Continuous monitoring of vital parameters for clinically valid assessment of human health status

Tese de mestrado integrado, Engenharia Biomédica e Biofísica (Sinais e Imagens Médicas) Universidade de Lisboa, Faculdade de Ciências, 2019The lack of devices suitable for acquiring accurate and reliable measures of patients' physiolog-ical signals in a remote and continuous manner together with the advances in data acquisition technol-ogies during the last decades, have led to the emergence of wearable devices for healthcare. Wearable devices enable remote, continuous and long-term health monitoring in unattended setting. In this con-text, the Swiss Federal Laboratories for Material Science and Technology (Empa) developed a wearable system for long-term electrocardiogram measurements, referred to as textile belt. It consists of a chest strap with two embroidered textile electrodes. The validity of Empa’s system for electrocardiogram monitoring has been proven in a clinical setting. This work aimed to assess the validity of the textile belt for electrocardiogram monitoring in a home setting and to supplement the existing system with sensors for respiratory monitoring. Another objective was to evaluate the suitability of the same weara-ble, as a multi-sensor system, for activity monitoring. A study involving 12 patients (10 males and 2 females, interquartile range for age of 48–59 years and for body mass indexes of 28.0–35.5 kg.m-2) with suspected sleep apnoea was carried out. Overnight electrocardiogram was measured in a total of 28 nights. The quality of recorded signals was assessed using signal-to-noise ratio, artefacts detection and Poincaré plots. Study data were compared to data from the same subjects, acquired in the clinical setting. For respiratory monitoring, optical fibre-based sensors of different geometries were integrated into the textile belt. Signal processing algorithms for breathing rate and tidal volume estimation based on respiratory signals acquired by the sensors were developed. Pilot studies were conducted to compare the different approaches for respiratory monitoring. The quality of respiratory signals was determined based on signal segments “sinusoidality”, evaluated through the calculation of the cross-correlation between signal segments and segment-specific reference waves. A method for accelerometry-based lying position recognition was proposed, and the proof of concept of activity intensity classification through the combination of subjects’ inertial acceleration, heart rate and breathing rate data, was presented. Finally, a study with three participants (1 male and 2 females, aged 21 ± 2 years, body mass index of 20.3 ± 1.5 kg.m-2) was conducted to assess the validity of the textile belt for respiratory and activity monitoring. Electrocardiogram signals acquired by the textile belt in the home setting were found to have better quality than the data acquired by the same device in the clinical setting. Although a higher artefact percentage was found for the textile belt, signal-to-noise ratio of electrocardiogram signals recorded by the textile belt in the home setting was similar to that of signals acquired by the gel electrodes in the clinical setting. A good agreement was found between the RR-intervals derived from signals recorded in home and clinical settings. Besides, for artefact percentages greater than 3%, visual assessment of Poincaré plots proved to be effective for the determination of the primary source of artefacts (noise or ectopic beats). Acceleration data allowed posture recognition (i.e. lying or standing/sitting, lying position) with an accuracy of 91% and positive predictive value of 80%. Lastly, preliminary results of physical activity intensity classification yielded high accuracy, showing the potential of the proposed method. The textile belt proved to be appropriate for long-term, remote and continuous monitoring of subjects’ physical and physiological parameters. It can monitor not only electrocardiogram, but also breathing rate, body posture and physical activity intensity, having the potential to be used as tool for disease prediction and diagnose support.Contexto: A falta de dispositivos adequados para a monitorização de sinais fisiológicos de um modo remoto e contínuo, juntamente com avanços tecnológicos na área de aquisição de dados nas últimas décadas, levaram ao surgimento de wearable devices, i.e. dispositivos vestíveis, no sector da saúde. Wearable devices possibilitam a monitorização do estado de saúde, de uma forma remota, contínua e de longa duração. Quando feito em ambiente domiciliar, este tipo de monitorização (i.e. contínua, remota e de longa duração) tem várias vantagens: diminui a pressão posta sobre o sistema de saúde, reduz despesas associadas ao internamento e acelera a resposta a emergências, permitindo deteção precoce e prevenção de condições crónicas. Neste contexto, a Empa, Laboratórios Federais Suíços de Ciência e Tecnologia de Materiais, desenvolveu um sistema vestível para a monitorização de eletrocardiograma de longa duração. Este sistema consiste num cinto peitoral com dois elétrodos têxteis integrados. Os elétrodos têxteis são feitos de fio de polietileno tereftalato revestido com prata e uma ultrafina camada de titânio no topo. De modo a garantir a aquisição de sinais de alta qualidade, o cinto tem nele integrado um reservatório de água que liberta vapor de água para humidificar os elétrodos. Este reservatório per-mite a monitorização contínua de eletrocardiograma por 5 a 10 dias, sem necessitar de recarga. A vali-dade do cinto para a monitorização de eletrocardiograma em ambiente clínico já foi provada. Objetivo: Este trabalho teve por objetivo avaliar a validade do cinto para a monitorização de eletrocar-diograma em ambiente domiciliar e complementar o sistema existente com sensores para monitorização respiratória. Um outro objetivo foi analisar a adequação do cinto, como um sistema multisensor, para monitorização da atividade física. Métodos: Um estudo com 12 pacientes com suspeita de apneia do sono (10 homens e 2 mulheres, am-plitude interquartil de 48–59 anos para a idade e de 28.0–35.5 kg.m-2 para o índice de massa corporal) foi conduzido para avaliar a qualidade do sinal de eletrocardiograma medido em ambiente domiciliar. O sinal de eletrocardiograma dos pacientes foi monitorizado continuamente, num total de 28 noites. A qualidade dos sinais adquiridos foi analisada através do cálculo da razão sinal-ruído; da deteção de ar-tefactos, i.e., intervalos RR com um valor inviável de um ponto de vista fisiológico; e de gráficos de Poincaré, um método de análise não linear da distribuição dos intervalos RR registados. Os dados ad-quiridos neste estudo foram comparados com dados dos mesmos pacientes, adquiridos em ambiente hospitalar. Para a monitorização respiratória, sensores feitos de fibra óptica foram integrados no cinto. Al-gorítmicos para a estimar a frequência respiratória e o volume corrente dos sujeitos tendo por base o sinal medido pelas fibras ópticas foram desenvolvidos neste trabalho. As diferentes abordagens foram comparadas através de estudos piloto. Diferentes métodos para avaliação da qualidade do sinal adquirido foram sugeridos. Um método de reconhecimento da postura corporal através do cálculo de ângulos de orientação com base na aceleração medida foi proposto. A prova de conceito da determinação da intensidade da atividade física pela combinação de informações relativas á aceleração inercial e frequências cardíaca e respiratória dos sujeitos, é também apresentada neste trabalho. Um estudo foi conduzido para avaliar a validade do cinto para monitorização da respiração e da atividade física. O estudo contou com 10 parti-cipantes, dos quais 3 vestiram o cinto para monitorização da respiração (1 homem e 2 mulheres, idade 21 ± 2 anos, índice de massa corporal 20.3 ± 1.5 kg.m-2). Resultados: O estudo feito com pacientes com suspeita de apneia do sono revelou que os sinais eletro-cardiográficos adquiridos pelo cinto em ambiente domiciliar foram de melhor qualidade que os sinais adquiridos pelo mesmo dispositivo em ambiente hospitalar. Uma percentagem de artefacto de 2.87% ±4.14% foi observada para os dados adquiridos pelos elétrodos comummente usados em ambiente hospi-talar, 7.49% ± 10.76% para os dados adquiridos pelo cinto em ambiente domiciliar e 9.66% ± 14.65% para os dados adquiridos pelo cinto em ambiente hospitalar. Embora tenham tido uma maior percenta-gem de artefacto, a razão sinal-ruído dos sinais eletrocardiográficos adquiridos pelo cinto em ambiente domiciliar foi semelhante á dos sinais adquiridos pelos elétrodos de gel em ambiente hospitalar. Resul-tados sugerem uma boa concordância entre os intervalos RR calculados com base nos eletrocardiogra-mas registados em ambientes hospitalar e domiciliar. Além disso, para sinais com percentagem de arte-facto superior a 3%, a avaliação visual dos gráficos de Poincaré provou ser um bom método para a determinação da fonte primária de artefactos (batimentos irregulares ou ruído). A monitorização da aceleração dos sujeitos permitiu o reconhecimento da postura corporal (isto é, deitado ou sentado/em pé) com uma exatidão de 91% e valor preditivo positivo de 80%. Por fim, a classificação da intensidade da atividade física baseado na aceleração inercial e frequências cardíaca e respiratória revelou elevada exatidão, mostrando o potencial desta técnica. Conclusão: O cinto desenvolvido pela Empa provou ser apropriado para monitorização de longa-dura-ção de variáveis físicas e fisiológicos, de uma forma remota e contínua. O cinto permite não só monito-rizar eletrocardiograma, mas também frequência respiratória, postura corporal e intensidade da atividade física. Outros estudos devem ser conduzidos para corroborar os resultados e conclusões deste trabalho. Outros sensores poderão ser integrados no cinto de modo a possibilitar a monitorização de outras vari-áveis fisiológicas de relevância clínica. Este sistema tem o potencial de ser usado como uma ferramenta para predição de doenças e apoio ao diagnóstico

Unified Quality-Aware Compression and Pulse-Respiration Rates Estimation Framework for Reducing Energy Consumption and False Alarms of Wearable PPG Monitoring Devices

Due to the high demands of tiny, compact, lightweight, and low-cost photoplethysmogram (PPG) monitoring devices, these devices are resource-constrained including limited battery power. Consequently, it highly demands frequent charge or battery replacement in the case of continuous PPG sensing and transmission. Further, PPG signals are often severely corrupted under ambulatory and exercise recording conditions, leading to frequent false alarms. In this paper, we propose a unified quality-aware compression and pulse-respiration rates estimation framework for reducing energy consumption and false alarms of wearable and edge PPG monitoring devices by exploring predictive coding techniques for jointly performing signal quality assessment (SQA), data compression and pulse rate (PR) and respiration rate (RR) estimation without the use of different domains of signal processing techniques that can be achieved by using the features extracted from the smoothed prediction error signal. By using the five standard PPG databases, the performance of the proposed unified framework is evaluated in terms of compression ratio (CR), mean absolute error (MAE), false alarm reduction rate (FARR), processing time (PT) and energy saving (ES). The compression, PR, RR estimation, and SQA results are compared with the existing methods and results of uncompressed PPG signals with sampling rates of 125 Hz and 25 Hz. The proposed unified qualityaware framework achieves an average CR of 4%, SQA (Se of 92.00%, FARR of 84.87%), PR (MAE: 0.46 ±1.20) and RR (MAE: 1.75 (0.65-4.45), PT (sec) of 15.34 ±0.01) and ES of 70.28% which outperforms the results of uncompressed PPG signal with a sampling rate of 125 Hz. Arduino Due computing platformbased implementation demonstrates the real-time feasibility of the proposed unified quality-aware PRRR estimation and data compression and transmission framework on the limited computational resources. Thus, it has great potential in improving energy-efficiency and trustworthiness of wearable and edge PPG monitoring devices.publishedVersio

Clinical deterioration detection for continuous vital signs monitoring using wearable sensors

Surgical patients are at risk of experiencing clinical deterioration events, especially when transferred to general wards during the postoperative period of their hospital stay. Cur rently, such events are detected by combining Early Warning Scores (EWS) with manual and periodical vital signs measurements, performed by nurses every 4 to 6 hours. Hence, deterioration may remain unnoticed for hours, delaying patient treatment, which might lead to increased morbidity and mortality. Also, EWS are inadequate to predict events so physiologically complex. So that early warning of deterioration could be provided, it was investigated the potential of warning systems that combine machine learning-based prediction models with continuous vital signs monitoring, provided by wearable sensors. This dissertation presents the development of such a warning system, fully indepen dent of manual measurements and based on a logistic regression prediction model with 85% sensitivity, 79% precision and 98% specificity. Additionally, a new personalized ap proach to handle missing data periods in vital signs and a novel variation of a RR-interval preprocessing technique were developed. The results obtained revealed a relevant im provement in the detection of deterioration events and a significant reduction in false alarms, when comparing the warning system with a commonly employed EWS (42% sensitivity, 14% precision and 90% specificity). It was also found that the developed sys tem can assess patient’s condition much more frequently and with timely deterioration detection, without even requiring nurses to interrupt their workflow. These findings sup port the idea that these warning systems are reliable, more practical, more appropriate and produce smarter alarms than current methods, making early deterioration detection possible, thus contributing for better patients outcomes. Nonetheless, the performance achieved may yet reveal insufficient for application in real clinical contexts. Therefore, further work is necessary to improve prediction performance to a greater extent and to confirm these systems reliability

Continuous Estimation of Smoking Lapse Risk from Noisy Wrist Sensor Data Using Sparse and Positive-Only Labels

Estimating the imminent risk of adverse health behaviors provides opportunities for developing effective behavioral intervention mechanisms to prevent the occurrence of the target behavior. One of the key goals is to find opportune moments for intervention by passively detecting the rising risk of an imminent adverse behavior. Significant progress in mobile health research and the ability to continuously sense internal and external states of individual health and behavior has paved the way for detecting diverse risk factors from mobile sensor data. The next frontier in this research is to account for the combined effects of these risk factors to produce a composite risk score of adverse behaviors using wearable sensors convenient for daily use. Developing a machine learning-based model for assessing the risk of smoking lapse in the natural environment faces significant outstanding challenges requiring the development of novel and unique methodologies for each of them. The first challenge is coming up with an accurate representation of noisy and incomplete sensor data to encode the present and historical influence of behavioral cues, mental states, and the interactions of individuals with their ever-changing environment. The next noteworthy challenge is the absence of confirmed negative labels of low-risk states and adequate precise annotations of high-risk states. Finally, the model should work on convenient wearable devices to facilitate widespread adoption in research and practice. In this dissertation, we develop methods that account for the multi-faceted nature of smoking lapse behavior to train and evaluate a machine learning model capable of estimating composite risk scores in the natural environment. We first develop mRisk, which combines the effects of various mHealth biomarkers such as stress, physical activity, and location history in producing the risk of smoking lapse using sequential deep neural networks. We propose an event-based encoding of sensor data to reduce the effect of noises and then present an approach to efficiently model the historical influence of recent and past sensor-derived contexts on the likelihood of smoking lapse. To circumvent the lack of confirmed negative labels (i.e., annotated low-risk moments) and only a few positive labels (i.e., sensor-based detection of smoking lapse corroborated by self-reports), we propose a new loss function to accurately optimize the models. We build the mRisk models using biomarker (stress, physical activity) streams derived from chest-worn sensors. Adapting the models to work with less invasive and more convenient wrist-based sensors requires adapting the biomarker detection models to work with wrist-worn sensor data. To that end, we develop robust stress and activity inference methodologies from noisy wrist-sensor data. We first propose CQP, which quantifies wrist-sensor collected PPG data quality. Next, we show that integrating CQP within the inference pipeline improves accuracy-yield trade-offs associated with stress detection from wrist-worn PPG sensors in the natural environment. mRisk also requires sensor-based precise detection of smoking events and confirmation through self-reports to extract positive labels. Hence, we develop rSmoke, an orientation-invariant smoking detection model that is robust to the variations in sensor data resulting from orientation switches in the field. We train the proposed mRisk risk estimation models using the wrist-based inferences of lapse risk factors. To evaluate the utility of the risk models, we simulate the delivery of intelligent smoking interventions to at-risk participants as informed by the composite risk scores. Our results demonstrate the envisaged impact of machine learning-based models operating on wrist-worn wearable sensor data to output continuous smoking lapse risk scores. The novel methodologies we propose throughout this dissertation help instigate a new frontier in smoking research that can potentially improve the smoking abstinence rate in participants willing to quit

A Heartbeat Classifier for Continuous Prediction Using a Wearable Device

Heartbeat monitoring may play an essential role in the early detection of cardiovascular disease. When using a traditional monitoring system, an abnormal heartbeat may not appear during a recording in a healthcare facility due to the limited time. Thus, continuous and long-term monitoring is needed. Moreover, the conventional equipment may not be portable and cannot be used at arbitrary times and locations. A wearable sensor device such as Polar H10 offers the same capability as an alternative. It has gold-standard heartbeat recording and communication ability but still lacks analytical processing of the recorded data. An automatic heartbeat classification system can play as an analyzer and is still an open problem in the development stage. This paper proposes a heartbeat classifier based on RR interval data for real-time and continuous heartbeat monitoring using the Polar H10 wearable device. Several machine learning and deep learning methods were used to train the classifier. In the training process, we also compare intra-patient and inter-patient paradigms on the original and oversampling datasets to achieve higher classification accuracy and the fastest computation speed. As a result, with a constrain in RR interval data as the feature, the random forest-based classifier implemented in the system achieved up to 99.67% for accuracy, precision, recall, and F1-score. We are also conducting experiments involving healthy people to evaluate the classifier in a real-time monitoring system

Physiological and behavior monitoring systems for smart healthcare environments: a review

Healthcare optimization has become increasingly important in the current era, where numerous challenges are posed by population ageing phenomena and the demand for higher quality of the healthcare services. The implementation of Internet of Things (IoT) in the healthcare ecosystem has been one of the best solutions to address these challenges and therefore to prevent and diagnose possible health impairments in people. The remote monitoring of environmental parameters and how they can cause or mediate any disease, and the monitoring of human daily activities and physiological parameters are among the vast applications of IoT in healthcare, which has brought extensive attention of academia and industry. Assisted and smart tailored environments are possible with the implementation of such technologies that bring personal healthcare to any individual, while living in their preferred environments. In this paper we address several requirements for the development of such environments, namely the deployment of physiological signs monitoring systems, daily activity recognition techniques, as well as indoor air quality monitoring solutions. The machine learning methods that are most used in the literature for activity recognition and body motion analysis are also referred. Furthermore, the importance of physical and cognitive training of the elderly population through the implementation of exergames and immersive environments is also addressedinfo:eu-repo/semantics/publishedVersio