Posture-Dependent Variability in Wrist Ballistocardiogram-Photoplethysmogram Pulse Transit Time: Implication to Cuff-Less Blood Pressure Tracking

Objective:
Toward the ultimate goal of robust cuff-less blood pressure (BP) tracking with wrist wearables against postural changes, the goal of this work was to investigate posture-dependent variability in pulse transit time (PTT) measured with ballistocardiogram (BCG) and photoplethysmogram (PPG) signal pair at the wrist.
Methods:
BCG and PPG signals were acquired from 25 subjects under the combination of 3 body (standing, sitting, and supine) and 3 arm (vertical in head-to-foot direction, placed on the chest, and holding a shoulder) postures. PTT was computed as the time interval between the BCG J wave and the PPG foot, and the impact of the 9 postures on PTT was analyzed by invoking an array of possible physical mechanisms.
Results:
Our work suggests that (i) wrist BCG-PPG PTT is consistent under standing and sitting postures with vertically held arms; and (ii) changes in wrist orientation and height as well as restrictions in body and arm movement may alter wrist BCG-PPG PTT via distortions in the wrist BCG and PPG waveforms. The results indicate that wrist BCG-PPG PTT varies with respect to postures even when BP remains constant.
Conclusion:
The potential of cuff-less BP tracking via wrist BCG-PPG PTT demonstrated under standing posture with arms vertically down in the head-to-foot direction may not generalize to other body and arm postures.
Significance:
Understanding the physical mechanisms responsible for posture-induced BCG-PPG PTT variability may increase the versatility of the wrist BCG for cuff-less BP tracking.