We present a novel method for estimating respiratory rate in real time from the photoplethysmogram (PPG) obtained from pulse oximetry. Three respiratory-induced variations (frequency, intensity, and amplitude) are extracted from the PPG using the Incremental-Merge Segmentation algorithm. Frequency content of each respiratory-induced variation is analyzed using fast Fourier transforms. The proposed Smart Fusion method then combines the results of the three respiratory-induced variations using a transparent mean calculation. It automatically eliminates estimations considered to be unreliable because of detected presence of artifacts in the PPG or disagreement between the different individual respiratory rate estimations. The algorithm has been tested on data obtained from 29 children and 13 adults. Results show that it is important to combine the three respiratory-induced variations for robust estimation of respiratory rate. The Smart Fusion showed trends of improved estimation (mean root mean square error 3.0 breaths/min) compared to the individual estimation methods (5.8, 6.2, and 3.9 breaths/min). The Smart Fusion algorithm is being implemented in a mobile phone pulse oximeter device to facilitate the diagnosis of severe childhood pneumonia in remote areas.

Functional near-infrared spectroscopy (fNIRS) is a powerful tool for monitoring brain functional activities. Due to its non-invasive and non-restraining nature, fNIRS has found broad applications in brain functional studies. However, for fNIRS to work well, it is important to reduce its sensitivity to motion artifacts. We propose a new wavelet-based method for removing motion artifacts from fNIRS signals. The method relies on differences between artifacts and fNIRS signal in terms of duration and amplitude and is specifically designed for spike artifacts. We assume a gaussian distribution for the wavelet coefficients corresponding to the underlying hemodynamic signal in detail levels and identify the artifact coefficients using this distribution. An input parameter controls the intensity of artifact attenuation in trade-off with the level of distortion introduced in the signal. The method only modifies wavelet coefficients in levels adaptively selected based on the degree of contamination with motion artifact. To demonstrate the feasibility of the method, we tested it on experimental fNIRS data collected from three infant subjects. Normalized mean-square error and artifact energy attenuation were used as criteria for performance evaluation. The results show 18.29 and 16.42 dB attenuation in motion artifacts energy for 700 and 830 nm wavelength signals in a total of 29 motion events with no more than -16.7 dB distortion in terms of normalized mean-square error in the artifact-free regions of the signal.

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The circadian and sleep stage-specific effects on heart rate variability are clinically relevant and contribute to the understanding of the degree of cardiovascular vulnerability during sleep.

BackgroundSleep disordered breathing (SDB) can lead to daytime sleepiness, growth failure and developmental delay in children. Polysomnography (PSG), the gold standard to diagnose SDB, is a highly resource-intensive test, confined to the sleep laboratory.AimTo combine the blood oxygen saturation (SpO2) characterization and cardiac modulation, quantified by pulse rate variability (PRV), to identify children with SDB using the Phone Oximeter, a device integrating a pulse oximeter with a smartphone.MethodsFollowing ethics approval and informed consent, 160 children referred to British Columbia Children's Hospital for overnight PSG were recruited. A second pulse oximeter sensor applied to the finger adjacent to the one used for standard PSG was attached to the Phone Oximeter to record overnight pulse oximetry (SpO2 and photoplethysmogram (PPG)) alongside the PSG.ResultsWe studied 146 children through the analysis of the SpO2 pattern, and PRV as an estimate of heart rate variability calculated from the PPG. SpO2 variability and SpO2 spectral power at low frequency, was significantly higher in children with SDB due to the modulation provoked by airway obstruction during sleep (p-value ). PRV analysis reflected a significant augmentation of sympathetic activity provoked by intermittent hypoxia in SDB children. A linear classifier was trained with the most discriminating features to identify children with SDB. The classifier was validated with internal and external cross-validation, providing a high negative predictive value (92.6%) and a good balance between sensitivity (88.4%) and specificity (83.6%). Combining SpO2 and PRV analysis improved the classification performance, providing an area under the receiver operating characteristic curve of 88%, beyond the 82% achieved using SpO2 analysis alone.ConclusionsThese results demonstrate that the implementation of this algorithm in the Phone Oximeter will provide an improved portable, at-home screening tool, with the capability of monitoring patients over multiple nights.

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This paper presents a systematic procedure to design both robust PID controllers and robust controllers based on fractional calculus (based on Commande Robuste d'Ordre Non Entier, or CRONE methodology) to regulate the hypnotic state of anesthesia with the intravenous administration of propofol. The objective of the controllers is to provide an adequate drug administration regimen for propofol to avoid under or over dosing of the patients. The controllers are designed to compensate for the patients inherent drugresponse variability (uncertainty), to achieve good output disturbance rejection, and to attain good set point response. The performance of the controllers is assessed by calculating typical time domain measures and using the median PE, median absolute PE, divergence, and wobble.

This paper reports on a novel method for quantifying the cortical activity of a patient during general anesthesia as a surrogate measure of the patient's level of consciousness. The proposed technique is based on the analysis of a single-channel (frontal) electroencephalogram (EEG) signal using stationary wavelet transform (SWT). The wavelet coefficients calculated from the EEG are pooled into a statistical representation, which is then compared to two well-defined states: the awake state with normal EEG activity, and the isoelectric state with maximal cortical depression. The resulting index, referred to as the wavelet-based anesthetic value for central nervous system monitoring (WAV(CNS)), quantifies the depth of consciousness between these two extremes. To validate the proposed technique, we present a clinical study which explores the advantages of the WAV(CNS) in comparison with the BIS monitor (Aspect Medical Systems, MA), currently a reference in consciousness monitoring. Results show that the WAV(CNS) and BIS are well correlated (r = 0.969) during periods of steady-state despite fundamental algorithmic differences. However, in terms of dynamic behavior, the WAV(CNS) offers faster tracking of transitory changes at induction and emergence, with an average lead of 15-30 s. Furthermore, and conversely to the BIS, the WAV(CNS) regains its preinduction baseline value when patients are responding to verbal command after emergence from anesthesia. We conclude that the proposed analysis technique is an attractive alternative to BIS monitoring. In addition, we show that the WAV(CNS) dynamics can be modeled as a linear time invariant transfer function. This index is, therefore, well suited for use as a feedback sensor in advisory systems, closed-loop control schemes, and for the identification of the pharmacodynamic models of anesthetic drugs.