Respiratory activity extracted from wrist-worn reflective photoplethysmography in a sleep-disordered population

Objective: Respiratory activity is an essential parameter to monitor healthy and disordered sleep, and unobtrusive measurement methods have important clinical applications in diagnostics of sleep-related breathing disorders. We propose a respiratory activity surrogate extracted from wrist-worn reflective photoplethysmography validated on a heterogeneous dataset of 389 sleep recordings. Approach: The surrogate was extracted by interpolating the amplitude of the PPG pulses after evaluation of pulse morphological quality. Subsequent multistep post-processing was applied to remove parts of the surrogate with low quality and high motion levels. In addition to standard respiration rate performance, we evaluated the similarity between surrogate respiratory activity and reference inductance plethysmography of the thorax, using Spearman's correlations and spectral coherence, and assessed the influence of PPG signal quality, motion levels, sleep stages and obstructive sleep apnea. Main results: Prior to post-processing, the surrogate already had a strong similarity with the reference (correlation=0.54, coherence=0.81), and reached respiration rate estimation performance in line with the literature (estimation error=0.76±2.11 breaths/min). Detrimental effects of low PPG quality, high motion levels and sleep stage-dependent physiological phenomena were significantly mitigated by the proposed post-processing steps (correlation=0.62, coherence=0.88, estimation error=0.53±1.98 breaths/min). Significance: Wrist-worn PPG can be used to extract respiratory activity, thus allowing respiration monitoring in real-world sleep medicine applications using (consumer) wearable devices.