Detection of decreases in the amplitude fluctuation of pulse photoplethysmography signal as indication of obstructive sleep apnea syndrome in children

In this paper, a methodology for using pulse photoplethysmography (PPG) signal to automatically detect sleep apnea is proposed. The hypothesis is that decreases in the amplitude fluctuations of PPG (DAP), are originated by discharges of the sympathetic branch of autonomic nervous system, related to arousals caused by apnea. To test this hypothesis, an automatic system to detect DAP events is proposed. The detector was evaluated using real signals, and tested on a clinical experiment. The overall data set used in the studies includes the polysomnographic records of 26 children which were further subdivided depending on the evaluation of interest. For real signals, the sensitivity and positive predictive value of the DAP detector were 76% and 73%, respectively. An apnea detector has been developed to analyze the relationship between apneas and DAP, indicating that DAP events increase by about 15% when an apnea occurs compared to when apneas do not occur. A clinical study evaluating the diagnostic power of DAP in sleep apnea in children was carried out. The DAP per hour ratio r(DAP) was statistically significant (p = 0.033) in classifying children as either normal r(DAP) = 13.5 +/- 6.35 (mean +/- S.D.) or pathologic r(DAP) = 21.1 +/- 8.93. These results indicate a correlation between apneic events and DAP events, which suggests that DAP events could provide relevant information in sleep studies. Therefore, PPG signals might be useful in the diagnosis of OSAS. (C) 2007 Elsevier Ltd. All rights reserved.