Using the morphology of photoplethysmogram peaks to detect changes in posture

The morphology of the pulsatile component of the photoplethysmogram (PPG) has been shown to vary with physiology, but changes in the morphology caused by the baroreflex response to orthostatic stress have not been investigated. Using two FDA approved Nonin pulse oximeters placed on the finger and ear, we monitored 11 subjects, for three trials each, as they stood from a supine position. Each cardiac cycle was automatically extracted from the PPG waveform and characterized using statistics corresponding to normalized peak width, instantaneous heart rate, and amplitude of the pulsatile component of the ear PPG. A nonparametric Wilcoxon rank sum test was then used to detect in real-time changes in these features with p < 0.01. In all 33 trials, the standing event was detected as an abrupt change in at least two of these features, with only one false alarm. In 26 trials, an abrupt change was detected in all three features, with no false alarms. An increase in the normalize peak width was detected before an increase in heart rate, and in 21 trials a peak in the feature was detected before or as standing commenced. During standing, the pulse rate always increases, and then amplitude of the ear PPG constricts by a factor of two or more. We hypothesis that the baroreflex first reduces the percentage of time blood flow is stagnant during the cardiac cycle, then increases the hear rate, and finally vasoconstricts the peripheral tissue in order to reestablishing a nominal blood pressure. These three features therefore can be used as a detector of the baroreflex response to changes in posture or other forms of blood volume sequestration.