Estimation of breathing interval from the photoplethysmographic signals in children

Two important parameters that are generally under continual observation during clinical monitoring are heart rate (HR) variability and breathing interval (BI) of patients. Current HR monitoring during night-long childhood respiratory sleep studies is well tolerated but BI monitoring requires instrumentation, like nasal cannula, that can be less accommodating for children. In this study, BI was extracted from the photoplethysmographic (PPG) signals using a two-stage signal processing technique termed zero-phase digital filtering. Eight children (7 male) aged 8.6 +/- 2.6 years were recruited to perform two breathing activities: during tidal and with customized externally applied inspiratory resistive loading (IRL). The accuracy of BI derived from the PPG signals was compared with that estimated by a calibrated air pressure transducer in children. Statistical analysis revealed that mean BI attained from the PPG signals were significantly related during tidal breathing (r(2) = 0.76; range 0.61-0.83; p < 0.05) and with the IRL (r(2) = 0.79; range 0.68-0.85; p < 0.05) in the absence of motion artefacts. Preliminary findings herein suggest that besides having the capability to monitor HR and arterial blood oxygen saturation measurements, the PPG signals can be used to derive BI for children. This can be an attractive alternative for children who are more disturbed by intrusive techniques in prolonged clinical monitoring.