ECG-derived Respiration Research Articles

Signal Quality-Aware Frequency Demodulation-Based ECG-Derived Respiration Rate Estimation Method With Reduced False Alarms

Signal Quality-Aware Frequency Demodulation-Based ECG-Derived Respiration Rate Estimation Method With Reduced False Alarms

Automatic detection of sleep apnea from a single-lead ECG signal based on spiking neural network model

BackgroundSleep apnea (SLA) is a commonly encountered sleep disorder characterized by repetitive cessation of respiration while sleeping. In the past few years, researchers have focused on developing less complex and more cost-effective diagnostic approaches for identifying SLA recipients, in contrast to the cumbersome, complicated, and expensive conventional methods. MethodThis study presents a biologically plausible learning approach of spiking neural networks (SNN) with temporal coding and a tempotron learning model for diagnosing SLA disorder using single-lead electrocardiogram (ECG) data information. The proposed framework utilizes temporal encoding and the leaky integrate and fire model to transform the ECG signal into spikes for capturing the signal's dynamic pattern nature and to simulate input response behaviors. The tempoton learning technique, a spike-based algorithm, trains the SNN model to identify SLA event patterns from encoded output spike trains. This study utilized ECG data to extract heart rate variability (HRV) and ECG-derived respiration (EDR) signals from 1-min segment data of ECG records for input to SNN model. Thirty-five recordings of both released and withheld data from the Apnea-ECG databases from Physionet have been applied to train the SNN model and validate the model's efficacy in identifying SLA occurrences. ResultsThe proposed method demonstrated substantial improvements compared to other SLA detection techniques, achieving a significant accuracy of 94.63 % for per-segment detection, along with specificity, sensitivity, F1-score and AUC values of 96.21 %, 92.04 %, 0.9285, and 0.9851 respectively. The accuracy for per-recording detection achieved 100 %, with a correlation coefficient value of 0.986. Additionally, the experiment used UCD data for validation methods, achieving an accuracy of 84.573 %. ConclusionsThese results suggest the effectiveness and accessibility of the presented approach for accurately identifying SLA cases. The suggested model enhances the performance of SLA detection when contrasted with various techniques based on feature engineering and feature learning.

Cardiorespiratory disturbances in focal impaired awareness seizures: Insights from wearable ECG monitoring

PurposeSeizures are characterized by periictal autonomic changes. Wearable devices could help improve our understanding of these phenomena through long-term monitoring. In this study, we used wearable electrocardiogram (ECG) data to evaluate differences between temporal and extratemporal focal impaired awareness (FIA) seizures monitored in the hospital and at home. We assessed periictal heart rate, respiratory rate, heart rate variability (HRV), and respiratory sinus arrhythmia (RSA). MethodsWe extracted ECG signals across three time points — five minutes baseline and preictal, ten minutes postictal — and the seizure duration. After automatic Rpeak selection, we calculated the heart rate and estimated the respiratory rate using the ECG-derived respiration methodology. HRV was calculated in both time and frequency domains. To evaluate the influence of other modulators on the HRV after removing the respiratory influences, we recalculated the residual power in the high-frequency (HF) and low-frequency (LF) bands using orthogonal subspace projections. Finally, 5-minute and 30-second (ultra-short) ECG segments were used to calculate RSA using three different methods. Seizures from temporal and extratemporal origins were compared using mixed-effects models and estimated marginal means. ResultsThe mean preictal heart rate was 69.95 bpm (95 % CI 65.6 – 74.3), and it increased to 82 bpm, 95 % CI (77.51 – 86.47) and 84.11 bpm, 95 % CI (76.9 – 89.5) during the ictal and postictal periods. Preictal, ictal and postictal respiratory rates were 16.1 (95 % CI 15.2 – 17.1), 14.8 (95 % CI 13.4 – 16.2) and 15.1 (95 % CI 14 – 16.2), showing not statistically significant bradypnea. HRV analysis found a higher baseline power in the LF band, which was still significantly higher after removing the respiratory influences. Postictally, we found decreased power in the HF band and the respiratory influences in both frequency bands. The RSA analysis with the new methods confirmed the lower cardiorespiratory interaction during the postictal period. Additionally, using ultra-short ECG segments, we found that RSA decreases before the electroclinical seizure onset. No differences were observed in the studied parameters between temporal and extratemporal seizures. ConclusionsWe found significant increases in the ictal and postictal heart rates and lower respiratory rates. Isolating the respiratory influences on the HRV showed a postictal reduction of respiratory modulations on both LF and HF bands, suggesting a central role of respiratory influences in the periictal HRV, unlike the baseline measurements. We found a reduced cardiorespiratory interaction during the periictal period using other RSA methods, suggesting a blockade in vagal efferences before the electroclinical onset. These findings highlight the importance of respiratory influences in cardiac dynamics during seizures and emphasize the need to longitudinally assess HRV and RSA to gain insights into long-term autonomic dysregulation.

Tracking Tidal Volume From Holter and Wearable Armband Electrocardiogram Monitoring.

A novel method for tracking the tidal volume (TV) from electrocardiogram (ECG) is presented. The method is based on the amplitude of ECG-derived respiration (EDR) signals. Three different morphology-based EDR signals and three different amplitude estimation methods have been studied, leading to a total of 9 amplitude-EDR (AEDR) signals per ECG channel. The potential of these AEDR signals to track the changes in TV was analyzed. These methods do not need a calibration process. In addition, a personalized-calibration approach for TV estimation is proposed, based on a linear model that uses all AEDR signals from a device. All methods have been validated with two different ECG devices: a commercial Holter monitor, and a custom-made wearable armband. The lowest errors for the personalized-calibration methods, compared to a reference TV, were -3.48% [-17.41% / 12.93%] (median [first quartile / third quartile]) for the Holter monitor, and 0.28% [-10.90% / 17.15%] for the armband. On the other hand, medians of correlations to the reference TV were higher than 0.8 for uncalibrated methods, while they were higher than 0.9 for personal-calibrated methods. These results suggest that TV changes can be tracked from ECG using either a conventional (Holter) setup, or our custom-made wearable armband. These results also suggest that the methods are not as reliable in applications that induce small changes in TV, but they can be potentially useful for detecting large changes in TV, such as sleep apnea/hypopnea and/or exacerbations of a chronic respiratory disease.

A novel method for chronic obstructive pulmonary disease detection using comprehensive respiratory impedance and electrocardiogram-derived respiration

Currently, pulmonary function test is the only standard method for diagnosing COPD, but it often involves high testing costs, poor compliance, and a high dependence on patient cooperation. Other new detection methods, such as CT and FOT, also have disadvantages such as radiation exposure and high usage costs. Existing non-invasive COPD detection methods consider the impact of COPD on the lungs or heart, thus they can only roughly detect COPD in individuals, without the ability to grade COPD. Therefore, this study proposed a method for COPD detection using comprehensive respiratory impedance (CRI) and electrocardio-derived respiration (EDR) signals. The method measured both respiratory impedance and ECG synchronously, and the CRI and EDR signals were obtained through an algorithm. The effects of COPD on respiratory pattern were studied by taking CRI and EDR signal morphology as objects, from which characteristic parameters were extracted and input into the supervised classifier to fuse the information of COPD on the changes of respiratory signal morphology pattern in the heart and lungs. The final result is accurate detection of normal, mild COPD and moderate COPD. The experimental results of 46 subjects showed that the accuracy, sensitivity and specificity of CRI and EDR signal characteristics for COPD detection by different classifiers were up to 93.5 %, 90.5 % and 96.5 %, and the AUC values of different classifiers were all > 0.88. Therefore, the method can not only effectively distinguish COPD patients from healthy people, but also provide differentiated detection capabilities for different COPD clinical grades, providing strong support for the early diagnosis and treatment of COPD, and can be applied to the development of portable medical devices for the detection of COPD.

Three methods for determining the respiratory waves from ECG (Part II)

This paper presents the results of a study of three methods for estimating the respiratory wave (RW) and respiratory rate (RR) using the electrocardiogram (ECG). There were applied methods from different groups: amplitude modulation ECG-Derived Respiration (EDR), frequency modulation Respiratory Sinus Arrhythmia (RSA) and Baseline Wander (BW) processing with the Savitzky–Golay filter (S–G). The theoretical aspects of the methods were presented in the Part 1 of the publication which was entitled: “Three Methods for the Determination of the Respiratory Waves from ECG Part I”. RR parameter estimation was performed for all the three methods for 12 subjects. The research concerning the influence of the parameters: Body Mass Index (BMI), Tidal Volume (TV) -, Forced Expiratory Volume in 1 second (FEV1) and – Forced Vital Capacity (FVC) on the errors of the estimated parameter RR. Moreover, all 12 signals, which were acquired with the help of a 12-lead Holter ECG were taken into consideration. The results indicate a preliminary dependence of respiratory parameters and BMI on the Respiratory Wave and, further, on the RR estimation errors. Consequently, the type of method and ECG Holter leads depend on the BMI and respiratory parameters. Studies with larger numbers of objects to definitively confirm these relationships are planned. In addition, an optimal selection of S–G filter parameters was carried out. Finally, a proprietary reference embedded system for recording RW and calculating RR was demonstrated.

ECG-based estimation of respiration-induced autonomic modulation of AV nodal conduction during atrial fibrillation.

Introduction: Information about autonomic nervous system (ANS) activity may offer insights about atrial fibrillation (AF) progression and support personalized AF treatment but is not easily accessible from the ECG. In this study, we propose a new approach for ECG-based assessment of respiratory modulation in atrioventricular (AV) nodal refractory period and conduction delay. Methods: A 1-dimensional convolutional neural network (1D-CNN) was trained to estimate respiratory modulation of AV nodal conduction properties from 1-minute segments of RR series, respiration signals, and atrial fibrillatory rates (AFR) using synthetic data that replicates clinical ECG-derived data. The synthetic data were generated using a network model of the AV node and 4 million unique model parameter sets. The 1D-CNN was then used to analyze respiratory modulation in clinical deep breathing test data of 28 patients in AF, where an ECG-derived respiration signal was extracted using a novel approach based on periodic component analysis. Results: We demonstrated using synthetic data that the 1D-CNN can estimate the respiratory modulation from RR series alone with a Pearson sample correlation of r = 0.805 and that the addition of either respiration signal (r = 0.830), AFR (r = 0.837), or both (r = 0.855) improves the estimation. Discussion: Initial results from analysis of ECG data suggest that our proposed estimate of respiration-induced autonomic modulation, a resp, is reproducible and sufficiently sensitive to monitor changes and detect individual differences. However, further studies are needed to verify the reproducibility, sensitivity, and clinical significance of a resp.

Unsupervised ensembling of multiple software sensors with phase synchronization: a robust approach for electrocardiogram-derived respiration

Objective. We aimed to fuse the outputs of different electrocardiogram-derived respiration (EDR) algorithms to create one higher quality EDR signal. Methods. We viewed each EDR algorithm as a software sensor that recorded breathing activity from a different vantage point, identified high-quality software sensors based on the respiratory signal quality index, aligned the highest-quality EDRs with a phase synchronization technique based on the graph connection Laplacian, and finally fused those aligned, high-quality EDRs. We refer to the output as the sync-ensembled EDR signal. The proposed algorithm was evaluated on two large-scale databases of whole-night polysomnograms. We evaluated the performance of the proposed algorithm using three respiratory signals recorded from different hardware sensors, and compared it with other existing EDR algorithms. A sensitivity analysis was carried out for a total of five cases: fusion by taking the mean of EDR signals, and the four cases of EDR signal alignment without and with synchronization and without and with signal quality selection. Results. The sync-ensembled EDR algorithm outperforms existing EDR algorithms when evaluated by the synchronized correlation ( γ -score), optimal transport (OT) distance, and estimated average respiratory rate score, all with statistical significance. The sensitivity analysis shows that the signal quality selection and EDR signal alignment are both critical for the performance, both with statistical significance. Conclusion. The sync-ensembled EDR provides robust respiratory information from electrocardiogram. Significance. Phase synchronization is not only theoretically rigorous but also practical to design a robust EDR.

Using spectral continuity to extract breathing rate from heart rate and its applications in sleep physiology.

Introduction: ECG Derived Respiration (EDR) are a set of methods used for extracting the breathing rate from the Electrocardiogram (ECG). Recent studies revealed a tight connection between breathing rate and more specifically the breathing patterns during sleep and several related pathologies. Yet, while breathing rate and more specifically the breathing pattern is recognised as a vital sign it is less employed than Electroencephalography (EEG) and heart rate in sleep and polysomnography studies. Methods: This study utilised open-access data from the ISRUC sleep database to test a novel spectral-based EDR technique (scEDR). In contrast to previous approaches, the novel method emphasizes spectral continuity and not only the power of the different spectral peaks. scEDR is then compared against a more widely used spectral EDR method that selects the frequency with the highest power as the respiratory frequency (Max Power EDR). Results: scEDR yielded improved performance against the more widely used Max Power EDR in terms of accuracy across all sleep stages and the whole sleep. This study further explores the breathing rate across sleep stages, providing evidence in support of a putative sleep stage "REM0" which was previously proposed based on analysis of the Heart Rate Variability (HRV) but not yet widely discussed. Most importantly, this study observes that the frequency distribution of the heart rate during REM0 is closer to REM than other NREM periods even though most of REM0 was previously classified as NREM sleep by sleep experts following either the original or revised sleep staging criteria. Discussion: Based on the results of the analysis, this study proposes scEDR as a potential low-cost and non-invasive method for extracting the breathing rate using the heart rate during sleep with further studies required to validate its accuracy in awake subjects. In this study, the autonomic balance across different sleep stages, including REM0, was examined using HRV as a metric. The results suggest that sympathetic activity decreases as sleep progresses to NREM3 until it reaches a level similar to the awake state in REM through a transition from REM0.

Three methods for determining respiratory waves from ECG (Part I)

In the diagnosis of many disease entities directly or indirectly related to disorders of respiratory parameters and heart disease, an important support would be to estimate the temporal changes in these parameters (most often respiratory wave (RW) and respiratory rate (RR)) on the basis the results of measurements of other physiological parameters of the patient. Such a possibility exists during ECG examination. The paper presents three methods for estimating RWand RR using ECG signal processing. The three procedures developed are shown: using Savitzky–Golay filtering (S-G), the ECG-Derived Respiration method (EDR) and the Respiratory Sinus Arrhythmia Analysis method (RSA). It must be clearly stated that the proposed methods are not designed to fully diagnose the patient’s respiratory function, but they can be applied to detect some conditions that are difficult to diagnose when performing an ECG, such as sleep-disordered breathing. The obtained results of the analysis were compared with those obtained from a dedicated measurement system developed by the authors. The second part of the paper will show the results of preliminary clinical verification of the developed analysis methods, taking into account the physiological parameters of the patient.

HealthGuard: Heart Attack and Respiratory Monitoring System

The method for producing respiration- derived cardiogram (RDC) and electrocardiogram (ECG) derived respiration (EDR) utilising a respiratory stretch sensor from a single lead ECG is presented in this study. The objective of the study is to detect heartbeats and compute the heart rate (HR) using the respiration signal. It also aims to rebuild the respiration waveform and compute the respiration rate using ECG QRS heartbeat complexes data. The accuracy of both approaches will be evaluated by comparing reference points to located QRS complexes and inspiration maxima. The results of this study will eventually aid in the development of new, more precise, and effective techniques for detecting heartbeats in respiratory signals, leading to improved cardiovascular disease diagnosis and management, particularly during sleep, when respiration monitoring is crucial for identifying apnea and other breathing problems , a recognised cause of cardiovascular disorders and ones that are associated to a lower quality of life. Additionally, the results of this study might be used to assess if it is feasible to use low-cost, no-contact wearable sensors to collect cardiac and respiratory data simultaneously. Keywords respiration, cardiology, electrocardiogram, plethysmography, signal processing, fantasia, MATLAB

Evaluation of three approaches used for respiratory measurement in healthy subjects

Objective. Respiration is one of the critical vital signs of human health status, and accurate respiratory monitoring has important clinical significance. There is substantial evidence that alterations in key respiratory parameters can be used to determine a patient’s health status, aid in the selection of appropriate treatments, predict potentially serious clinical events and control respiratory activity. Although various approaches have been developed for respiration monitoring, no definitive conclusions have been drawn regarding the accuracy of these approaches because each has different advantages and limitations. In the present study, we evaluated the performance of three non-invasive respiratory measurement approaches, including transthoracic impedance (IMP), surface diaphragm electromyography-derived respiration (EMGDR) and electrocardiogram-derived respiration (ECGDR), and compared them with the direct measurement of airflow (FLW) in 33 male and 38 female healthy subjects in the resting state. Approach. The accuracy of six key respiratory parameters, including onset of inspiration (Ion ), onset of expiration (Eon ), inspiratory time (It ), expiratory time (Et ), respiratory rate (RR) and inspiratory–expiratory ratio (I:E), measured from the IMP, EMGDR and ECGDR, were compared with those annotated from the reference FLW. Main results. The correlation coefficients between the estimated inspiratory volume and reference value were 0.72 ± 0.20 for IMP, 0.62 ± 0.23 for EMGDR and 0.46 ± 0.21 for ECGDR (p < 0.01 among groups). The positive predictive value and sensitivity for respiration detection were 100% and 100%, respectively, for IMP, which were significantly higher than those of the EMGDR (97.2% and 95.5%, p < 0.001) and the ECGDR (96.9% and 90.0%, p < 0.001). Additionally, the mean error (ME) for Ion , Eon , It , Et and RR detection were markedly lower for IMP than for EMGDR and ECGDR (p < 0.001). Significance. Compared with EMGDR and ECGDR, the IMP signal had a higher positive predictive value, higher sensitivity and lower ME for respiratory parameter detection. This suggests that IMP is more suitable for dedicated respiratory monitoring and parameter evaluation.

Combined Cardiac and Respiratory Monitoring from a Single Signal: A Case Study Employing the Fantasia Database.

This study proposes a novel method for obtaining the electrocardiogram (ECG) derived respiration (EDR) from a single lead ECG and respiration-derived cardiogram (RDC) from a respiratory stretch sensor. The research aims to reconstruct the respiration waveform, determine the respiration rate from ECG QRS heartbeat complexes data, locate heartbeats, and calculate a heart rate (HR) using the respiration signal. The accuracy of both methods will be evaluated by comparing located QRS complexes and inspiration maxima to reference positions. The findings of this study will ultimately contribute to the development of new, more accurate, and efficient methods for identifying heartbeats in respiratory signals, leading to better diagnosis and management of cardiovascular diseases, particularly during sleep where respiration monitoring is paramount to detect apnoea and other respiratory dysfunctions linked to a decreased life quality and known cause of cardiovascular diseases. Additionally, this work could potentially assist in determining the feasibility of using simple, no-contact wearable devices for obtaining simultaneous cardiology and respiratory data from a single device.

The Use of Respiratory Effort Improves an ECG-Based Deep Learning Algorithm to Assess Sleep-Disordered Breathing.

Sleep apnea is a prevalent sleep-disordered breathing (SDB) condition that affects a large population worldwide. Research has demonstrated the potential of using electrocardiographic (ECG) signals (heart rate and ECG-derived respiration, EDR) to detect SDB. However, EDR may be a suboptimal replacement for respiration signals. We evaluated a previously described ECG-based deep learning algorithm in an independent dataset including 198 patients and compared performance for SDB event detection using thoracic respiratory effort versus EDR. We also evaluated the algorithm in terms of apnea-hypopnea index (AHI) estimation performance, and SDB severity classification based on the estimated AHI. Using respiratory effort instead of EDR, we achieved an improved performance in SDB event detection (F1 score = 0.708), AHI estimation (Spearman's correlation = 0.922), and SDB severity classification (Cohen's kappa of 0.62 was obtained based on AHI). Respiratory effort is superior to EDR to assess SDB. Using respiratory effort and ECG, the previously described algorithm achieves good performance in a new dataset from an independent laboratory confirming its adequacy for this task.

Estimating Thoracic Movement with High-Sampling Rate THz Technology.

We use a high-sampling rate terahertz (THz) homodyne spectroscopy system to estimate thoracic movement from healthy subjects performing breathing at different frequencies. The THz system provides both the amplitude and phase of the THz wave. From the raw phase information, a motion signal is estimated. An electrocardiogram (ECG) signal is recorded with a polar chest strap to obtain ECG-derived respiration information. While the ECG showed sub-optimal performance for the purpose and only provided usable information for some subjects, the signal derived from the THz system showed good agreement with the measurement protocol. Over all the subjects, a root mean square estimation error of 1.40 BPM is obtained.

Autonomic response to walk tests is useful for assessing outcome measures in people with multiple sclerosis.

Objective: The aim of this study was to evaluate the association between changes in the autonomic control of cardiorespiratory system induced by walk tests and outcome measures in people with Multiple Sclerosis (pwMS). Methods: Electrocardiogram (ECG) recordings of 148 people with Relapsing-Remitting MS (RRMS) and 58 with Secondary Progressive MS (SPMS) were acquired using a wearable device before, during, and after walk test performance from a total of 386 periodical clinical visits. A subset of 90 participants repeated a walk test at home. Various MS-related symptoms, including fatigue, disability, and walking capacity were evaluated at each clinical visit, while heart rate variability (HRV) and ECG-derived respiration (EDR) were analyzed to assess autonomic nervous system (ANS) function. Statistical tests were conducted to assess differences in ANS control between pwMS grouped based on the phenotype or the severity of MS-related symptoms. Furthermore, correlation coefficients (r) were calculated to assess the association between the most significant ANS parameters and MS-outcome measures. Results: People with SPMS, compared to RRMS, reached higher mean heart rate (HRM) values during walk test, and larger sympathovagal balance after test performance. Furthermore, pwMS who were able to adjust their HRM and ventilatory values, such as respiratory rate and standard deviation of the ECG-derived respiration, were associated with better clinical outcomes. Correlation analyses showed weak associations between ANS parameters and clinical outcomes when the Multiple Sclerosis phenotype is not taken into account. Blunted autonomic response, in particular HRM reactivity, was related with worse walking capacity, yielding r = 0.36 r = 0.29 (RRMS) and r > 0.5 (SPMS). A positive strong correlation r > 0.7 r > 0.65 between cardiorespiratory parameters derived at hospital and at home was also found. Conclusion: Autonomic function, as measured by HRV, differs according to MS phenotype. Autonomic response to walk tests may be useful for assessing clinical outcomes, mainly in the progressive stage of MS. Participants with larger changes in HRM are able to walk longer distance, while reduced ventilatory function during and after walk test performance is associated with higher fatigue and disability severity scores. Monitoring of disorder severity could also be feasible using ECG-derived cardiac and respiratory parameters recorded with a wearable device at home.

Increased respiratory modulation of cardiovascular control reflects improved blood pressure regulation in pregnancy.

Hypertensive pregnancy disorders put the maternal-fetal dyad at risk and are one of the leading causes of morbidity and mortality during pregnancy. Multiple efforts have been made to understand the physiological mechanisms behind changes in blood pressure. Still, to date, no study has focused on analyzing the dynamics of the interactions between the systems involved in blood pressure control. In this work, we aim to address this question by evaluating the phase coherence between different signals using wavelet phase coherence. Electrocardiogram, continuous blood pressure, electrocardiogram-derived respiration, and muscle sympathetic nerve activity signals were obtained from ten normotensive pregnant women, ten normotensive non-pregnant women, and ten pregnant women with preeclampsia during rest and cold pressor test. At rest, normotensive pregnant women showed higher phase coherence in the high-frequency band (0.15-0.4Hz) between muscle sympathetic nerve activity and the RR interval, blood pressure, and respiration compared to non-pregnant normotensive women. Although normotensive pregnant women showed no phase coherence differences with respect to hypertensive pregnant women at rest, higher phase coherence between the same pairs of variables was found during the cold pressor test. These results suggest that, in addition to the increased sympathetic tone of normotensive pregnant women widely described in the existing literature, there is an increase in cardiac parasympathetic modulation and respiratory-driven modulation of muscle sympathetic nerve activity and blood pressure that could compensate sympathetic increase and make blood pressure control more efficient to maintain it in normal ranges. Moreover, blunted modulation could prevent its buffer effect and produce an increase in blood pressure levels, as observed in the hypertensive women in this study. This initial exploration of cardiorespiratory coupling in pregnancy opens the opportunity to follow up on more in-depth analyses and determine causal influences.

A Novel ECG-Derived Respiration Method Combining Frequency-Domain Feature and Interacting Multiple Model Smoother.

ECG-derived respiration (EDR) is a low-cost and productive means for capturing respiratory activity. In particular, as the primary procedure in some cardiorespiratory-related studies, the quality of EDR is decisive for the performance of subsequent analyses. In this paper, we proposed a novel EDR method based on the feature derived from the first moment (mean frequency) of the power spectrum (FMS). After obtaining the EDR signal from the feature, we introduced the Interacting Multiple Model (IMM) smoother to enhance the similarity of the EDR signal to the reference respiration. The assessment of the approach consisted of two steps: 1) the performance of extracted feature was verified against R-peak misalignment and noise. 2) the enhancement of IMM smoother to EDR waveforms was evaluated based on waveform correlation and respiratory rate estimation. All the assessments were conducted under the Fantasia database and Drivers database. The FMS improved robustness against R peak offsets compared to most established feature-based EDR algorithms, but a slight 5% improvement of waveform correlation against RR interval-based feature under accurate R peaks. The IMM smoother performed similarly with the Kalman filter in the static database but realized the enhancement of some extent of the EDR waveform in the ambulatory database. The proposed method investigated frequency domain mapping of ECG morphological changes caused by respiratory modulation and explained the EDR signal as a non-stationary time series, which provided a direction of better fitting the natural respiration process and enhancing the EDR waveform.

Can Respiration Complexity Help the Diagnosis of Disorders of Consciousness in Rehabilitation?

Autonomic Nervous System (ANS) activity, as cardiac, respiratory and electrodermal activity, has been shown to provide specific information on different consciousness states. Respiration rates (RRs) are considered indicators of ANS activity and breathing patterns are currently already included in the evaluation of patients in critical care. The aim of this work was to derive a proxy of autonomic functions via the RR variability and compare its diagnostic capability with known neurophysiological biomarkers of consciousness. In a cohort of sub-acute patients with brain injury during post-acute rehabilitation, polygraphy (ECG, EEG) recordings were collected. The EEG was labeled via descriptors based on American Clinical Neurophysiology Society terminology and the respiration variability was extracted by computing the Approximate Entropy (ApEN) of the ECG-derived respiration signal. Competing logistic regressions were applied to evaluate the improvement in model performances introduced by the RR ApEN. Higher RR complexity was significantly associated with higher consciousness levels and improved diagnostic models' performances in contrast to the ones built with only electroencephalographic descriptors. Adding a quantitative, instrumentally based complexity measure of RR variability to multimodal consciousness assessment protocols may improve diagnostic accuracy based only on electroencephalographic descriptors. Overall, this study promotes the integration of biomarkers derived from the central and the autonomous nervous system for the most comprehensive diagnosis of consciousness in a rehabilitation setting.

Sleep Quality Evaluation Based on Single-Lead Wearable Cardiac Cycle Acquisition Device.

In clinical conditions, polysomnography (PSG) is regarded as the "golden standard" for detecting sleep disease and offering a reference of objective sleep quality. For healthy adults, scores from sleep questionnaires are more reliable than other methods in obtaining knowledge of subjective sleep quality. In practice, the need to simplify PSG to obtain subjective sleep quality by recording a few channels of physiological signals such as single-lead electrocardiogram (ECG) or photoplethysmography (PPG) signal is still very urgent. This study provided a two-step method to differentiate sleep quality into "good sleep" and "poor sleep" based on the single-lead wearable cardiac cycle data, with the comparison of the subjective sleep questionnaire score. First, heart rate variability (HRV) features and ECG-derived respiration features were extracted to construct a sleep staging model (wakefulness (W), rapid eye movement (REM), light sleep (N1&N2) and deep sleep (N3)) using the multi-classifier fusion method. Then, features extracted from the sleep staging results were used to construct a sleep quality evaluation model, i.e., classifying the sleep quality as good and poor. The accuracy of the sleep staging model, tested on the international public database, was 0.661 and 0.659 in Cardiology Challenge 2018 training database and Sleep Heart Health Study Visit 1 database, respectively. The accuracy of the sleep quality evaluation model was 0.786 for our recording subjects, with an average F1-score of 0.771. The proposed sleep staging model and sleep quality evaluation model only requires one channel of wearable cardiac cycle signal. It is very easy to transplant to portable devices, which facilitates daily sleep health monitoring.