in clinical and research settings. Common sleep monitoring devices utilize a variety of sensors to track movement as well as cardiac and respiratory physiology. The variety of sensors and user-specific factors offer the potential, at least theoretically, for clinically relevant information. We describe the current challenges for interpretation of consumer sleep monitoring data, since the devices are mainly used in non-medical contexts (consumer use) although medically-definable sleep disorders may commonly occur in this setting. A framework for addressing questions of how certain devices might be useful is offered. We suggest that multistage validation efforts are crucially needed, from the level of sensor data and algorithm output, to extrapolations beyond healthy adults and into other populations and real-world environments

Recent development of respiratory rate measurement technologies

Respiratory rate (RR) is an important physiological parameter whose abnormity has been regarded as an important indicator of serious illness. In order to make RR monitoring simple to do, reliable and accurate, many different methods have been proposed for such automatic monitoring. According to the theory of respiratory rate extraction, methods are categorized into three modalities: extracting RR from other physiological signals, RR measurement based on respiratory movements, and RR measurement based on airflow. The merits and limitations of each method are highlighted and discussed. In addition, current works are summarized to suggest key directions for the development of future RR monitoring methodologies

Cognitive and emotional effects of one season of head impact exposure in high school contact sport athletes

Short-term and long-term neurological damage as a result of sports-related brain trauma is a major concern for athletes today. In the last decade, studies of subconcussive repetitive head impacts (RHI) in contact sports have found associations with functional and structural brain changes, even in the absence of diagnosed concussion. Risk and thresholds for brain dysfunction in the setting of sports-related RHI remain poorly understood. This prospective study enrolled 119 athletes (72 contact, 47 noncontact) of both sexes (79 male, 40 female), to explore the effect of one season of subconcussive RHI on brain function in high school football, boys lacrosse, and boys and girls soccer versus a comparison group of noncontact athletes. This study is the first to assess the effects of one season of RHI exposure on traditional and novel cognitive measures as well as self-reported emotion, sleep and headache in high school athletes. Contact sport athletes wore a commercial accelerometer to investigate if there is a dose-response relationship between RHI exposure and brain function. Paired t-test comparisons of all measures revealed contact sport athletes were not different than noncontact athletes in experiencing negative changes over the course of one season on the assessment battery. Given the number of subjects evaluated and the resultant power to detect change, this study had an 82.5% power to detect a Cohenʼs d of 0.66. Regression analysis of multiple measures of RHI among contact sport athletes did not identify a significant relationship between exposure and changes in cognition, emotion, sleep or headache over one season. Secondary analyses found significant relationships between a greater number of total head impacts at postseason assessment and higher scores on NIH Emotion Battery elements Perceived Stress (p=0.0002) and Perceived Hostility (p=0.0004), but it was unrelated to total years of football exposure. Overall, this study showed that there does not appear to be an association between one season of RHI exposure and short-term changes in cognition or self-reported aspects of emotion, sleep, or headache. Results from this study may help in the design of future investigations that will increase our understanding of the short-term consequences of RHI. Future studies should concentrate on the question of a clinically significant threshold at which RHI above a certain magnitude is more likely to cause brain dysfunction

Characterization and processing of novel neck photoplethysmography signals for cardiorespiratory monitoring

Epilepsy is a neurological disorder causing serious brain seizures that severely affect the patients' quality of life. Sudden unexpected death in epilepsy (SUDEP), for which no evident decease reason is found after post-mortem examination, is a common cause of mortality. The mechanisms leading to SUDEP are uncertain, but, centrally mediated apneic respiratory dysfunction, inducing dangerous hypoxemia, plays a key role. Continuous physiological monitoring appears as the only reliable solution for SUDEP prevention. However, current seizure-detection systems do not show enough sensitivity and present a high number of intolerable false alarms. A wearable system capable of measuring several physiological signals from the same body location, could efficiently overcome these limitations. In this framework, a neck wearable apnea detection device (WADD), sensing airflow through tracheal sounds, was designed. Despite the promising performance, it is still necessary to integrate an oximeter sensor into the system, to measure oxygen saturation in blood (SpO2) from neck photoplethysmography (PPG) signals, and hence, support the apnea detection decision. The neck is a novel PPG measurement site that has not yet been thoroughly explored, due to numerous challenges. This research work aims to characterize neck PPG signals, in order to fully exploit this alternative pulse oximetry location, for precise cardiorespiratory biomarkers monitoring. In this thesis, neck PPG signals were recorded, for the first time in literature, in a series of experiments under different artifacts and respiratory conditions. Morphological and spectral characteristics were analyzed in order to identify potential singularities of the signals. The most common neck PPG artifacts critically corrupting the signal quality, and other breathing states of interest, were thoroughly characterized in terms of the most discriminative features. An algorithm was further developed to differentiate artifacts from clean PPG signals. Both, the proposed characterization and classification model can be useful tools for researchers to denoise neck PPG signals and exploit them in a variety of clinical contexts. In addition to that, it was demonstrated that the neck also offered the possibility, unlike other body parts, to extract the Jugular Venous Pulse (JVP) non-invasively. Overall, the thesis showed how the neck could be an optimum location for multi-modal monitoring in the context of diseases affecting respiration, since it not only allows the sensing of airflow related signals, but also, the breathing frequency component of the PPG appeared more prominent than in the standard finger location. In this context, this property enabled the extraction of relevant features to develop a promising algorithm for apnea detection in near-real time. These findings could be of great importance for SUDEP prevention, facilitating the investigation of the mechanisms and risk factors associated to it, and ultimately reduce epilepsy mortality.Open Acces

Methods for Doppler Radar Monitoring of Physiological Signals

Unobtrusive health monitoring includes advantages such as long-term monitoring of rarely occurring conditions or of slow changes in health, at reasonable costs. In addition, the preparation of electrodes or other sensors is not needed. Currently, the main limitation of remote patient monitoring is not in the existing communication infrastructure but the lack of reliable, easy-to-use, and well-studied sensors.The aim of this thesis was to develop methods for monitoring cardiac and respiratory activity with microwave continuous wave (CW) Doppler radar. When considering cardiac and respiration monitoring, the heart and respiration rates are often the first monitored parameters. The motivation of this thesis, however, is to measure not only rate-related parameters but also the cardiac and respiratory waveforms, including the chest wall displacement information.This dissertation thoroughly explores the signal processing methods for accurate chest wall displacement measurement with a radar sensor. The sensor prototype and measurement setup choices are reported. The contributions of this dissertation encompass an I/Q imbalance estimation method and a nonlinear demodulation method for a quadrature radar sensor. Unlike the previous imbalance estimation methods, the proposed method does not require the use of laboratory equipment. The proposed nonlinear demodulation method, on the other hand, is shown to be more accurate than other methods in low-noise cases. In addition, the separation of the cardiac and respiratory components with independent component analysis (ICA) is discussed. The developed methods were validated with simulations and with simplified measurement setups in an office environment. The performance of the nonlinear demodulation method was also studied with three patients for sleep-time respiration monitoring. This is the first time that whole-night measurements have been analyzed with the method in an uncontrolled environment. Data synchronization between the radar sensor and a commercial polysomnographic (PSG) device was assured with a developed infrared (IR) link, which is reported as a side result.The developed methods enable the extraction of more useful information from a radar sensor and extend its application. This brings Doppler radar sensors one step closer to large-scale commercial use for a wide range of applications, including home health monitoring, sleep-time respiration monitoring, and measuring gating signals for medical imaging

Deep sleep: deep learning methods for the acoustic analysis of sleep-disordered breathing

Sleep-disordered breathing (SDB) is a serious and prevalent condition that results from the collapse of the upper airway during sleep, which leads to oxygen desaturations, unphysiological variations in intrathoracic pressure, and sleep fragmentation. Its most common form is obstructive sleep apnoea (OSA). This has a big impact on quality of life, and is associated with cardiovascular morbidity. Polysomnography, the gold standard for diagnosing SDB, is obtrusive, time-consuming and expensive. Alternative diagnostic approaches have been proposed to overcome its limitations. In particular, acoustic analysis of sleep breathing sounds offers an unobtrusive and inexpensive means to screen for SDB, since it displays symptoms with unique acoustic characteristics. These include snoring, loud gasps, chokes, and absence of breathing. This thesis investigates deep learning methods, which have revolutionised speech and audio technology, to robustly screen for SDB in typical sleep conditions using acoustics. To begin with, the desirable characteristics for an acoustic corpus of SDB, and the acoustic definition of snoring are considered to create corpora for this study. Then three approaches are developed to tackle increasingly complex scenarios. Firstly, with the aim of leveraging a large amount of unlabelled SDB data, unsupervised learning is applied to learn novel feature representations with deep neural networks for the classification of SDB events such as snoring. The incorporation of contextual information to assist the classifier in producing realistic event durations is investigated. Secondly, the temporal pattern of sleep breathing sounds is exploited using convolutional neural networks to screen participants sleeping by themselves for OSA. The integration of acoustic features with physiological data for screening is examined. Thirdly, for the purpose of achieving robustness to bed partner breathing sounds, recurrent neural networks are used to screen a subject and their bed partner for SDB in the same session. Experiments conducted on the constructed corpora show that the developed systems accurately classify SDB events, screen for OSA with high sensitivity and specificity, and screen a subject and their bed partner for SDB with encouraging performance. In conclusion, this thesis makes promising progress in improving access to SDB diagnosis through low-cost and non-invasive methods