Abstract-This work is devoted to the evaluation of multilead digital wavelet transform (DWT)-based electrocardiogram (ECG)wave delineation algorithms, which were optimized and ported to a commercial wearable sensor platform. More specifically, we investigate the use of root-mean squared (RMS)-based multilead followed by a single-lead online delineation algorithm, which is based on a state-of-the-art offline single-lead delineator. The algorithmic transformations and software optimizations necessary to enable embedded ECG delineation notwithstanding the limited processing and storage resources of the target platform are described, and the performance of the resulting implementations are analyzed in terms of delineation accuracy, execution time, and memory usage. Interestingly, RMS-based multilead delineation is shown to perform equivalently to the best single-lead delineation for the 2-lead QT database (QTDB), within a fraction of a sample duration of the Common Standards for Electrocardiography (CSE) committee tolerances. Finally, a comprehensive evaluation of the energy consumption entailed by the considered algorithms is proposed, which allows very relevant insights into the dominant energy-draining functionalities and which suggests suitable design guidelines for long-lasting wearable ECG monitoring systems.Index Terms-Ambulatory electrocardiogram, delineation, digital wavelet transform, energy-constrained systems, multilead, wireless sensor node.

Obstructive Sleep Apnea (OSA) is one of the main under-diagnosed sleep disorder. It is an aggravating factor for several serious cardiovascular diseases, including stroke. There is, however, a lack of medical devices for long-term ambulatory monitoring of OSA since current systems are rather bulky, expensive, intrusive, and cannot be used for long-term monitoring in ambulatory settings. In this paper, we propose a wearable, accurate, and energy efficient system for monitoring obstructive sleep apnea on a long-term basis. As an embedded system for Internet of Things, it reduces the gap between home health-care and professional supervision. Our approach is based on monitoring the patient using a single-channel electrocardiogram signal. We develop an efficient time-domain analysis to meet the stringent resources constraints of embedded systems to compute the sleep apnea score. Our system, for a publicly available database (PhysioNet Apnea-ECG), has a classification accuracy of up to 88.2% for our new online and patient-specific analysis, which takes the distinct profile of each patient into account. While accurate, our approach is also energy efficient and can achieve a battery lifetime of 46 days for continuous screening of OSA.

Abstract-This work presents a new modular and lowcomplexity algorithm for the delineation of the different ECG waves (QRS, P and T peaks, onsets and end). Involving a reduced number of operations per second and having a small memory footprint, this algorithm is intended to perform realtime delineation on resource-constrained embedded systems. The modular design allows the algorithm to automatically adjust the delineation quality in run time to a wide range of modes and sampling rates, from a Ultra-low power mode when no arrhythmia is detected, in which the ECG is sampled at low frequency, to a complete High-accuracy delineation mode in which the ECG is sampled at high frequency and all the ECG fiducial points are detected, in case of arrhythmia. The delineation algorithm has been adjusted using the QT database, providing very high sensitivity and positive predictivity, and validated with the MIT database. The errors in the delineation of all the fiducial points are below the tolerances given by the Common Standards for Electrocardiography (CSE) committee in the High-accuracy mode, except for the P wave onset, for which the algorithm is above the agreed tolerances by only a fraction of the sample duration. The computational load for the ultra-low-power 8-MHz TI MSP430 series microcontroller ranges from 0.2 to 8.5% according to the mode used.

Abstract-The analysis of the electrocardiogram (ECG) is widely used for diagnosing many cardiac diseases. Since most of the clinically useful information in the ECG is found in characteristic wave peaks and boundaries, a significant amount of research effort has been devoted to the development of accurate and robust algorithms for automatic detection of the major ECG characteristic waves (i.e., the QRS complex, P and T waves), socalled ECG wave delineation.One of the most salient ECG wave delineation algorithms is based on the wavelet transform (WT). This work is dedicated to the sensible optimization and porting of this WT-based ECG wave delineator to an actual wearable embedded sensor platform with limited processing and storage resources. The porting was successful and the implementation was extensively validated using a standard manually annotated database. Interestingly, our results show that, despite the limitations of the embedded sensor platform, careful optimization allows to achieve comparable or even better delineation results than the original offline algorithm.

Personal health monitoring systems are emerging as promising solutions to develop ultra-small, portable devices that can continuously monitor and process several vital body parameters. In this work, we present a wearable device for physical and emotional health monitoring. The device obtains user's key physiological signals: ECG, respiration, Impedance Cardiogram (ICG), blood pressure and skin conductance and derives the user's emotion states as well. We have developed embedded algorithms that process the bio-signals in real-time to detect any abnormalities (cardiac arrhythmias and morphology changes) in the ECG and to detect key parameters (such as the Pre-Ejection Period and fluid status level) from the ICG. We present a novel method to detect continuous beat-by-beat blood pressure from the ECG and ICG signals, as well as a realtime embedded emotion classifier that computes the emotion levels of the user. Emotions are classified according to their attractiveness (positive valence) or their averseness (negative valence) in the horizontal valence dimension. The excitement level induced by the emotions is represented by high to low positions in the vertical arousal dimension of the valence-arousal space. The signals are measured either intermittently by touching the metal electrodes on the device (for point-of-care testing) or continuously, using a chest strap for long term monitoring. The processed data from device is sent to a mobile phone using a Bluetooth Low Energy protocol. Our results show that the device can monitor the signals continuously, providing accurate detection of the motion state, for over 72 hours on a single battery charge.

a b s t r a c tHypertension is known to affect around one third of adults globally and early diagnosis is essential to reduce the effects of this affliction. Today's Blood Pressure (BP) monitoring cuffs are obtrusive and inconvenient for performing regular measurements, and continuous non-invasive blood pressure devices are too complex and expensive for ambulatory use. Hence, there is a strong need for affordable systems that can measure blood pressure (BP) variations throughout the day as this will allow to monitor, diagnose and follow-up not only patients at risk, but also healthy population in general for early diagnosis. A promising method for arterial BP estimation is to measure the Pulse Transit Time (PTT) and derive pressure values from it. However, current methods for measuring this surrogate marker of BP require complex sensing and analysis circuitry and the related medical devices are expensive and inconvenient for the user. In this paper, we present new methods to estimate PTT reliably and subsequently BP, from the baseline sensors of smartphones. This new approach involves determining PTT by simultaneously measuring the time the blood leaves the heart, by recording the heart sound using the standard microphone of the phone, and the time it reaches the finger, by measuring the pulse wave using the phone's camera. We present algorithms that can be executed directly on current smartphones to obtain clean and robust heart sound signals and to extract the pulse wave characteristics. We also present methods to ensure a synchronous capture of the waveforms, which is essential to obtain reliable PTT values with inexpensive sensors. Additionally, we combine Autocorrelation and Fast Fourier Transform (FFT)-based methods for reliably estimating the user heart rate (HR) from his/her heart sounds, and describe how to use the calculate HR to compensate for the camera frame rate variations and to improve the robustness of PTT estimation. Our experiments show that the computational overhead of the proposed processing methods is minimum, which allows real-time feedback to the user, and that the PTT values are fully accurate (beat-to-beat), thereby enabling state-of-the-art smartphones to be used as affordable medical devices.

Abstract-This paper presents an automated real-time atrial fibrillation (AF) detection approach that relies on the observation of two characteristic irregularities of AF episodes in the electrocardiogram (ECG) signal. The results generated after the analysis of these irregularities are subsequently analyzed in real-time using a new fuzzy classifier. We have optimized this novel AF classification framework to require very limited processing, memory storage and energy resources, which makes it able to operate in real-time on a wearable wireless sensor platform. Moreover, our experimental results indicate that the proposed on-line approach shows a similar accuracy to stateof-the-art off-line AF detectors, achieving up to 96% sensitivity and 93% specificity. Finally, we present a detailed energy study of each component of the target wearable wireless sensor platform, while executing the automated AF detection approach in a real operating scenario, in order to evaluate the lifetime of the overall system. This study indicates that the lifetime of the platform is increased by using the proposed method to detect AF in real-time and diagnose the patient with respect to a streaming application that sends the raw signal to a central coordinator (e.g., smartphone or laptop) for its ulterior processing.

Background Continuous cardiac monitoring with wireless sensors is an attractive option for early detection of arrhythmia and conduction disturbances and the prevention of adverse events leading to patient deterioration. We present a new sensor design (SmartCardia), a wearable wireless biosensor patch, for continuous cardiac and oxygen saturation (SpO2) monitoring. Objective This study aimed to test the clinical value of a new wireless sensor device (SmartCardia) and its usefulness in monitoring the heart rate (HR) and SpO2 of patients. Methods We performed an observational study and monitored the HR and SpO2 of patients admitted to the intensive care unit (ICU). We compared the device under test (SmartCardia) with the ICU-grade monitoring system (Dräger-Healthcare). We defined optimal correlation between the gold standard and the wireless system as <10% difference for HR and <4% difference for SpO2. Data loss and discrepancy between the two systems were critically analyzed. Results A total of 58 ICU patients (42 men and 16 women), with a mean age of 71 years (SD 11), were included in this study. A total of 13.49 (SD 5.53) hours per patient were recorded. This represents a total recorded period of 782.3 hours. The mean difference between the HR detected by the SmartCardia patch and the ICU monitor was 5.87 (SD 16.01) beats per minute (bias=–5.66, SD 16.09). For SpO2, the average difference was 3.54% (SD 3.86; bias=2.9, SD 4.36) for interpretable values. SmartCardia’s patch measures SpO2 only under low-to-no activity conditions and otherwise does not report a value. Data loss and noninterpretable values of SpO2 represented 26% (SD 24) of total measurements. Conclusions The SmartCardia device demonstrated clinically acceptable accuracy for HR and SpO2 monitoring in ICU patients.