PTT Variability for Discrimination of Sleep Apnea Related Decreases in the Amplitude Fluctuations of PPG Signal in Children

In this paper, an analysis of pulse transit time variability (PTTV) during decreases in the amplitude fluctuations of pulse photoplethysmography signal (PPG) (DAP) events for obstructive sleep apnea syndrome (OSAS) screening is presented. The temporal evolution of time–frequency PTTV parameters during DAP was analyzed. The results show an increase in the sympathetic activity index low-frequency component (LF) during DAP for PTTV (85%) significantly higher than for heart rate variability (HRV) (33%), ( $p< \,$10$^{-13}$). However, decreases in parasympathetic activity produce lower decrements in high-frequency component (HF) indexes for PTTV (18%) than for HRV (22%). Thus, PTTV reflects sympathetic changes more clearly than HRV. A clinical study was carried out. DAP events were classified as apneic or nonapneic using a linear discriminant analysis from the PTTV indexes. The ratio of DAP events per hour $r_{{\rm DAP}}$, the ratio after filtering based on HRV indexes $r^{{\rm HRV}}_{{\rm DAP}}$, or on PTTV indexes $r^{{\rm PTTV}}_{{\rm DAP}}$, were computed. The results show an accuracy of 75% for $r^{{\rm PTTV}}_{{\rm DAP}}$ (14% increase with respect to $r_{{\rm DAP}}$ and 5% increase with respect to $r^{{\rm HRV}}_{{\rm DAP}}$), a sensitivity of 81.8%, and a specificity of 73.9% when classifying 1-h polysomnographic excerpts as OSAS or normal. These results suggest that the combination of DAP and PTTV could be better alternative for sleep apnea screening using PPG with the added benefit of its low cost and simplicity.