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Abstract
Objective: Mental stress is detrimental to cardiovascular health, being a risk factor for coronary heart disease and a trigger for cardiac events. However, it is not currently routinely assessed. The aim of this study was to identify features of the photoplethysmogram (PPG) pulse wave which are indicative of mental stress. Approach: A numerical model of pulse wave propagation was used to simulate blood pressure signals, from which simulated PPG pulse waves were estimated using a transfer function. Pulse waves were simulated at six levels of stress by changing the model input parameters both simultaneously and individually, in accordance with haemodynamic changes associated with stress. Thirty-two feature measurements were extracted from pulse waves at three measurement sites: the brachial, radial and temporal arteries. Features which changed significantly with stress were identified using the Mann–Kendall monotonic trend test. Main results: Seventeen features exhibited significant trends with stress in measurements from at least one site. Three features showed significant trends at all three sites: the time from pulse onset to peak, the time from the dicrotic notch to pulse end, and the pulse rate. More features showed significant trends at the radial artery (15) than the brachial (8) or temporal (7) arteries. Most features were influenced by multiple input parameters. Significance: The features identified in this study could be used to monitor stress in healthcare and consumer devices. Measurements at the radial artery may provide superior performance than the brachial or temporal arteries. In vivo studies are required to confirm these observations.
Highlights
Mental stress is detrimental to cardiovascular health (Brotman et al 2007)
We demonstrate that a wide range of features extracted from the PPG pulse wave and its first and second derivatives were indicative of mental stress
We identified three PPG features which were indicative of stress at all three measurement sites: the crest time (CT, time from pulse onset to peak), the duration of diastole, and the instantaneous pulse rate (IPR)
Summary
Mental stress is detrimental to cardiovascular health (Brotman et al 2007) Acute stressors, such as disasters and family deaths, can trigger cardiac death (Leor et al 1996, Kales et al 2007, Dimsdale 2008). Chronic stressors, such as job strain, low income level and marital unhappiness, have been found to be a risk factor for coronary heart disease (Rosengren et al 1991, Greenwood et al 1996, Iso et al 2002, Rosengren et al 2004, Dimsdale 2008). If it was possible to extract a measure of mental stress from the PPG it may have great utility
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