Robust estimation of respiratory rate via ECG- and PPG-derived respiratory quality indices

Phase space reconstruction for noise-robust respiration rate estimation from PPG signal

Wearable devices that use optical sensing techniques have become increasingly popular in the healthcare industry for detecting diseases at an early stage and monitoring their progression. Multi-parameter monitoring, specifically the extraction of the respiratory signal, is a growing trend due to its simplicity and cost-effectiveness. However, this can result in an inaccurate respiratory rate (RR) due to external noise. To address this, we propose an attractor reconstruction technique with optimized (auto-correlation coefficient) delay 'τopt' and a Retract strategy to improve the RR accuracy. The performance is evaluated using the BIDMC dataset, and a mean absolute error of 2.19 and 1.87 breaths per minute are reported for the 32- and 64sec windowed PPG, respectively. The result indicates that the proposed method's RR accuracy surpassed the state-of-the-art techniques. Further, the result infers that τopt optimization is insignificant for the PPG signal. Hence, the τopt can be selected as 1/3rd of the signal's average cycle length. In addition, the proposed approach is well within an acceptable range for class II medical devices without losing vital signals.

Continuous Critical Respiratory Parameter Measurements Using a Single Low-Cost Relative Humidity Sensor: Evaluation Study

BACKGROUND

Accurate and portable respiratory parameter measurements are critical for properly managing chronic obstructive pulmonary diseases (COPDs) such as asthma or sleep apnea, as well as controlling ventilation for patients in intensive care units, during surgical procedures, or when using a positive airway pressure device for sleep apnea.

OBJECTIVE

The purpose of this research is to develop a new nonprescription portable measurement device that utilizes relative humidity sensors (RHS) to accurately measure key respiratory parameters at a cost that is approximately 10 times less than the industry standard.

METHODS

We present the development, implementation, and assessment of a wearable respiratory measurement device using the commercial Bosch BME280 RHS. In the initial stage, the RHS was connected to the pneumotach (PNT) gold standard device via its external connector to gather breathing metrics. Data collection was facilitated using the Arduino platform with a Bluetooth Low Energy connection, and all measurements were taken in real time without any additional data processing. The device's efficacy was tested with 7 participants (5 men and 2 women), all in good health. In the subsequent phase, we specifically focused on comparing breathing cycle and respiratory rate measurements and determining the tidal volume by calculating the region between inhalation and exhalation peaks. Each participant's data were recorded over a span of 15 minutes. After the experiment, detailed statistical analysis was conducted using ANOVA and Bland-Altman to examine the accuracy and efficiency of our wearable device compared with the traditional methods.

RESULTS

The perfused air measured with the respiratory monitor enables clinicians to evaluate the absolute value of the tidal volume during ventilation of a patient. In contrast, directly connecting our RHS device to the surgical mask facilitates continuous lung volume monitoring. The results of the 1-way ANOVA showed high P values of .68 for respiratory volume and .89 for respiratory rate, which indicate that the group averages with the PNT standard are equivalent to those with our RHS platform, within the error margins of a typical instrument. Furthermore, analysis utilizing the Bland-Altman statistical method revealed a small bias of 0.03 with limits of agreement (LoAs) of -0.25 and 0.33. The RR bias was 0.018, and the LoAs were -1.89 and 1.89.

CONCLUSIONS

Based on the encouraging results, we conclude that our proposed design can be a viable, low-cost wearable medical device for pulmonary parametric measurement to prevent and predict the progression of pulmonary diseases. We believe that this will encourage the research community to investigate the application of RHS for monitoring the pulmonary health of individuals.

Indirect Estimation of Breathing Rate from Heart Rate Monitoring System during Running

Recent advances in wearable technologies integrating multi-modal sensors have enabled the in-field monitoring of several physiological metrics. In sport applications, wearable devices have been widely used to improve performance while minimizing the risk of injuries and illness. The objective of this project is to estimate breathing rate (BR) from respiratory sinus arrhythmia (RSA) using heart rate (HR) recorded with a chest belt during physical activities, yielding additional physiological insight without the need of an additional sensor. Thirty-one healthy adults performed a run at increasing speed until exhaustion on an instrumented treadmill. RR intervals were measured using the Polar H10 HR monitoring system attached to a chest belt. A metabolic measurement system was used as a reference to evaluate the accuracy of the BR estimation. The evaluation of the algorithms consisted of exploring two pre-processing methods (band-pass filters and relative RR intervals transformation) with different instantaneous frequency tracking algorithms (short-term Fourier transform, single frequency tracking, harmonic frequency tracking and peak detection). The two most accurate BR estimations were achieved by combining band-pass filters with short-term Fourier transform, and relative RR intervals transformation with harmonic frequency tracking, showing 5.5% and 7.6% errors, respectively. These two methods were found to provide reasonably accurate BR estimation over a wide range of breathing frequency. Future challenges consist in applying/validating our approaches during in-field endurance running in the context of fatigue assessment.

Determining respiratory rate from photoplethysmogram and electrocardiogram signals using respiratory quality indices and neural networks

Continuous and non-invasive respiratory rate (RR) monitoring would significantly improve patient outcomes. Currently, RR is under-recorded in clinical environments and is often measured by manually counting breaths. In this work, we investigate the use of respiratory signal quality quantification and several neural network (NN) structures for improved RR estimation. We extract respiratory modulation signals from the electrocardiogram (ECG) and photoplethysmogram (PPG) signals, and calculate a possible RR from each extracted signal. We develop a straightforward and efficient respiratory quality index (RQI) scheme that determines the quality of each moonddulation-extracted respiration signal. We then develop NNs for the estimation of RR, using estimated RRs and their corresponding quality index as input features. We determine that calculating RQIs for modulation-extracted RRs decreased the mean absolute error (MAE) of our NNs by up to 38.17%. When trained and tested using 60-sec waveform segments, the proposed scheme achieved an MAE of 0.638 breaths per minute. Based on these results, our scheme could be readily implemented into non-invasive wearable devices for continuous RR measurement in many healthcare applications.

Modulation Model of the Photoplethysmography Signal for Vital Sign Extraction

This paper introduces an amplitude and frequency modulation (AM-FM) model to characterize the photoplethysmography (PPG) signal. The model indicates that the PPG signal spectrum contains one dominant frequency component - the heart rate (HR), which is guarded by two weaker frequency components on both sides; the distance from the dominant component to the guard components represents the respiratory rate (RR). Based on this model, an efficient algorithm is proposed to estimate both HR and RR by searching for the dominant frequency component and two guard components. The proposed method is performed in the frequency domain to estimate RR, which is more robust to additive noise than the prior art based on temporal features. Experiments were conducted on two types of PPG signals collected with a contact sensor (an oximeter) and a contactless visible imaging sensor (a color camera), respectively. The PPG signal from the contactless sensor is much noisier than the signal from the contact sensor. The experimental results demonstrate the effectiveness of the proposed algorithm, including under relatively noisy scenarios.

Design Rationale and Performance Evaluation of the Wavelet Health Wristband: Benchtop Validation of a Wrist-Worn Physiological Signal Recorder

Background

Wearable and connected health devices along with the recent advances in mobile and cloud computing provide a continuous, convenient-to-patient, and scalable way to collect personal health data remotely. The Wavelet Health platform and the Wavelet wristband have been developed to capture multiple physiological signals and to derive biometrics from these signals, including resting heart rate (HR), heart rate variability (HRV), and respiration rate (RR).

Objective

This study aimed to evaluate the accuracy of the biometric estimates and signal quality of the wristband.

Methods

Measurements collected from 35 subjects using the Wavelet wristband were compared with simultaneously recorded electrocardiogram and spirometry measurements.

Results

The HR, HRV SD of normal-to-normal intervals, HRV root mean square of successive differences, and RR estimates matched within 0.7 beats per minute (SD 0.9), 7 milliseconds (SD 10), 11 milliseconds (SD 12), and 1 breaths per minute (SD 1) mean absolute deviation of the reference measurements, respectively. The quality of the raw plethysmography signal collected by the wristband, as determined by the harmonic-to-noise ratio, was comparable with that obtained from measurements from a finger-clip plethysmography device.

Conclusions

The accuracy of the biometric estimates and high signal quality indicate that the wristband photoplethysmography device is suitable for performing pulse wave analysis and measuring vital signs.

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.