Mathematical Modeling of Arterial Blood Pressure Using Photo-Plethysmography Signal in Breath-hold Maneuver

Recent research has shown that each apnea episode results in a significant rise in the beat-to-beat blood pressure and by a drop to the pre-episode levels when patient resumes normal breathing. While the physiological implications of these repetitive and significant oscillations are still unknown, it is of interest to quantify them. Since current array of instruments deployed for polysomnography studies does not include beat-to-beat measurement of blood pressure, but includes oximetry, it is both of clinical interest to estimate the magnitude of BP oscillations from the photoplethysmography (PPG) signal that is readily available from sleep lab oximeters. We have investigated a new method for continuous estimation of systolic (SBP), diastolic (DBP), and mean (MBP) blood pressure waveforms from PPG. Peaks and troughs of PPG waveform are used as input to a 5th order autoregressive moving average model to construct estimates of SBP, DBP, and MBP waveforms. Since breath hold maneuvers are shown to simulate apnea episodes faithfully, we evaluated the performance of the proposed method in 7 subjects (4 F; 32+-4 yrs., BMI 24.57+-3.87 kg/m2) in supine position doing 5 breath maneuvers with 90s of normal breathing between them. The modeling error ranges were (all units are in mmHg) -0.88+-4.87 to -2.19+-5.73 (SBP); 0.29+-2.39 to -0.97+-3.83 (DBP); and -0.42+-2.64 to -1.17+-3.82 (MBP). The cross validation error ranges were 0.28+-6.45 to -1.74+-6.55 (SBP); 0.09+-3.37 to -0.97+-3.67 (DBP); and 0.33+-4.34 to -0.87+-4.42 (MBP). The level of estimation error in, as measured by the root mean squared of the model residuals, was less than 7 mmHg