Classification of photoplethysmographic signal quality with fuzzy neural network for improvement of stroke volume measurement

Photoplethysmography (PPG) has been extensively employed to acquire some physiological parameters such as heart rate, oxygen saturation, and blood pressure. However, PPG signals are frequently corrupted by motion artifacts and baseline wandering, especially for the reflective PPG sensor. Several different algorithms have been studied for determining the signal quality of PPG by the characteristic parameters of its waveform and the rule-based methods. The levels of signal quality usually were defined by the manual operations. Thus, whether the good PPG waveforms are enough to increase the accuracy of the measurement is still a subjective issue. The aim of this study is to use a fuzzy neural network to determine the signal quality indexes (SQI) of PPG pulses measured by the impedance cardiography. To test the algorithm performance, the beat-to-beat stroke volumes (SV) were measured with our device and the medis® CS 2000, synchronously. A total of 1466 pulses from 10 subjects were used to validate our algorithm in which the SQIs of 1007 pulses were high, those of 71 pulses were in the middle, and those of 388 pulses were low. The total error of SV measurement was -18 ± 22.0 mL. The performances of the classification were that the sensitivity and specificity for the 1007 pulses with the high SQIs were 0.81 and 0.90, and the error of SV measurement was 6.4 ± 12.8 mL. The sensitivity and specificity for the 388 pulses with the low SQIs were 0.84 and 0.93, while the error of SV measurement was 30.4 ± 3.6 mL. The results show that the proposed algorithm could be helpful in choosing good-quality PPG pulses to increase the accuracy of SV measurement in the impedance plethysmography.