We present a novel smartwatch, CareUp ${}^{\circledR }$ , for estimating the Blood Pressure (BP) in real time. It consists of two pulse oximeters: one placed on the back and one on the front of the device. Placing the index finger on the front oximeter starts the acquisition of two photoplethysmograms (PPG); the signals are then filtered and cross-correlated to obtain a Time Delay between them, called Pulse Transit Time (PTT). The Heart Rate (HR) (estimated from the finger PPG) and the PTT are then input in a linear model to give an estimation of the Systolic and Diastolic BP. The performance of the smartwatch in measuring BP have been validated in the Institut Coeur Paris Centre Turin (ICPC), using a sphygmomanometer, on 44 subjects. During the validation, the measures of the CareUp ${}^{\circledR }$ were compared to those of two oscillometry-based devices already available on the market: Thuasne ${}^{\circledR }$ and Magnien ${}^{\circledR }$ . The results showed an accuracy comparable to the oscillometry-based devices and they almost agreed with the American Association for the Advancement of Medical Instrumentation standard for non-automated sphygmomanometers. The integration of the BP estimation algorithm in the smartwatch makes the CareUp ${}^{\circledR }$ an easy-to-use, wearable device for monitoring the BP in real time.

In this work, a detection and classification method for sleep apnea and hypopnea, using photopletysmography (PPG) and peripheral oxygen saturation ( $SpO_2$ ) signals, is proposed. The detector consists of two parts: one that detects reductions in amplitude fluctuation of PPG (DAP) and one that detects oxygen desaturations. To further differentiate among sleep disordered breathing events (SDBE), the pulse rate variability (PRV) was extracted from the PPG signal, and then used to extract features that enhance the sympatho-vagal arousals during apneas and hypopneas. A classification was performed to discriminate between central and obstructive events, apneas and hypopneas. The algorithms were tested on 96 overnight signals recorded at the UZ Leuven hospital, annotated by clinical experts, and from patients without any kind of co-morbidity. An accuracy of 75.1% for the detection of apneas and hypopneas, in one-minute segments, was reached. The classification of the detected events showed 92.6% accuracy in separating central from obstructive apnea, 83.7% for central apnea and central hypopnea and 82.7% for obstructive apnea and obstructive hypopnea. The low implementation cost showed a potential for the proposed method of being used as screening device, in ambulatory scenarios.

Objective: The objective of this study is to obtainaccurate estimations of breathing rate (BR), using only the electrocardiogram (ECG) or the photoplethysmogram (PPG) signals, to avoid wearing cumbersome and uncomfortable sensors for direct measurements. Methods: Several respiration waveforms are derived from ECG or PPG signals based on amplitude, frequency and baseline wander modulations. It is however difficult to determine their optimal combination for BR estimation due to the noise and patient specificity. We first propose to quantify the quality of modulation waveforms using respiratory quality indices (RQIs). We then present two methods: the first automatically selects the modulation signal with highest RQI for BR estimation, the second tracks the respiration signal using the Kalman Smoother (KS) to fuse modulation signals with highest RQI. Results: These two methods are evaluated on two independent datasets, one benchmark DB with immobilized patients recordings and the second with those performing daily activities. Our results outperform existing methods in the literature in both cases. Conclusion: Experimental results show that the RQIs coupled with a fusion algorithm increases the accuracy for BR estimations in dealing with derived modulation signals. Significance: This work describes a robust Kalman Smoother method applicable in multiple clinical contexts to improve breathing rate estimation from data fusion.

Continuous measurement of heart rate variability (HRV) in the short and ultra-short-term using wearable devices allows monitoring of physiological status and prevention of diseases. This study aims to evaluate the agreement of HRV features between a commercial device (Bora Band, Biosency) measuring photoplethysmography (PPG) and reference electrocardiography (ECG) and to assess the validity of ultra-short-term HRV as a surrogate for short-term HRV features. PPG and ECG recordings were acquired from 5 healthy subjects over 18 nights in total. HRV features include time-domain, frequency-domain, nonlinear, and visibility graph features and are extracted from 5 min 30 s and 1 min 30 s duration PPG recordings. The extracted features are compared with reference features of 5 min 30 s duration ECG recordings using repeated-measures correlation, Bland–Altman plots with 95% limits of agreements, Cliff’s delta, and an equivalence test. Results showed agreement between PPG recordings and ECG reference recordings for 37 out of 48 HRV features in short-term durations. Sixteen of the forty-eight HRV features were valid and retained very strong correlations, negligible to small bias, with statistical equivalence in the ultra-short recordings (1 min 30 s). The current study concludes that the Bora Band provides valid and reliable measurement of HRV features in short and ultra-short duration recordings.