Detection of respiratory arousals using photoplethysmography (PPG) signal in sleep apnea patients

Chandan Karmakar, Ahsan Khandoker, Thomas Penzel, Christoph Schobel, Marimuthu Palaniswami

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Respiratory events during sleep induce cortical arousals and manifest changes in autonomic markers in sleep disorder breathing (SDB). Finger photoplethysmography (PPG) has been shown to be a reliable method of determining sympathetic activation. We hypothesize that changes in PPG signals are sufficient to predict the occurrence of respiratory-event-related cortical arousal. In this study, we develop a respiratory arousal detection model in SDB subjects by using PPG features. PPG signals from 10 SDB subjects (9 male, 1 female) with age range 43-75 years were used in this study. Time domain features of PPG signals, such as 1) PWA-pulse wave amplitude, 2) PPI-peak-to-peak interval, and 3) Area-area under peak, were used to detect arousal events. In this study, PWA and Area have shown better performance (higher accuracy and lower false rate) compared to PPI features. After investigating possible groupings of these features, combination of PWA and Area (PWA + Area) was shown to provide better accuracy with a lower false detection rate in arousal detection. PPG-based arousal indexes agreed well across a wide range of decision thresholds, resulting in a receiver operating characteristic with an area under the curve of 0.91. For the decision threshold (\hbox{PC}-{\rm thresh} =\hbox{25\%}) chosen for the final analyses, a sensitivity of 68.1% and a specificity of 95.2% were obtained. The results showed an accuracy of 84.68%, 85.15%, 86.93%, and 50.79% with a false rate of 21.80%, 55.41%, 64.78%, and 50.79% at PC-{\rm thresh} =\hbox{25\%} or PPI, PWA, Area, and PWA +\hbox{Area} features, respectively. This indicates that combining PWA and Area features reduced the false positive rate without much affecting the sensitivity of the arousal detection system. In conclusion, the PPG-based respiratory arousal detection model is a simple and promising alternative to the conventional electroencephalogram (EEG)-based respiratory arousal detection system.

Original languageBritish English
Article number6606860
Pages (from-to)1065-1073
Number of pages9
JournalIEEE Journal of Biomedical and Health Informatics
Issue number3
StatePublished - May 2014


  • Heart rate variability
  • photoplethysmography (PPG)
  • respiratory arousal
  • sleep apnea


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