The technical field is characterization of blood pressure using an optical method.
Most devices allowing blood pressure to be characterized use a pressure sensor coupled to a compression cuff placed on a limb, generally an arm. Blood pressure is characterized by measuring the pressure exerted by the cuff at one or more characteristic times. The pressure sensor or acoustic sensor is sensitive to heartbeats and their amplitudes.
In mass-market blood-pressure monitors, a pressure sensor determines the air pressure in the cuff. The cuff is compressed so as to obtain arterial occlusion. During deflation of the cuff, pressure oscillations appear. The oscillations increase until they reach, transiently, a maximum amplitude. At this time, the pressure in the cuff is considered to be equal to the mean arterial pressure. From the detected maximum amplitude, the times respectively corresponding to the systolic and diastolic blood pressures are estimated on the basis of empirical laws. It is conventionally considered that:
Such methods, which are conventionally employed in mass-market blood-pressure monitors, may be open to doubt, notably because of the use of empirical laws.
Optical measurements are frequently employed to determine physiological parameters of a living being. The technique of photoplethysmography (PPG) is a known technique, allowing variations in the volume of blood in blood vessels in living bodily tissues to be detected. Thus, PPG is a common technique for estimating heart rate.
Use of optical techniques has certain advantages, for example low cost and easy integration into compact devices intended for mass-market applications.
The inventors have developed an optical method that allows a characterization of blood pressure to be achieved.
A first subject of the invention is a method for achieving characterization of a blood pressure of a user, comprising the following steps:
The low-pass filtering is carried out with a cut-off frequency. Advantageously, the cut-off frequency is strictly lower than a heart rate of the individual. The cut-off frequency is for example lower than 1 Hz or than 0.5 Hz.
According to one embodiment, the characterization comprises estimating systolic blood pressure, the method comprising, during the inflation phase:
By to form a plateau, what is meant is that the low-frequency component is considered to remain stable.
The method may comprise:
According to one embodiment, the characterization comprises estimating systolic blood pressure, the method comprising, during the deflation phase:
By edge time at which the low-frequency component starts a phase of marked decrease following a phase of stability, what is meant is a time at which the variation as a function of time of the low-frequency component exhibits a sharp change in slope, passing from a low slope to a marked slope.
The method may comprise:
According to one embodiment, the characterization comprises estimating mean arterial pressure, the method comprising, during the deflation phase:
The method may comprise:
According to one embodiment, the method comprises estimating a diastolic blood pressure from the systolic blood pressure and mean arterial pressure.
According to one embodiment, the characterization comprises estimating a time at which the low-frequency component reaches a minimum value, during deflation, this time corresponding to a time of venous return. The method may comprise determining the pressure applied at the time of venous return.
In step c), the limb may be illuminated in an illumination spectral band comprised between 500 nm and 1200 nm.
A second subject of the invention is an optical device for achieving characterization of a blood pressure, the device comprising:
Steps d) to e) are implemented during a compression of the limb. The compression may be achieved via a compression cuff, placed between the optical device and the heart of the user. The compression cuff may form part of the device or be associated with the device.
The invention will be better understood on reading the description of the examples of embodiment, which are described, in the rest of the description, with reference to the figures listed below.
The device 1 comprises a light source 10, configured to emit a light beam towards the limb 2 facing which the light source is placed. The light source 10 emits an incident light beam 12 that propagates to the limb 2 along a propagation axis Z. The photons of the incident light beam 12 penetrate into the limb and some of said photons are backscattered, for example in a direction parallel to the propagation axis Z, back the way they came. The backscattered photons form backscattered radiation 14. The backscattered radiation 14 may be detected by a photodetector 20 placed facing a surface 2s of the limb. The photodetector 20 may be configured so as to detect backscattered radiation emanating from the sample at a distance d, called the backscatter distance, which is generally nonzero and smaller than a few millimetres, typically smaller than 15 mm or 10 mm. The photodetector 20 allows the intensity of the backscattered radiation to be measured.
In the example shown, the light source emits in a spectral band centred on 660 nm, the bandwidth being of 10 nm. Preferably, the spectral band is comprised between 500 nm and 1200 nm, and more preferably between 600 nm and 1200 nm. In the following example, the source emits in a spectral band centred on 660 nm, the bandwidth being of 10 nm.
According to one possibility, the light source may comprise elementary light sources that emit in various spectral bands.
The optical device 1 comprises a processing unit 30 configured to process a signal detected by the photodetector 20. The processing unit 30 is connected to a memory, in which instructions for implementing the method described below are stored. The processing unit may comprise a microprocessor.
According to one alternative, shown in
Whatever the embodiment, the photodetector 20 is arranged to measure an intensity of a light beam formed by photons that have propagated through the limb 2: it is a question either of backscattered photons, or of photons having passed through the medium. In the rest of the description, the backscattering configuration shown in
Implementation of the invention assumes that the limb 2, against which the device 1 is applied, is momentarily compressed, so as to decrease, or even block, blood flow through the portion of the limb against which the device 1 is placed. The compression is applied to the limb of the user upstream of a position of the device on the limb, the term upstream being to be considered with reference to arterial circulation. Thus, the compression is exerted between the heart of the user and the position of the device on the limb. In this example, the device is placed on the wrist of a person, the arm of whom may be compressed by a compression cuff. It may for example be a question of a cuff used in blood-pressure monitors such as described in the prior art. The cuff may be integrated into the device. The processing unit 30 is preferably connected to the cuff 3, in such a way that the processing unit receives information regarding whether the cuff is in an inflation or deflation phase.
During deflation, and preferably also during inflation, the limb is illuminated by the light source 10, and the intensity of the backscattered beam 14, i.e. an intensity of photons emitted by the light source and having propagated through the examined limb, is measured. The intensity I(t) of the backscattered beam comprises a continuous, or low-frequency, component IDC(t), and a pulse-related, or high-frequency, component IAC(t), which is due to a periodic variation in the volume of the vessels under the effect of heartbeats.
When the pressure exerted by the cuff reaches and exceeds the systolic blood pressure (SP), blood flow is interrupted. The pulse-related component IAC(t) then becomes negligible. After the pressure exerted by the cuff has led to the interruption of blood flow, the exerted pressure reaches a maximum supra-systolic level, then gradually decreases, until blood flow begins again. During deflation, when the pressure exerted by the cuff drops below the systolic pressure, the pulse-related component IAC(t) once again exhibits oscillations. The amplitude of the oscillations increases, until a maximum, located at about 420 s in
In a way quite analogous to conventional measurements based on oscillations in cuff pressure, the pulse-related component allows a time at which the oscillations are maximum to be determined. At this time, the pressure of the cuff may be considered to correspond to the mean arterial pressure. The curves shown in
Use of a pulse-related component of a backscattered optical signal to estimate blood pressure is described in the publication Lubin M. et al “Blood pressure measurement by coupling an external pressure and photo-plethysmographic signals”, EMBC, July 2020. However, the inventors believe one drawback of this method to be that the pulse-related component IAC(t) may be “drowned out” in variations in the continuous component IDC(t). Thus, the extracted pulse-related component may be associated with a poor signal-to-noise ratio. In addition, the inventors have observed that the measurements of the pulse-related component are sensitive to the position of the device on the user.
The inventors have concluded that it is preferable to analyse the continuous component, i.e. a low-frequency component IDC(t), rather than the pulse-related component IAC(t) of the intensity detected by the sensor 20. This component is not used to estimate blood pressure. Specifically, the pulse-related component IAC(t) is considered to contain more information, because of the similarities with the pressure oscillations measured during deflation of a cuff.
Thus, and it is an important element of the invention, the “low-frequency” intensity IDC(t) of the beam 14, once “disencumbered” of the pulse-related component, turns out to be a relevant indicator, allowing an estimation of the time at which the pressure exerted by the cuff corresponds to the systolic blood pressure or to the mean arterial pressure or to another characteristic blood pressure.
The low-frequency component IDC(t) reflects the quantity of blood present in the tissues located facing the optical device 1. During the inflation, blood flow decreases little by little, until blocked. The accumulation of blood leads to a decrease in the backscattered signal, and therefore in the low-frequency component IDC(t) because of an increase in the absorption of photons by the blood accumulating downstream of the compression. When blood flow is blocked, the low-frequency component stabilizes, thereby forming a plateau. This plateau corresponds to a relative stagnation of the intensity IDC(t). The plateau extends between:
Between the start of the inflation and the stabilization time ts, the derivative I′DC(t) of IDC(t) is negative, this expressing a decrease in IDC(t). The stabilization time t0 corresponds to the time at which, during inflation, the derivative I′DC(t) drops to zero, or, more generally, the absolute value |IDC(t)| of the derivative I′DC(t) drops below a threshold, called the stabilization threshold Ths. The stabilization time corresponds to a time at which, during inflation, IDC(t) passes from a marked decrease to a moderate decrease, or even a stabilization.
Thus, at ts,
The edge time tf corresponds to a time at which, during deflation, the derivative I′DC(t) of the low-frequency component is negative, and the absolute value of the derivative |I′DC(t)| rises above an edge threshold Thf. The edge threshold may have the same value as the stabilization threshold mentioned in the preceding paragraph. The edge time corresponds to a time at which, during deflation, IDC(t) passes from relative stability to a marked decrease, forming an edge.
Thus, at tf,
Between the stabilization time ts and the edge time tf, the cuff exerts a pressure higher than the systolic blood pressure: the pressure exerted is said to be supra-systolic.
During deflation, after the edge time tf, blood flow starts again, firstly through the arteries. However, the veins, which are more supple than the arteries, remain occluded temporarily by the pressure exerted by the cuff. An additional accumulation of blood results thereby, this resulting in a substantial decrease in the intensity of the backscattered signal. The detected signal reaches a maximum slope, at a time tm of maximum slope. The time tm is considered to be the time at which the slope of IDC(t) is maximum during deflation. This corresponds to a maximum value of |I′DC(t)| during deflation. At this time, the pressure exerted by the cuff is considered to correspond to the mean arterial pressure MAP: the artery is said to be compliant.
During deflation, when the venous occlusion ceases, this being designated by the term “venous return”, the amount of blood facing the device decreases. Absorption of photons by the blood also decreases, this leading to an increase in detected intensity. This corresponds to the time at which, during deflation, the derivative I′DC(t) becomes positive again. The time of venous return is denoted tv. It corresponds to the time at which IDC(t) is minimum. It is then possible to measure the pressure of the cuff at the time tv of venous return.
In
Step 100: Applying a pressure to the limb 2, upstream of the optical device, during a compression duration. The term upstream is to be understood with reference to the direction of arterial flow. The compression duration comprises an inflation phase I, in which the applied pressure increases, and a deflation phase D, in which the applied pressure decreases.
Step 110: Measuring the intensity of the light backscattered or transmitted by the limb 2 during the compression. Thus, a time-dependent function representing a variation in the intensity 40 during compression is obtained.
Step 120: Low-pass filtering of the function I(t), the cut-off frequency of the filter being strictly lower than the heart rate of the user. Thus, the low-frequency component IDC(t) of the measured intensity, or low-frequency intensity, is obtained. The filtering may be obtained using a moving average, a Gaussian filter, or a more refined low-pass filter.
Steps 130, 135 or 140, 145, which are described below, aim to determine the systolic blood pressure. Either steps 130 and 135, or steps 140 and 145, or all of these steps, are implemented. When all of these steps are implemented, two estimations of systolic pressure are obtained, which may be averaged, or only the estimation considered to be most reliable of which is retained.
Step 130: Detecting, during inflation, the stabilization time ts, at which the decreasing low-frequency component IDC(t) reaches a plateau, or, more generally, may be considered to remain stable. The stabilization time may be detected as corresponding to a time at which, during inflation, the absolute value |I′DC (t)| of the derivative I′DC(t) drops below the stabilization threshold Ths, this threshold possibly for example being 0 or close to 0. The threshold Ths may be preset.
Step 135: Measuring the pressure applied at the stabilization time ts resulting from step 130. The measured pressure corresponds to the systolic blood pressure SP. In other words, SP=P(ts).
Step 140: During the deflation phase, detecting the edge time tf, which corresponds to the time at which the systolic pressure is reached. The edge time corresponds to a time at which, during deflation, the absolute value |I′Dc(t)| of the derivative I′DC(t) rises above the edge threshold Thf. The threshold Thf may be preset.
Step 145: Measuring the pressure applied at the edge time tf. The measured pressure corresponds to the systolic blood pressure SP. In other words, SP=P(tf).
Step 150: During the deflation phase, detecting the time tm at which the slope of IDC(t) is maximum. This time corresponds to the time at which the mean arterial pressure is reached.
Step 155: Measuring the pressure applied at the time tm. The measured pressure corresponds to the mean arterial pressure MAP. In other words, MAP=P(tm).
Step 160: During the deflation phase, detecting the time tv at which the value IDC(t) is minimum. This time corresponds to the time of venous return.
Step 165: Measuring the pressure at the time tv.
Step 170: In this step, on the basis of the MAP resulting from step 155, and of the SP resulting from step 135 and/or from step 145, the diastolic blood pressure is determined, using an empirical relationship:
Steps 130/135, 140/145, 150/155 and 160/165 may be implemented independently of one another. The method may comprise all these steps, or only some of these steps. For example, if only the MAP is sought, only steps 150 and 155 are implemented after step 120.
The invention allows a reliable characterization of blood pressure, using simple optical components that may be integrated into portable devices, worn by the user: it may for example be a question of instrumented watches or armbands.
Number | Date | Country | Kind |
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20 14163 | Dec 2020 | FR | national |