Intervals of low-quality photoplethysmogram (PPG) signals might lead to significant inaccuracies in estimation of pulse arrival time (PAT) during polysomnography (PSG) studies. While PSG is considered to be a “gold standard” test for diagnosing obstructive sleep apnea (OSA), it also enables tracking apnea-related nocturnal blood pressure fluctuations correlated with PAT. Since the electrocardiogram (ECG) is recorded synchronously with the PPG during PSG, it makes sense to use the ECG signal for PPG signal-quality assessment. (1) Objective: to develop a PPG signal-quality assessment algorithm for robust PAT estimation, and investigate the influence of signal quality on PAT during various sleep stages and events such as OSA. (2) Approach: the proposed algorithm uses R and T waves from the ECG to determine approximate locations of PPG pulse onsets. The MESA database of 2055 PSG recordings was used for this study. (3) Results: the proportions of high-quality PPG were significantly lower in apnea-related oxygen desaturation (matched-pairs $r_c$ = 0.88 and $r_c$ = 0.97, compared to OSA and hypopnea, respectively, when p < 0.001) and arousal ($r_c$ = 0.93 and $r_c$ = 0.98, when p < 0.001) than in apnea events. The significantly large effect size of interquartile ranges of PAT distributions was between low- and high-quality PPG (p < 0.001, $r_c$ = 0.98), and regular and irregular pulse waves (p < 0.001, $r_c$ = 0.74), whereas a lower quality of the PPG signal was found to be associated with a higher interquartile range of PAT across all subjects. Suggested PPG signal quality-based PAT evaluation reduced deviations (e.g., $r_c$ = 0.97, $r_c$ = 0.97, $r_c$ = 0.99 in hypopnea, oxygen desaturation, and arousal stages, respectively, when p < 0.001) and allowed obtaining statistically larger differences between different sleep stages and events. (4) Significance: the implemented algorithm has the potential to increase the robustness of PAT estimation in PSG studies related to nocturnal blood pressure monitoring.

Obstructive sleep apnea (OSA) is believed to contribute significantly to atrial fibrillation (AF) development in certain patients. Recent studies indicate a rising risk of AF with increasing OSA severity. However, the commonly used apnea-hypopnea index in clinical practice may not adequately account for the potential cardiovascular risks associated with OSA. (1) Objective : to propose and explore a novel method for assessing OSA severity considering potential connection to cardiac arrhythmias. (2) Method : the approach utilizes cross-recurrence features to characterize OSA and AF by considering the relationships among oxygen desaturation, pulse arrival time, and heart-beat intervals. Multinomial logistic regression models were trained to predict four levels of OSA severity and four groups related to heart rhythm issues. The rank biserial correlation coefficient, \boldmath $r_{rb}$ , was used to estimate effect size for statistical analysis. The investigation was conducted using the MESA database, which includes polysomnography data from 2055 subjects. (3) Results : a derived cross-recurrence-based index showed a significant association with a higher OSA severity (\boldmath p $< $ 0.01) and the presence of AF (\boldmath p $< $ 0.01). Additionally, the proposed index had a significantly larger effect, \boldmath $r_{rb}$ , than the conventional apnea-hypopnea index in differentiating increasingly severe heart rhythm issue groups: 0.14 $>$ 0.06, 0.33 $>$ 0.10, and 0.41 $>$ 0.07. (4) Significance : the proposed method holds relevance as a supplementary diagnostic tool for assessing the authentic state of sleep apnea in clinical practice.

Obstructive sleep apnea (OSA) is believed to contribute significantly to atrial fibrillation (AF) development in certain patients. Recent studies indicate a rising risk of AF with increasing OSA severity. However, the commonly used apnea-hypopnea index in clinical practice may not adequately account for the potential cardiovascular risks associated with OSA. (1) Objective: to propose and explore a novel method for assessing OSA severity considering potential connection to cardiac arrhythmias. (2) Method: the approach utilizes cross-recurrence features to characterize OSA and AF by considering the relationships among oxygen desaturation, pulse arrival time, and heart-beat intervals. Multinomial logistic regression models were trained to predict four levels of OSA severity and four groups related to heart rhythm issues. The rank biserial correlation coefficient, rrb, was used to estimate effect size for statistical analysis. The investigation was conducted using the MESA database, which includes polysomnography data from 2055 subjects. (3) Results: a derived cross-recurrence-based index showed a significant association with a higher OSA severity (p < 0.01) and the presence of AF (p < 0.01). Additionally, the proposed index had a significantly larger effect, rrb, than the conventional apnea-hypopnea index in differentiating increasingly severe heart rhythm issue groups: 0.14 > 0.06, 0.33 > 0.10, and 0.41 > 0.07. (4) Significance: the proposed method holds relevance as a supplementary diagnostic tool for assessing the authentic state of sleep apnea in clinical practice.