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Background
The actual task of electrocardiographic examinations is to increase the reliability of diagnosing the condition of the heart. Within the framework of this task, an important direction is the solution of the inverse problem of electrocardiography, based on the processing of electrocardiographic signals of multichannel cardio leads at known electrode coordinates in these leads (Titomir et al. Noninvasiv electrocardiotopography, 2003), (Macfarlane et al. Comprehensive Electrocardiology, 2nd ed. (Chapter 9), 2011).
Results
In order to obtain more detailed information about the electrical activity of the heart, we carry out a reconstruction of the distribution of equivalent electrical sources on the heart surface. In this area, we hold reconstruction of the equivalent sources during the cardiac cycle at relatively low hardware cost. ECG maps of electrical potentials on the surface of the torso (TSPM) and electrical sources on the surface of the heart (HSSM) were studied for different times of the cardiac cycle. We carried out a visual and quantitative comparison of these maps in the presence of pathological regions of different localization. For this purpose we used the model of the heart electrical activity, based on cellular automata.
Conclusions
The model of cellular automata allows us to consider the processes of heart excitation in the presence of pathological regions of various sizes and localization. It is shown, that changes in the distribution of electrical sources on the surface of the epicardium in the presence of pathological areas with disturbances in the conduction of heart excitation are much more noticeable than changes in ECG maps on the torso surface.
Vehicles have been so far improved in terms of energy-efficiency and safety mainly by optimising the engine and the power train. However, there are opportunities to increase energy-efficiency and safety by adapting the individual driving behaviour in the given driving situation. In this paper, an improved rule match algorithm is introduced, which is used in the expert system of a human-centred driving system. The goal of the driving system is to optimise the driving behaviour in terms of energy-efficiency and safety by giving recommendations to the driver. The improved rule match algorithm checks the incoming information against the driving rules to recognise any breakings of a driving rule. The needed information is obtained by monitoring the driver, the current driving situation as well as the car, using in-vehicle sensors and serial-bus systems. On the basis of the detected broken driving rules, the expert system will create individual recommendations in terms of energy-efficiency and safety, which will allow eliminating bad driving habits, while considering the driver needs.
Detecting the adherence of driving rules in an energy-efficient, safe and adaptive driving system
(2016)
An adaptive and rule-based driving system is being developed that tries to improve the driving behavior in terms of the energy-efficiency and safety by giving recommendations. Therefore, the driving system has to monitor the adherence of driving rules by matching the rules to the driving behavior. However, existing rule matching algorithms are not sufficient, as the data within a driving system is changing frequently. In this paper a rule matching algorithm is introduced that is able to handle frequently changing data within the context of the driving system. 15 journeys were used to evaluate the performance of the rule matching algorithms. The results showed that the introduced algorithm outperforms existing algorithms in the context of the driving system. Thus, the introduced algorithm is suited for matching frequently changing data against rules with a higher performance, why it will be used in the driving system for the detection of broken energy-efficiency of safety-relevant driving rules.
Saving energy and road safety became important in the last decades, hence several driving assistant systems were developed that help to improve the driving behaviour. However, these driving systems cover the area of either energy-efficiency or safety. Furthermore, they do not consider the reaction of the driver to a shown recommendation and the driver stress level. In this paper, the decision process of showing a recommendation to the driver in an energy-efficient and safety relevant driving system is presented. The decision process considers the driver's reaction to a shown recommendation and the driver stress in order to increase the user acceptance and the road safety. The results of the evaluation showed that the driving system was able to show recommendations when needed, while suppressing recommendations when the driver ignored a recommendation repeatedly or when the driver was in stress.
Development of an expert system to overpass citizens technological barriers on smart home and living
(2023)
Adopting new technologies can be overwhelming, even for people with experience in the field. For the general public, learning about new implementations, releases, brands, and enhancements can cause them to lose interest. There is a clear need to create point sources and platforms that provide helpful information about the novel and smart technologies, assisting users, technicians, and providers with products and technologies. The purpose of these platforms is twofold, as they can gather and share information on interests common to manufacturers and vendors. This paper presents the ”Finde-Dein-SmartHome” tool. Developed in association with the Smart Home & Living competence center [5] to help users learn about, understand, and purchase available technologies that meet their home automation needs. This tool aims to lower the usability barrier and guide potential customers to clear their doubts about privacy and pricing. Communities can use the information provided by this tool to identify market trends that could eventually lower costs for providers and incentivize access to innovative home technologies and devices supporting long-term care.
Respiratory diseases are leading causes of death and disability in the world. The recent COVID-19 pandemic is also affecting the respiratory system. Detecting and diagnosing respiratory diseases requires both medical professionals and the clinical environment. Most of the techniques used up to date were also invasive or expensive.
Some research groups are developing hardware devices and techniques to make possible a non-invasive or even remote respiratory sound acquisition. These sounds are then processed and analysed for clinical, scientific, or educational purposes.
We present the literature review of non-invasive sound acquisition devices and techniques.
The results are about a huge number of digital tools, like microphones, wearables, or Internet of Thing devices, that can be used in this scope.
Some interesting applications have been found. Some devices make easier the sound acquisition in a clinic environment, but others make possible daily monitoring outside that ambient. We aim to use some of these devices and include the non-invasive recorded respiratory sounds in a Digital Twin system for personalized health.
This work is a study about a comparison of survey tools and it should help developers in selecting a suited tool for application in an AAL environment. The first step was to identify the basic required functionality of the survey tools used for AAL technologies and to compare these tools by their functionality and assignments. The comparative study was derived from the data obtained, previous literature studies and further technical data. A list of requirements was stated and ordered in terms of relevance to the target application domain. With the help of an integrated assessment method, the calculation of a generalized estimate value was performed and the result is explained. Finally, the planned application of this tool in a running project is explained.
The use of deep learning models with medical data is becoming more widespread. However, although numerous models have shown high accuracy in medical-related tasks, such as medical image recognition (e.g. radiographs), there are still many problems with seeing these models operating in a real healthcare environment. This article presents a series of basic requirements that must be taken into account when developing deep learning models for biomedical time series classification tasks, with the aim of facilitating the subsequent production of the models in healthcare. These requirements range from the correct collection of data, to the existing techniques for a correct explanation of the results obtained by the models. This is due to the fact that one of the main reasons why the use of deep learning models is not more widespread in healthcare settings is their lack of clarity when it comes to explaining decision making.
Background: Polysomnography (PSG) is the gold standard for detecting obstructive sleep apnea (OSA). However, this technique has many disadvantages when using it outside the hospital or for daily use. Portable monitors (PMs) aim to streamline the OSA detection process through deep learning (DL).
Materials and methods: We studied how to detect OSA events and calculate the apnea-hypopnea index (AHI) by using deep learning models that aim to be implemented on PMs. Several deep learning models are presented after being trained on polysomnography data from the National Sleep Research Resource (NSRR) repository. The best hyperparameters for the DL architecture are presented. In addition, emphasis is focused on model explainability techniques, concretely on Gradient-weighted Class Activation Mapping (Grad-CAM).
Results: The results for the best DL model are presented and analyzed. The interpretability of the DL model is also analyzed by studying the regions of the signals that are most relevant for the model to make the decision. The model that yields the best result is a one-dimensional convolutional neural network (1D-CNN) with 84.3% accuracy.
Conclusion: The use of PMs using machine learning techniques for detecting OSA events still has a long way to go. However, our method for developing explainable DL models demonstrates that PMs appear to be a promising alternative to PSG in the future for the detection of obstructive apnea events and the automatic calculation of AHI.
Introduction
Despite its high accuracy, polysomnography (PSG) has several drawbacks for diagnosing obstructive sleep apnea (OSA). Consequently, multiple portable monitors (PMs) have been proposed.
Objective
This systematic review aims to investigate the current literature to analyze the sets of physiological parameters captured by a PM to select the minimum number of such physiological signals while maintaining accurate results in OSA detection.
Methods
Inclusion and exclusion criteria for the selection of publications were established prior to the search. The evaluation of the publications was made based on one central question and several specific questions.
Results
The abilities to detect hypopneas, sleep time, or awakenings were some of the features studied to investigate the full functionality of the PMs to select the most relevant set of physiological signals. Based on the physiological parameters collected (one to six), the PMs were classified into sets according to the level of evidence. The advantages and the disadvantages of each possible set of signals were explained by answering the research questions proposed in the methods.
Conclusions
The minimum number of physiological signals detected by PMs for the detection of OSA depends mainly on the purpose and context of the sleep study. The set of three physiological signals showed the best results in the detection of OSA.
The development of automatic solutions for the detection of physiological events of interest is booming. Improvements in the collection and storage of large amounts of healthcare data allow access to these data faster and more efficiently. This fact means that the development of artificial intelligence models for the detection and monitoring of a large number of pathologies is becoming increasingly common in the medical field. In particular, developing deep learning models for detecting obstructive apnea (OSA) events is at the forefront. Numerous scientific studies focus on the architecture of the models and the results that these models can provide in terms of OSA classification and Apnea-Hypopnea-Index (AHI) calculation. However, little focus is put on other aspects of great relevance that are crucial for the training and performance of the models. Among these aspects can be found the set of physiological signals used and the preprocessing tasks prior to model training. This paper covers the essential requirements that must be considered before training the deep learning model for obstructive sleep apnea detection, in addition to covering solutions that currently exist in the scientific literature by analyzing the preprocessing tasks prior to training.
The citizen-centered health platform project is intended to provide a platform that can be used in EU cross-border regions, where social and economic exchange occurs across national borders. The overriding challenges are: (a) social: improving citizen-centered health and care provision; (b) technical: providing a digital platform for networking citizens, service providers, and municipal actors; (c) economic: developing long-term successful (sustainable) business models/value chains. The platform should strengthen and expand existing networks and establish new regional networks. Each network addresses particular challenges and apply them in a region-specific manner. Here, the national boundary conditions and the interregional needs play an essential role. These objectives require sufficient participation of civil society representatives. Furthermore, the platform will establish an overarching, sustainable, and knowledge-based network of health experts. The platform is to be jointly developed and implemented in the regions and follow an open-access approach. Therefore, synergies will be shared more quickly, strengthening competencies and competitiveness. In addition to practice partners, scientific and municipal institutions and SMEs are involved. The actors thus contribute to scientific performance, innovative strength, and resilience.
To evaluate the quality of sleep, it is important to determine how much time was spent in each sleep stage during the night. The gold standard in this domain is an overnight polysomnography (PSG). But the recording of the necessary electrophysiological signals is extensive and complex and the environment of the sleep laboratory, which is unfamiliar to the patient, might lead to distorted results. In this paper, a sleep stage detection algorithm is proposed that uses only the heart rate signal, derived from electrocardiogram (ECG), as a discriminator. This would make it possible for sleep analysis to be performed at home, saving a lot of effort and money. From the heart rate, using the fast Fourier transformation (FFT), three parameters were calculated in order to distinguish between the different sleep stages. ECG data along with a hypnogram scored by professionals was used from Physionet database, making it easy to compare the results. With an agreement rate of 41.3%, this approach is a good foundation for future research.
While driving, stress is caused by situations in which the driver estimates their ability to manage the driving demands as insufficient or loses the capability to handle the situation. This leads to increased numbers of driver mistakes and traffic violations. Additional stressing factors are time pressure, road conditions, or dislike for driving. Therefore, stress affects driver and road safety. Stress is classified into two categories depending on its duration and the effects on the body and psyche: short-term eustress and constantly present distress, which causes degenerative effects. In this work, we focus on distress. Wearable sensors are handy tools for collecting biosignals like heart rate, activity, etc. Easy installation and non-intrusive nature make them convenient for calculating stress. This study focuses on the investigation of stress and its implications. Specifically, the research conducts an analysis of stress within a select group of individuals from both Spain and Germany. The primary objective is to examine the influence of recognized psychological factors, including personality traits such as neuroticism, extroversion, psychoticism, stress and road safety. The estimation of stress levels was accomplished through the collection of physiological parameters (R-R intervals) using a Polar H10 chest strap. We observed that personality traits, such as extroversion, exhibited similar trends during relaxation, with an average heart rate 6% higher in Spain and 3% higher in Germany. However, while driving, introverts, on average, experienced more stress, with rates 4% and 1% lower than extroverts in Spain and Germany, respectively.
In previous studies, we used a method for detecting stress that was based exclusively on heart rate and ECG for differentiation between such situations as mental stress, physical activity, relaxation, and rest. As a response of the heart to these situations, we observed different behavior in the Root Mean Square of the Successive differences heartbeats (RMSSD). This study aims to analyze Virtual Reality via a virtual reality headset as an effective stressor for future works. The value of the Root Mean Square of the Successive Differences is an important marker for the parasympathetic effector on the heart and can provide information about stress. For these measurements, the RR interval was collected using a breast belt. In these studies, we can observe the Root Mean Square of the successive differences heartbeats. Additional sensors for the analysis were not used. We conducted experiments with ten subjects that had to drive a simulator for 25 minutes using monitors and 25 minutes using virtual reality headset. Before starting and after finishing each simulation, the subjects had to complete a survey in which they had to describe their mental state. The experiment results show that driving using virtual reality headset has some influence on the heart rate and RMSSD, but it does not significantly increase the stress of driving.
Cardiovascular diseases are directly or indirectly responsible for up to 38.5% of all deaths in Germany and thus represent the most frequent cause of death. At present, heart diseases are mainly discovered by chance during routine visits to the doctor or when acute symptoms occur. However, there is no practical method to proactively detect diseases or abnormalities of the heart in the daily environment and to take preventive measures for the person concerned. Long-term ECG devices, as currently used by physicians, are simply too expensive, impractical, and not widely available for everyday use. This work aims to develop an ECG device suitable for everyday use that can be worn directly on the body. For this purpose, an already existing hardware platform will be analyzed, and the corresponding potential for improvement will be identified. A precise picture of the existing data quality is obtained by metrological examination, and corresponding requirements are defined. Based on these identified optimization potentials, a new ECG device is developed. The revised ECG device is characterized by a high integration density and combines all components directly on one board except the battery and the ECG electrodes. The compact design allows the device to be attached directly to the chest. An integrated microcontroller allows digital signal processing without the need for an additional computer. Central features of the evaluation are a peak detection for detecting R-peaks and a calculation of the current heart rate based on the RR interval. To ensure the validity of the detected R-peaks, a model of the anatomical conditions is used. Thus, unrealistic RR-intervals can be excluded. The wireless interface allows continuous transmission of the calculated heart rate. Following the development of hardware and software, the results are verified, and appropriate conclusions about the data quality are drawn. As a result, a very compact and wearable ECG device with different wireless technologies, data storage, and evaluation of RR intervals was developed. Some tests yelled runtimes up to 24 hours with wireless Lan activated and streaming.
Artefaktkorrektur und verfeinerte Metriken für ein EEG-basiertes System zur Müdigkeitserkennung
(2019)
Fragestellung: Müdigkeit ist ein oft unterschätztes, aber dennoch großes Problem im Straßenverkehr. Von rund 2,5 Mio. Verkehrsunfällen 2015 in Deutschland, waren 2898 Unfälle, mit insgesamt 59 Toten (~1,7 % der Todesfälle), auf Übermüdung zurückzuführen. Schätzungen gehen von einer Dunkelziffer von bis zu 20 % aus. In einer ersten eigenen Studie wurde überprüft, ob ein mobiles EEG in einem Fahrsimulator Müdigkeitszustände zuverlässig erkennen kann. Die Erkennungsrate lag lediglich bei 61 %. Ziel dieser Arbeit ist, das verwendete Messsystem zu verbessern. Dazu wird die Genauigkeit durch eine Artefaktkorrektur und mit Hilfe von verfeinerten Qualitätsmetriken erhöht. Eine erkannte Übermüdung wird dem Fahrer dann in angemessener Weise angezeigt, so dass er entsprechend reagieren kann.
Patienten und Methoden: Die Independent Component Analysis (ICA) ist ein multivariates Verfahren, um mehrere Zufallsvariablen zu analysieren. Für die Entscheidung, ob ein Fahrer gerade müde oder wach ist, wird der erstellte Merkmalsvektor für jede Sequenz mit ICA klassifiziert. Dafür wird ein trainierter Machine-Learning-Algorithmus eingesetzt, der in der Lage ist, auch unbekannte Datensätze in Klassen einzuteilen. Um die benötigten Frequenzwerte zu erhalten, wurde für jeden EEG-Kanal eine Fourier Transformation durchgeführt. Der erstellte Merkmalsvektor wird im nächsten Schritt durch ein Künstliches Neuronales Netz klassifiziert. Für das Training werden vorab erstellte Merkmalsvektoren mit den Klassen „Wach“ und „Müde“ versehen. Diese Daten werden zufällig gemischt und im Verhältnis 2:1 in eine Trainings- und Testmenge geteilt. Das Experiment wurde mit acht Personen mit jeweils zweimal 45 min Testfahrt durchgeführt.
Ergebnisse: Der komplette Datensatz besteht aus 150.000 Signalwerten, welche zu ca. 7000 Sequenzen zusammengefasst werden. Durch die Anwendung der Qualitätsmetrik bleiben 4370 Sequenzen für das Training übrig. Bei invaliden Sequenzen aufgrund von EEG-Artefakten gibt es deutliche Unterschiede. Im „Wach“ Zustand werden dreimal so viele Sequenzen verworfen als im „Müde“ Zustand. Insgesamt werden bei wachen Probanden im Schnitt ca. 50 % der Sequenzen verworfen, bei Müden lediglich 25 %. Im Durchschnitt erreicht das System eine Erkennungsrate von 73 % für beide Zustände. Vergleicht man nun das Verhältnis von „Wach“ und „Müde“ und lässt „Leichte Müdigkeit“ außen vor, liegen die Ergebnisse bei über 90 %.
Schlussfolgerungen: Die Ergebnisse zeigen, dass die Aufmerksamkeit während des Experiments abnimmt bzw. die Müdigkeit zunimmt. Dies verdeutlichen zum einen subjektive und objektive Beobachtungen von Müdigkeitsanzeichen. Zum anderen lassen sich messbare und klassifizierbare Unterschiede im EEG Signal nachweisen. Die als Merkmale eingesetzten Theta-Wellen zeigten eine niedrigere Amplitude gegen Ende des Experiments. Die Erweiterung der binären Klassifizierung führt zu einer weiteren Stabilisierung der Ergebnisse. Artefaktkorrektur und Qualitätsmetriken steigern die Güte der Daten weiter. Die entwickelte Anwendung zur Müdigkeitserkennung ermittelt messbare Zeichen von Müdigkeit und kann eine gute Entscheidung über die Fahrtauglichkeit treffen.
Preliminary results of homomorphic deconvolution application to surface EMG signals during walking
(2021)
Homomorphic deconvolution is applied to sEMG signals recorded during walking. Gastrocnemius lateralis and tibialis anterior signals were acquired according to SENIAM recommendation. MUAP parameters like amplitude and scale were estimated, whilst the MUAP shape parameter was fixed. This features a useful time-frequency representation of sEMG signal. Estimation of scale MUAP parameter was verified extracting the mean frequency of filtered EMG signal, extracted from the scale parameter estimated with two different MUAP shape values.
The present work proposes the use of modern ICT technologies such as smartphones, NFCs, internet, and web technologies, to help patients in carrying out their therapies. The implemented system provides a calendar with a reminder of the assumptions, ensures the drug identification through NFC, allows remote assistance from healthcare staff and family members to check and manage the therapy in real-time. The system also provides centralized information on the patient's therapeutic situation, helpful in choosing new compatible therapies.
Background: One of the most promising health care development areas is introducing telemedicine services and creating solutions based on blockchain technology. The study of systems combining both these domains indicates the ongoing expansion of digital technologies in this market segment.
Objective: This paper aims to review the feasibility of blockchain technology for telemedicine.
Methods: The authors identified relevant studies via systematic searches of databases including PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar. The suitability of each for inclusion in this review was assessed independently. Owing to the lack of publications, available blockchain-based tokens were discovered via conventional web search engines (Google, Yahoo, and Yandex).
Results: Of the 40 discovered projects, only 18 met the selection criteria. The 5 most prevalent features of the available solutions (N=18) were medical data access (14/18, 78%), medical service processing (14/18, 78%), diagnostic support (10/18, 56%), payment transactions (10/18, 56%), and fundraising for telemedical instrument development (5/18, 28%).
Conclusions: These different features (eg, medical data access, medical service processing, epidemiology reporting, diagnostic support, and treatment support) allow us to discuss the possibilities for integration of blockchain technology into telemedicine and health care on different levels. In this area, a wide range of tasks can be identified that could be accomplished based on digital technologies using blockchains.
Sleep disorders can impact daily life, affecting physical, emotional, and cognitive well-being. Due to the time-consuming, highly obtrusive, and expensive nature of using the standard approaches such as polysomnography, it is of great interest to develop a noninvasive and unobtrusive in-home sleep monitoring system that can reliably and accurately measure cardiorespiratory parameters while causing minimal discomfort to the user’s sleep. We developed a low-cost Out of Center Sleep Testing (OCST) system with low complexity to measure cardiorespiratory parameters. We tested and validated two force-sensitive resistor strip sensors under the bed mattress covering the thoracic and abdominal regions. Twenty subjects were recruited, including 12 males and 8 females. The ballistocardiogram signal was processed using the 4th smooth level of the discrete wavelet transform and the 2nd order of the Butterworth bandpass filter to measure the heart rate and respiration rate, respectively. We reached a total error (concerning the reference sensors) of 3.24 beats per minute and 2.32 rates for heart rate and respiration rate, respectively. For males and females, heart rate errors were 3.47 and 2.68, and respiration rate errors were 2.32 and 2.33, respectively. We developed and verified the reliability and applicability of the system. It showed a minor dependency on sleeping positions, one of the major cumbersome sleep measurements. We identified the sensor under the thoracic region as the optimal configuration for cardiorespiratory measurement. Although testing the system with healthy subjects and regular patterns of cardiorespiratory parameters showed promising results, further investigation is required with the bandwidth frequency and validation of the system with larger groups of subjects, including patients.
Fatigue and drowsiness are responsible for a significant percentage of road traffic accidents. There are several approaches to monitor the driver's drowsiness, ranging from the driver's steering behavior to the analysis of the driver, e.g. eye tracking, blinking, yawning, or electrocardiogram (ECG). This paper describes the development of a low-cost ECG sensor to derive heart rate variability (HRV) data for drowsiness detection. The work includes hardware and software design. The hardware was implemented on a printed circuit board (PCB) designed so that the board can be used as an extension shield for an Arduino. The PCB contains a double, inverted ECG channel including low-pass filtering and provides two analog outputs to the Arduino, which combines them and performs the analog-to-digital conversion. The digital ECG signal is transferred to an NVidia embedded PC where the processing takes place, including QRS-complex, heart rate, and HRV detection as well as visualization features. The resulting compact sensor provides good results in the extraction of the main ECG parameters. The sensor is being used in a larger frame, where facial-recognition-based drowsiness detection is combined with ECG-based detection to improve the recognition rate under unfavorable light or occlusion conditions.
Normal breathing during sleep is essential for people’s health and well-being. Therefore, it is crucial to diagnose apnoea events at an early stage and apply appropriate therapy. Detection of sleep apnoea is a central goal of the system design described in this article. To develop a correctly functioning system, it is first necessary to define the requirements outlined in this manuscript clearly. Furthermore, the selection of appropriate technology for the measurement of respiration is of great importance. Therefore, after performing initial literature research, we have analysed in detail three different methods and made a selection of a proper one according to determined requirements. After considering all the advantages and disadvantages of the three approaches, we decided to use the impedance measurement-based one. As a next step, an initial conceptual design of the algorithm for detecting apnoea events was created. As a result, we developed an activity diagram on which the main system components and data flows are visually represented.
The scoring of sleep stages is one of the essential tasks in sleep analysis. Since a manual procedure requires considerable human and financial resources, and incorporates some subjectivity, an automated approach could result in several advantages. There have been many developments in this area, and in order to provide a comprehensive overview, it is essential to review relevant recent works and summarise the characteristics of the approaches, which is the main aim of this article. To achieve it, we examined articles published between 2018 and 2022 that dealt with the automated scoring of sleep stages. In the final selection for in-depth analysis, 125 articles were included after reviewing a total of 515 publications. The results revealed that automatic scoring demonstrates good quality (with Cohen's kappa up to over 0.80 and accuracy up to over 90%) in analysing EEG/EEG + EOG + EMG signals. At the same time, it should be noted that there has been no breakthrough in the quality of results using these signals in recent years. Systems involving other signals that could potentially be acquired more conveniently for the user (e.g. respiratory, cardiac or movement signals) remain more challenging in the implementation with a high level of reliability but have considerable innovation capability. In general, automatic sleep stage scoring has excellent potential to assist medical professionals while providing an objective assessment.
Healthy sleep is one of the prerequisites for a good human body and brain condition, including general well-being. Unfortunately, there are several sleep disorders that can negatively affect this. One of the most common is sleep apnoea, in which breathing is impaired. Studies have shown that this disorder often remains undiagnosed. To avoid this, developing a system that can be widely used in a home environment to detect apnoea and monitor the changes once therapy has been initiated is essential. The conceptualisation of such a system is the main aim of this research. After a thorough analysis of the available literature and state of the art in this area of knowledge, a concept of the system was created, which includes the following main components: data acquisition (including two parts), storage of the data, apnoea detection algorithm, user and device management, data visualisation. The modules are interchangeable, and interfaces have been defined for data transfer, most of which operate using the MQTT protocol. System diagrams and detailed component descriptions, including signal requirements and visualisation mockups, have also been developed. The system's design includes the necessary concepts for the implementation and can be realised in a prototype in the next phase.
Comparison of sleep characteristics measurements: a case study with a population aged 65 and above
(2020)
Good sleep is crucial for a healthy life of every person. Unfortunately, its quality often decreases with aging. A common approach to measuring the sleep characteristics is based on interviews with the subjects or letting them fill in a daily questionnaire and afterward evaluating the obtained data. However, this method has time and personal costs for the interviewer and evaluator of responses. Therefore, it would be important to execute the collection and evaluation of sleep characteristics automatically. To do that, it is necessary to investigate the level of agreement between measurements performed in a traditional way using questionnaires and measurements obtained using electronic monitoring devices. The study presented in this manuscript performs this investigation, comparing such sleep characteristics as "time going to bed", "total time in bed", "total sleep time" and "sleep efficiency". A total number of 106 night records of elderly persons (aged 65+) were analyzed. The results achieved so far reveal the fact that the degree of agreement between the two measurement methods varies substantially for different characteristics, from 31 minutes of mean difference for "time going to bed" to 77 minutes for "total sleep time". For this reason, a direct exchange of objective and subjective measuring methods is currently not possible.
Fragestellung: Das klinische Standardverfahren und Referenz der Schlafmessung und der Klassifizierung der einzelnen Schlafstadien ist die Polysomnographie (PSG). Alternative Ansätze zu diesem aufwändigen Verfahren könnten einige Vorteile bieten, wenn die Messungen auf eine komfortablere Weise durchgeführt werden. Das Hauptziel dieser Forschung Studie ist es, einen Algorithmus für die automatische Klassifizierung von Schlafstadien zu entwickeln, der ausschließlich Bewegungs- und Atmungssignale verwendet [1].
Patienten und Methoden: Nach der Analyse der aktuellen Forschungsarbeiten haben wir multinomiale logistische Regression als Grundlage für den Ansatz gewählt [2]. Um die Genauigkeit der Auswertung zu erhöhen, wurden vier Features entwickelt, die aus Bewegungs- und Atemsignalen abgeleitet wurden. Für die Auswertung wurden die nächtlichen Aufzeichnungen von 35 Personen verwendet, die von der Charité-Universitätsmedizin Berlin zur Verfügung gestellt wurden. Das Durchschnittsalter der Teilnehmer betrug 38,6 +/– 14,5 Jahre und der BMI lag bei durchschnittlich 24,4 +/– 4,9 kg/m2. Da der Algorithmus mit drei Stadien arbeitet, wurden die Stadien N1, N2 und N3 zum NREM-Stadium zusammengeführt. Der verfügbare Datensatz wurde strikt aufgeteilt: in einen Trainingsdatensatz von etwa 100 h und in einen Testdatensatz mit etwa 160 h nächtlicher Aufzeichnungen. Beide Datensätze wiesen ein ähnliches Verhältnis zwischen Männern und Frauen auf, und der durchschnittliche BMI wies keine signifikante Abweichung auf.
Ergebnisse: Der Algorithmus wurde implementiert und lieferte erfolgreiche Ergebnisse: die Genauigkeit der Erkennung von Wach-/NREM-/REM-Phasen liegt bei 73 %, mit einem Cohen’s Kappa von 0,44 für die analysierten 19.324 Schlafepochen von jeweils 30 s. Die beobachtete gewisse Überschätzung der NREM-Phase lässt sich teilweise durch ihre Prävalenz in einem typischen Schlafmuster erklären. Selbst die Verwendung eines ausbalancierten Trainingsdatensatzes konnte dieses Problem nicht vollständig lösen.
Schlussfolgerungen: Die erreichten Ergebnisse haben die Tauglichkeit des Ansatzes prinzipiell bestätigt. Dieser hat den Vorteil, dass nur Bewegungs- und Atemsignale verwendet werden, die mit weniger Aufwand und komfortabler für Benutzer aufgezeichnet werden können als z. B. Herz- oder EEG-Signale. Daher stellt das neue System eine deutliche Verbesserung im Vergleich zu bestehenden Ansätzen dar. Die Zusammenführung der beschriebenen algorithmischen Software mit dem in [1] beschriebenen Hardwaresystem zur Messung von Atem- und Körperbewegungssignalen zu einem autonomen, berührungslosen System zur kontinuierlichen Schlafüberwachung ist eine mögliche Richtung zukünftiger Arbeiten.
Sustainable technologies are being increasingly used in various areas of human life. While they have a multitude of benefits, they are especially useful in health monitoring, especially for certain groups of people, such as the elderly. However, there are still several issues that need to be addressed before its use becomes widespread. This work aims to clarify the aspects that are of great importance for increasing the acceptance of the use of this type of technology in the elderly. In addition, we aim to clarify whether the technologies that are already available are able to ensure acceptable accuracy and whether they could replace some of the manual approaches that are currently being used. A two-week study with people 65 years of age and over was conducted to address the questions posed here, and the results were evaluated. It was demonstrated that simplicity of use and automatic functioning play a crucial role. It was also concluded that technology cannot yet completely replace traditional methods such as questionnaires in some areas. Although the technologies that were tested were classified as being “easy to use”, the elderly population in the current study indicated that they were not sure that they would use these technologies regularly in the long term because the added value is not always clear, among other issues. Therefore, awareness-raising must take place in parallel with the development of technologies and services.
In order to ensure sufficient recovery of the human body and brain, healthy sleep is indispensable. For this purpose, appropriate therapy should be initiated at an early stage in the case of sleep disorders. For some sleep disorders (e.g., insomnia), a sleep diary is essential for diagnosis and therapy monitoring. However, subjective measurement with a sleep diary has several disadvantages, requiring regular action from the user and leading to decreased comfort and potential data loss. To automate sleep monitoring and increase user comfort, one could consider replacing a sleep diary with an automatic measurement, such as a smartwatch, which would not disturb sleep. To obtain accurate results on the evaluation of the possibility of such a replacement, a field study was conducted with a total of 166 overnight recordings, followed by an analysis of the results. In this evaluation, objective sleep measurement with a Samsung Galaxy Watch 4 was compared to a subjective approach with a sleep diary, which is a standard method in sleep medicine. The focus was on comparing four relevant sleep characteristics: falling asleep time, waking up time, total sleep time (TST), and sleep efficiency (SE). After evaluating the results, it was concluded that a smartwatch could replace subjective measurement to determine falling asleep and waking up time, considering some level of inaccuracy. In the case of SE, substitution was also proved to be possible. However, some individual recordings showed a higher discrepancy in results between the two approaches. For its part, the evaluation of the TST measurement currently does not allow us to recommend substituting the measurement method for this sleep parameter. The appropriateness of replacing sleep diary measurement with a smartwatch depends on the acceptable levels of discrepancy. We propose four levels of similarity of results, defining ranges of absolute differences between objective and subjective measurements. By considering the values in the provided table and knowing the required accuracy, it is possible to determine the suitability of substitution in each individual case. The introduction of a “similarity level” parameter increases the adaptability and reusability of study findings in individual practical cases.
Healthy sleep is required for sufficient restoration of the human body and brain. Therefore, in the case of sleep disorders, appropriate therapy should be applied timely, which requires a prompt diagnosis. Traditionally, a sleep diary is a part of diagnosis and therapy monitoring for some sleep disorders, such as cognitive behaviour therapy for insomnia. To automatise sleep monitoring and make it more comfortable for users, substituting a sleep diary with a smartwatch measurement could be considered. With the aim of providing accurate results, a study with a total of 30 night recordings was conducted. Objective sleep measurement with a Samsung Galaxy Watch 4 was compared with a subjective approach (sleep diary), evaluating the four relevant sleep characteristics: time of getting asleep, wake up time, sleep efficiency (SE), and total sleep time (TST). The performed analysis has demonstrated that the median difference between both measurement approaches was equal to 7 and 3 minutes for a time of getting asleep and wake up time correspondingly, which allows substituting a subjective measurement with a smartwatch. The SE was determined with a median difference between the two measurement methods of 5.22%. This result also implicates a possibility of substitution. Some single recordings have indicated a higher variance between the two approaches. Therefore, the conclusion can be made that a substitution provides reliable results primarily in the case of long-term monitoring. The results of the evaluation of the TST measurement do not allow to recommend substitution of the measurement method.
The influence of sleep on human health is enormous. Accordingly, sleep disorders can have a negative impact on it. To avoid this, they should be identified and treated in time. For this purpose, objective (with an appropriate device) or subjective (based on perceived values) measurement methods are used for sleep analysis to understand the problem. The aim of this work is to find out whether an exchange of the two methods is possible and can provide reliable results. In accordance with this goal, a study was conducted with people aged over 65 years old (a total of 154 night-time recordings) in which both measurement methods were compared. Sleep questionnaires and electronic devices for sleep assessment placed under the mattress were applied to achieve the study aims. The obtained results indicated that the correlation between both measurement methods could be observed for sleep characteristics such as total sleep time, total time in bed and sleep efficiency. However, there are also significant differences in absolute values of the two measurement approaches for some subjects/nights, which leads us to conclude that the substitution is more likely to be considered in case of long-term monitoring where the trends are of more importance and not the absolute values for individual nights.
The scoring of sleep stages is an essential part of sleep studies. The main objective of this research is to provide an algorithm for the automatic classification of sleep stages using signals that may be obtained in a non-obtrusive way. After reviewing the relevant research, the authors selected a multinomial logistic regression as the basis for their approach. Several parameters were derived from movement and breathing signals, and their combinations were investigated to develop an accurate and stable algorithm. The algorithm was implemented to produce successful results: the accuracy of the recognition of Wake/NREM/REM stages is equal to 73%, with Cohen's kappa of 0.44 for the analyzed 19324 sleep epochs of 30 seconds each. This approach has the advantage of using the only movement and breathing signals, which can be recorded with less effort than heart or brainwave signals, and requiring only four derived parameters for the calculations. Therefore, the new system is a significant improvement for non-obtrusive sleep stage identification compared to existing approaches.
Home health applications have evolved over the last few decades. Assistive systems such as a data platform in connection with health devices can allow for health-related data to be automatically transmitted to a database. However, there remain significant challenges concerning intermodular communication. Central among them is the challenge of achieving interoperability, the ability of devices to communicate and share data with each other. A major goal of this project was to extend an existing data platform (COMES®) and establish working interoperability by connecting assistive devices with differing approaches. We describe this process for a sleep monitoring and a physical exercise device. Furthermore, we aimed to test this setup and the implementation with a data platform in both a laboratory and an in-home setting with 11 elderly participants. The platform modification was realized, and the relevant changes were made so that the incoming data could be processed by the data platform, as well as visually displayed in real-time. Data was recorded by the respective device and transmitted into the data server with minor disruptions. Our observations affirmed that difficulties and data loss are far more likely to occur with increasing technical complexity, in the event of instable internet connection, or when the device setup requires (elderly) subjects to take specific steps for proper functioning. We emphasize the importance for tests and evaluations of home health technologies in real-life circumstances.
Thematic issue on human-centred ambient intelligence: cognitive approaches, reasoning and learning
(2017)
This editorial presents advances on human-centred Ambient Intelligence applications which take into account cognitive issues when modelling users (i.e. stress, attention disorders), and learn users’ activities/preferences and adapt to them (i.e. at home, driving a car). These papers also show AmI applications in health and education, which make them even more valuable for the general society.
Globalization has increased the number of road trips and vehicles. The result has been an intensification of traffic accidents, which are becoming one of the most important causes of death worldwide. Traffic accidents are often due to human error, the probability of which increases when the cognitive ability of the driver decreases. Cognitive capacity is closely related to the driver’s mental state, as well as other external factors such as the CO2 concentration inside the vehicle. The objective of this work is to analyze how these elements affect driving. We have conducted an experiment with 50 drivers who have driven for 25 min using a driving simulator. These drivers completed a survey at the start and end of the experiment to obtain information about their mental state. In addition, during the test, their stress level was monitored using biometric sensors and the state of the environment (temperature, humidity and CO2 level) was recorded. The results of the experiment show that the initial level of stress and tiredness of the driver can have a strong impact on stress, driving behavior and fatigue produced by the driving test. Other elements such as sadness and the conditions of the interior of the vehicle also cause impaired driving and affect compliance with traffic regulations.
Sleep is essential to physical and mental health. However, the traditional approach to sleep analysis—polysomnography (PSG)—is intrusive and expensive. Therefore, there is great interest in the development of non-contact, non-invasive, and non-intrusive sleep monitoring systems and technologies that can reliably and accurately measure cardiorespiratory parameters with minimal impact on the patient. This has led to the development of other relevant approaches, which are characterised, for example, by the fact that they allow greater freedom of movement and do not require direct contact with the body, i.e., they are non-contact. This systematic review discusses the relevant methods and technologies for non-contact monitoring of cardiorespiratory activity during sleep. Taking into account the current state of the art in non-intrusive technologies, we can identify the methods of non-intrusive monitoring of cardiac and respiratory activity, the technologies and types of sensors used, and the possible physiological parameters available for analysis. To do this, we conducted a literature review and summarised current research on the use of non-contact technologies for non-intrusive monitoring of cardiac and respiratory activity. The inclusion and exclusion criteria for the selection of publications were established prior to the start of the search. Publications were assessed using one main question and several specific questions. We obtained 3774 unique articles from four literature databases (Web of Science, IEEE Xplore, PubMed, and Scopus) and checked them for relevance, resulting in 54 articles that were analysed in a structured way using terminology. The result was 15 different types of sensors and devices (e.g., radar, temperature sensors, motion sensors, cameras) that can be installed in hospital wards and departments or in the environment. The ability to detect heart rate, respiratory rate, and sleep disorders such as apnoea was among the characteristics examined to investigate the overall effectiveness of the systems and technologies considered for cardiorespiratory monitoring. In addition, the advantages and disadvantages of the considered systems and technologies were identified by answering the identified research questions. The results obtained allow us to determine the current trends and the vector of development of medical technologies in sleep medicine for future researchers and research.
Sleep is an essential part of human existence, as we are in this state for approximately a third of our lives. Sleep disorders are common conditions that can affect many aspects of life. Sleep disorders are diagnosed in special laboratories with a polysomnography system, a costly procedure requiring much effort for the patient. Several systems have been proposed to address this situation, including performing the examination and analysis at the patient's home, using sensors to detect physiological signals automatically analysed by algorithms. This work aims to evaluate the use of a contactless respiratory recording system based on an accelerometer sensor in sleep apnea detection. For this purpose, an installation mounted under the bed mattress records the oscillations caused by the chest movements during the breathing process. The presented processing algorithm performs filtering of the obtained signals and determines the apnea events presence. The performance of the developed system and algorithm of apnea event detection (average values of accuracy, specificity and sensitivity are 94.6%, 95.3%, and 93.7% respectively) confirms the suitability of the proposed method and system for further ambulatory and in-home use.
Sleep is extremely important for physical and mental health. Although polysomnography is an established approach in sleep analysis, it is quite intrusive and expensive. Consequently, developing a non-invasive and non-intrusive home sleep monitoring system with minimal influence on patients, that can reliably and accurately measure cardiorespiratory parameters, is of great interest. The aim of this study is to validate a non-invasive and unobtrusive cardiorespiratory parameter monitoring system based on an accelerometer sensor. This system includes a special holder to install the system under the bed mattress. The additional aim is to determine the optimum relative system position (in relation to the subject) at which the most accurate and precise values of measured parameters could be achieved. The data were collected from 23 subjects (13 males and 10 females). The obtained ballistocardiogram signal was sequentially processed using a sixth-order Butterworth bandpass filter and a moving average filter. As a result, an average error (compared to reference values) of 2.24 beats per minute for heart rate and 1.52 breaths per minute for respiratory rate was achieved, regardless of the subject’s sleep position. For males and females, the errors were 2.28 bpm and 2.19 bpm for heart rate and 1.41 rpm and 1.30 rpm for respiratory rate. We determined that placing the sensor and system at chest level is the preferred configuration for cardiorespiratory measurement. Further studies of the system’s performance in larger groups of subjects are required, despite the promising results of the current tests in healthy subjects.
The evaluation of the effectiveness of different machine learning algorithms on a publicly available database of signals derived from wearable devices is presented with the goal of optimizing human activity recognition and classification. Among the wide number of body signals we choose a couple of signals, namely photoplethysmographic (optically detected subcutaneous blood volume) and tri-axis acceleration signals that are easy to be simultaneously acquired using commercial widespread devices (e.g. smartwatches) as well as custom wearable wireless devices designed for sport, healthcare, or clinical purposes. To this end, two widely used algorithms (decision tree and k-nearest neighbor) were tested, and their performance were compared to two new recent algorithms (particle Bernstein and a Monte Carlo-based regression) both in terms of accuracy and processing time. A data preprocessing phase was also considered to improve the performance of the machine learning procedures, in order to reduce the problem size and a detailed analysis of the compression strategy and results is also presented.
Monitoring heart rate and breathing is essential in understanding the physiological processes for sleep analysis. Polysomnography (PSG) system have traditionally been used for sleep monitoring, but alternative methods can help to make sleep monitoring more portable in someone's home. This study conducted a series of experiments to investigate the use of pressure sensors placed under the bed as an alternative to PSG for monitoring heart rate and breathing during sleep. The following sets of experiments involved the addition of small rubber domes - transparent and black - that were glued to the pressure sensor. The resulting data were compared with the PSG system to determine the accuracy of the pressure sensor readings. The study found that the pressure sensor provided reliable data for extracting heart rate and respiration rate, with mean absolute errors (MAE) of 2.32 and 3.24 for respiration and heart rate, respectively. However, the addition of small rubber hemispheres did not significantly improve the accuracy of the readings, with MAEs of 2.3 bpm and 7.56 breaths per minute for respiration rate and heart rate, respectively. The findings of this study suggest that pressure sensors placed under the bed may serve as a viable alternative to traditional PSG systems for monitoring heart rate and breathing during sleep. These sensors provide a more comfortable and non-invasive method of sleep monitoring. However, the addition of small rubber domes did not significantly enhance the accuracy of the readings, indicating that it may not be a worthwhile addition to the pressure sensor system.
Nowadays, the importance of early active patient mobilization in the recovery and rehabilitation phase has increased significantly. One way to involve patients in the treatment is a gamification-like approach, which is one of the methods of motivation in various life processes. This article shows a system prototype for patients who require physical activity because of active early mobilization after medical interventions or during illness. Bedridden patients and people with a sedentary lifestyle (predominantly lying in bed) are also potential users. The main idea for the concept was non-contact system implementation for the patients making them feel effortless during its usage. The system consists of three related parts: hardware, software, and game application. To test the relevance and coherence of the system, it was used by 35 people. The participants were asked to play a video game requiring them to make body movements while lying down. Then they were asked to take part in a small survey to evaluate the system's usability. As a result, we offer a prototype consisting of hardware and software parts that can increase and diversify physical activity during active early mobilization of patients and prevent the occurrence of possible health problems due to predominantly low activity. The proposed design can be possibly implemented in hospitals, rehabilitation centers, and even at home.