Sex-Related Differences in Photoplethysmography Signals Measured From Finger and Toe

Dehghanojamahalleh, Seyedmohsen; Kaya, Mehmet

doi:10.1109/jtehm.2019.2938506

Cited by 17 publications

(12 citation statements)

References 28 publications

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“…On the other hand, post-menopausal females experience an increase in arterial stiffness and pulse pressure. Dehghanojamahalleh et al demonstrated variations in PPG morphology attributed to gender differences [ 105 ]. Interestingly, direct influence of gender variation was only significantly different at the upper peripheral measurement site such as the hand and fingers as opposed to lower extremities such as the ankle and feet.…”

Section: Individual Variations In the Human Populationmentioning

confidence: 99%

Sources of Inaccuracy in Photoplethysmography for Continuous Cardiovascular Monitoring

et al. 2021

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Photoplethysmography (PPG) is a low-cost, noninvasive optical technique that uses change in light transmission with changes in blood volume within tissue to provide information for cardiovascular health and fitness. As remote health and wearable medical devices become more prevalent, PPG devices are being developed as part of wearable systems to monitor parameters such as heart rate (HR) that do not require complex analysis of the PPG waveform. However, complex analyses of the PPG waveform yield valuable clinical information, such as: blood pressure, respiratory information, sympathetic nervous system activity, and heart rate variability. Systems aiming to derive such complex parameters do not always account for realistic sources of noise, as testing is performed within controlled parameter spaces. A wearable monitoring tool to be used beyond fitness and heart rate must account for noise sources originating from individual patient variations (e.g., skin tone, obesity, age, and gender), physiology (e.g., respiration, venous pulsation, body site of measurement, and body temperature), and external perturbations of the device itself (e.g., motion artifact, ambient light, and applied pressure to the skin). Here, we present a comprehensive review of the literature that aims to summarize these noise sources for future PPG device development for use in health monitoring.

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Section: Individual Variations In the Human Populationmentioning

confidence: 99%

Sources of Inaccuracy in Photoplethysmography for Continuous Cardiovascular Monitoring

et al. 2021

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“…The relative probability of having F and E pulses against B pulses was considerably higher for female subjects than males. Previous studies reported significant sex-based differences in the pulse transit time, that is, the time between the R peak recorded through the electrocardiogram and the consecutive PPG cycle ( 24 ), and it is well-known that the cardiovascular system differs between women and men, both in physiological and in pathological conditions ( 52 ). A previous study has already found that commercial smartwatches are less accurate, for heart rate measurement only, for men than for women ( 53 ).…”

Section: Discussionmentioning

confidence: 99%

“…This factor can lower the probability of finding Diagnostic quality pulses in older subjects, limiting the possibility of conducting an in-depth morphological analysis. Also, it is well-known that sex can affect the cardiovascular system, thus, in turn, the PPG morphology ( 24 ). Finally, the health state can also have an impact on PPG, even in those cases in which the pathology is not closely related to the cardiovascular system.…”

Section: Introductionmentioning

confidence: 99%

Quality Assessment and Morphological Analysis of Photoplethysmography in Daily Life

Moscato

Palmerini

Palumbo

et al. 2022

Front. Digit. Health

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The photoplethysmographic (PPG) signal has been applied in various research fields, with promising results for its future clinical application. However, there are several sources of variability that, if not adequately controlled, can hamper its application in pervasive monitoring contexts. This study assessed and characterized the impact of several sources of variability, such as physical activity, age, sex, and health state on PPG signal quality and PPG waveform parameters (Rise Time, Pulse Amplitude, Pulse Time, Reflection Index, Delta T, and DiastolicAmplitude). We analyzed 31 24 h recordings by as many participants (19 healthy subjects and 12 oncological patients) with a wristband wearable device, selecting a set of PPG pulses labeled with three different quality levels. We implemented a Multinomial Logistic Regression (MLR) model to evaluate the impact of the aforementioned factors on PPG signal quality. We then extracted six parameters only on higher-quality PPG pulses and evaluated the influence of physical activity, age, sex, and health state on these parameters with Generalized Linear Mixed Effects Models (GLMM). We found that physical activity has a detrimental effect on PPG signal quality quality (94% of pulses with good quality when the subject is at rest vs. 9% during intense activity), and that health state affects the percentage of available PPG pulses of the best quality (at rest, 44% for healthy subjects vs. 13% for oncological patients). Most of the extracted parameters are influenced by physical activity and health state, while age significantly impacts two parameters related to arterial stiffness. These results can help expand the awareness that accurate, reliable information extracted from PPG signals can be reached by tackling and modeling different sources of inaccuracy.

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“…Sex is associated with cardiovascular function, affecting resting HR and arterial blood pressure. 48 Consequently, sex differences might also be reflected in PPG-based HR due to possible differences in device positioning and skin characteristics. 45 For example, differences seem to exist in the thickness and echo intensity of skin between males and females.…”

Section: Sexmentioning

confidence: 99%

“…A recent article clearly indicated that factors such as pulse arrival time, pulse transit time, systolic pulse transit time and the ratio of areas under the PPG waveform are affected by sex, with men showing a larger effect on the PPG signal. 48 Considering these findings, it appears that sex likely affects…”

Section: Sexmentioning

confidence: 99%

Recommendations for determining the validity of consumer wearable heart rate devices: expert statement and checklist of the INTERLIVE Network

et al. 2021

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Assessing vital signs such as heart rate (HR) by wearable devices in a lifestyle-related environment provides widespread opportunities for public health related research and applications. Commonly, consumer wearable devices assessing HR are based on photoplethysmography (PPG), where HR is determined by absorption and reflection of emitted light by the blood. However, methodological differences and shortcomings in the validation process hamper the comparability of the validity of various wearable devices assessing HR. Towards Intelligent Health and Well-Being: Network of Physical Activity Assessment (INTERLIVE) is a joint European initiative of six universities and one industrial partner. The consortium was founded in 2019 and strives towards developing best-practice recommendations for evaluating the validity of consumer wearables and smartphones. This expert statement presents a best-practice validation protocol for consumer wearables assessing HR by PPG. The recommendations were developed through the following multi-stage process: (1) a systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, (2) an unstructured review of the wider literature pertaining to factors that may introduce bias during the validation of these devices and (3) evidence-informed expert opinions of the INTERLIVE Network. A total of 44 articles were deemed eligible and retrieved through our systematic literature review. Based on these studies, a wider literature review and our evidence-informed expert opinions, we propose a validation framework with standardised recommendations using six domains: considerations for the target population, criterion measure, index measure, testing conditions, data processing and the statistical analysis. As such, this paper presents recommendations to standardise the validity testing and reporting of PPG-based HR wearables used by consumers. Moreover, checklists are provided to guide the validation protocol development and reporting. This will ensure that manufacturers, consumers, healthcare providers and researchers use wearables safely and to its full potential.

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Sex-Related Differences in Photoplethysmography Signals Measured From Finger and Toe

Cited by 17 publications

References 28 publications

Sources of Inaccuracy in Photoplethysmography for Continuous Cardiovascular Monitoring

Sources of Inaccuracy in Photoplethysmography for Continuous Cardiovascular Monitoring

Quality Assessment and Morphological Analysis of Photoplethysmography in Daily Life

Recommendations for determining the validity of consumer wearable heart rate devices: expert statement and checklist of the INTERLIVE Network

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