Automatic Detection of Onset and Offset of Respiratory Electromyographic Activity in Severe COPD Patients on...

Accurate detection of inspiratory onset and offset in the diaphragm electromyographic signal (EMGdi) is clinically relevant to assess patient-ventilator interaction in COPD patients undergoing non-invasive ventilation (NIV). Manual annotations are time-consuming and subject to inter-observer variability, highlighting the need for reliable automatic methods.

We developed a fully automatic algorithm to detect EMGdi activity cycles and their onset/offset timing in overnight NIV recordings. Four ECG suppression approaches were combined with root mean square (RMS) and fixed sample entropy (fSE) envelopes, and a novel bias correction strategy based on inspiratory-to-basal signal-to-noise ratio (I2BSNR) was introduced. Performance was compared with double-blind annotations from two independent experts.

In a cohort of 10 severe COPD patients (9212 annotated cycles), the best configuration (adaptive filtering with fSE exponential envelope) achieved F[Formula: see text], with onset bias -28 ms (SD 270 ms) and offset bias + 120 ms (SD 292 ms). We show that fSE-based envelopes consistently outperform RMS in onset/offset detection, and that I2BSNR-based correction reduces systematic bias to within accepted clinical timing windows.

The proposed method provides accurate and robust onset/offset detection of EMGdi during NIV in COPD patients. This enables reliable quantification of patient-ventilator asynchronies such as ineffective efforts and delayed cycling, offering direct clinical value for optimizing nightly ventilator settings in severe COPD. Clinical and Impact: Reliable detection of patient inspiratory activity offers a practical tool to guide real-time ventilator adjustments and reduce patient-ventilator asynchronies.