The use of pulse transit time in pediatric sleep studies: A systematic review

Smith, Lee; Dawes, P. J. D.; Galland, Barbara

doi:10.1016/j.smrv.2016.11.006

Cited by 19 publications

(10 citation statements)

References 51 publications

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“…Estimates of blood pressure based on pulse transit time are confounded by variability in the pre-ejection period and remain incompletely validated, particularly during sleep. As a result, the potential of these estimates as a core clinical tool remains to be determined (Smith et al, IN PRESS)…”

Section: Figurementioning

confidence: 99%

Dynamic coupling between the central and autonomic nervous systems during sleep: A review

Zambotti

Trinder

Silvani

et al. 2018

Neuroscience & Biobehavioral Reviews

141

145

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Sleep is characterized by coordinated cortical and cardiac oscillations reflecting communication between the central (CNS) and autonomic (ANS) nervous systems. Here, we review fluctuations in ANS activity in association with CNS-defined sleep stages and cycles, and with phasic cortical events during sleep (e.g., arousals, K-complexes). Recent novel analytic methods reveal a dynamic organization of integrated physiological networks during sleep and indicate how multiple factors (e.g., sleep structure, age, sleep disorders) affect "CNS-ANS coupling". However, these data are mostly correlational and there is a lack of clarity of the underlying physiology, making it challenging to interpret causality and direction of coupling. Experimental manipulations (e.g., evoking K-complexes or arousals) provide information on the precise temporal sequence of cortical-cardiac activity, and are useful for investigating physiological pathways underlying CNS-ANS coupling. With the emergence of new analytical approaches and a renewed interest in ANS and CNS communication during sleep, future work may reveal novel insights into sleep and cardiovascular interactions during health and disease, in which coupling could be adversely impacted.

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Section: Figurementioning

confidence: 99%

Dynamic coupling between the central and autonomic nervous systems during sleep: A review

Zambotti

Trinder

Silvani

et al. 2018

Neuroscience & Biobehavioral Reviews

141

145

View full text Add to dashboard Cite

show abstract

“…Although the degree of correlation between systolic blood pressure (SBP) and PTT was repeatedly reported to be moderate, it has been suggested that variations in PTT can be exploited to track changes in SBP in a semiquantitative fashion. 10,11 Increased BP variability and reduced BRS have been previously reported in children with SDB, indicative of impaired cardiovascular control, 12,13 and a long-term follow-up study suggests that resolution of SDB normalizes BRS. 14 The aim of this study was to probe cardiovascular control in children with SDB during quiet, event-free sleep in comparison to healthy children using a multivariate autoregressive closedloop process model by exploiting standard PSG and to establish whether AT improves cardiovascular control in the short term.…”

Section: Introductionmentioning

confidence: 79%

“…11,28,38 However, the utility of PTT as a surrogate for BP has been insufficiently validated in pediatric populations. 11 While one study reported moderate inverse correlation between PTT and SBP, 39 another study reported a nonsignificant inverse correlation with SBP. 40 An observational study found that PTT mimicked changes in SBP after arousal in infants and children.…”

Section: Discussionmentioning

confidence: 99%

Altered Nocturnal Cardiovascular Control in Children With Sleep-Disordered Breathing

El-Hamad

Immanuel

Liu

et al. 2017

Sleep

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“…Even though in this study the PTT has a resolution of 8 ms, it is clear that artifacts as large as measured in the current setup result in a PTT that cannot be used as an absolute value in clinical situations and thus not as a diagnostic tool. The finding that the PTT is unreliable as a diagnostic tool has to be taken into account in current research, as current research focusses on the PTT as a predictive or trend parameter [10,14,15]. Our study emphasizes the importance of quality control in the setup used for measuring PTT.…”

Section: Discussionmentioning

confidence: 98%

“…Increases in PTT are related to changes in the cardiovascular system such as lower systolic blood pressure, lower arterial stiffness or an increased pathway length [5–8]. PTT might be used, amongst others, to detect sleep disordered breathing [9] or as a surrogate measure of blood pressure due to the correlation of PTT with blood pressure [10]. Another promising application of PTT is monitoring of closure of the ductus arteriosus in a neonatal setting [11,12].…”

Section: Introductionmentioning

confidence: 99%

Artifacts in pulse transit time measurements using standard patient monitoring equipment

et al. 2019

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Objective Pulse transit time (PTT) refers to the time it takes a pulse wave to travel between two arterial sites. PTT can be estimated, amongst others, using the electrocardiogram (ECG) and photoplethysmogram (PPG). Because we observed a sawtooth artifact in the PTT while using standard patient monitoring equipment for ECG and PPG, we explored the reasons for this artifact. Methods PPG and ECG were simulated at a heartrate of both 100 and 160 beats per minute while using a Masimo PPG post-processing module and a Philips patient monitor setup at the neonatal intensive care unit. Two different post-processing modules were used. PTT was defined as the difference between the R-peak in the ECG and the point of 50% increase in the PPG. Results A sawtooth artifact was seen in all simulations. Both length (59.2 to 72.4 s) and amplitude (30.8 to 36.0 ms) of the sawtooth were dependent on the post-processing module used. Furthermore, the absolute PTT value differed up to 250 ms depending on post-processing module and heart rate. The sawtooth occurred because the PPG wave continuously showed a minimal prolongation during the length of the sawtooth, followed by a sudden shortening. Both artifacts were generated in the post-processing module containing Masimo algorithms. Conclusion Post-processing of the PPG signal in the Masimo module of the Philips patient monitor introduces a sawtooth in PPG and derived PTT. This sawtooth, together with a large module-dependent absolute difference in PTT, renders the thus-derived PTT insufficient for clinical purposes.

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The use of pulse transit time in pediatric sleep studies: A systematic review

Cited by 19 publications

References 51 publications

Dynamic coupling between the central and autonomic nervous systems during sleep: A review

Dynamic coupling between the central and autonomic nervous systems during sleep: A review

Altered Nocturnal Cardiovascular Control in Children With Sleep-Disordered Breathing

Artifacts in pulse transit time measurements using standard patient monitoring equipment

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