Pushing the Limit of PPG Sensing in Sedentary Conditions by Addressing Poor Skin-sensor Contact

Photoplethysmography (PPG) is a widely used non-invasive technique for monitoring cardiovascular health and various physiological parameters on consumer and medical devices. While motion artifacts are well-known challenges in dynamic settings, suboptimal skin-sensor contact in sedentary conditions - a critical issue often overlooked in existing literature - can distort PPG signal morphology, leading to the loss or shift of essential waveform features and therefore degrading sensing performance. In this work, we propose CP-PPG, a novel approach that transforms Contact Pressure-distorted PPG signals into ones with the ideal morphology. CP-PPG incorporates a novel data collection approach, a well-crafted signal processing pipeline, and an advanced deep adversarial model trained with a custom PPG-aware loss function. We validated CP-PPG through comprehensive evaluations, including 1) morphology transformation performance on our self-collected dataset, 2) downstream physiological monitoring performance on public datasets, and 3) in-the-wild performance. Extensive experiments demonstrate substantial and consistent improvements in signal fidelity (Mean Absolute Error: 0.09, 40% improvement over the original signal) as well as downstream performance across all evaluations in Heart Rate (HR), Heart Rate Variability (HRV), Respiration Rate (RR), and Blood Pressure (BP) estimation (on average, 21% improvement in HR; 41-46% in HRV; 6% in RR; and 4-5% in BP). These findings highlight the critical importance of addressing skin-sensor contact issues for accurate and dependable PPG-based physiological monitoring. Furthermore, CP-PPG can serve as a generic, plug-in API to enhance PPG signal quality.

Exploring Reliable PPG Authentication on Smartwatches in Daily Scenarios

Photoplethysmography (PPG) Sensors, widely deployed in smartwatches, offer a simple and non-invasive authentication approach for daily use. However, PPG authentication faces reliability issues due to motion artifacts from physical activity and physiological variability over time. To address these challenges, we propose MTL-RAPID, an efficient and reliable PPG authentication model, that employs a multitask joint training strategy, simultaneously assessing signal quality and verifying user identity. The joint optimization of these two tasks in MTL-RAPID results in a structure that outperforms models trained on individual tasks separately, achieving stronger performance with fewer parameters. In our comprehensive user studies regarding motion artifacts (N = 30), time variations (N = 32), and user preferences (N = 16), MTL-RAPID achieves a best AUC of 99.2\% and an EER of 3.5\%, outperforming existing baselines. We opensource our PPG authentication dataset along with the MTL-RAPID model to facilitate future research on GitHub.

rPPG-SysDiaGAN: Systolic-Diastolic Feature Localization in rPPG Using Generative Adversarial Network with Multi-Domain Discriminator

Remote photoplethysmography (rPPG) offers a novel approach to noninvasive monitoring of vital signs, such as respiratory rate, utilizing a camera. Although several supervised and self-supervised methods have been proposed, they often fail to accurately reconstruct the PPG signal, particularly in distinguishing between systolic and diastolic components. Their primary focus tends to be solely on extracting heart rate, which may not accurately represent the complete PPG signal. To address this limitation, this paper proposes a novel deep learning architecture using Generative Adversarial Networks by introducing multi-discriminators to extract rPPG signals from facial videos. These discriminators focus on the time domain, the frequency domain, and the second derivative of the original time domain signal. The discriminator integrates four loss functions: variance loss to mitigate local minima caused by noise; dynamic time warping loss to address local minima induced by alignment and sequences of variable lengths; Sparsity Loss for heart rate adjustment, and Variance Loss to ensure a uniform distribution across the desired frequency domain and time interval between systolic and diastolic phases of the PPG signal.

TAU: Modeling Temporal Consistency Through Temporal Attentive U-Net for PPG Peak Detection

Photoplethysmography (PPG) sensors have been widely used in consumer wearable devices to monitor heart rates (HR) and heart rate variability (HRV). Despite the prevalence, PPG signals can be contaminated by motion artifacts induced from daily activities. Existing approaches mainly use the amplitude information to perform PPG peak detection. However, these approaches cannot accurately identify peaks, since motion artifacts may bring random and significant amplitude variations. To improve the performance of PPG peak detection, the time information can be used. Specifically, heart rates exhibit temporal consistency that consecutive heartbeat intervals in a normal person can have limited variations. To leverage the temporal consistency, we propose the Temporal Attentive U-Net, i.e., TAU, to accurately detect peaks from PPG signals. In TAU, we design a time module that encodes temporal consistency in temporal embeddings. We integrate the amplitude information with temporal embeddings using the attention mechanism to estimate peak labels. Our experimental results show that TAU outperforms eleven baselines on heart rate estimation by more than 22.4%. Our TAU model achieves the best performance across various Signal-to-Noise Ratio (SNR) levels. Moreover, we achieve Pearson correlation coefficients higher than 0.9 (p < 0.01) on estimating HRV features from low-noise-level PPG signals.

GPT-PPG: A GPT-based Foundation Model for Photoplethysmography Signals

This study introduces a novel application of a Generative Pre-trained Transformer (GPT) model tailored for photoplethysmography (PPG) signals, serving as a foundation model for various downstream tasks. Adapting the standard GPT architecture to suit the continuous characteristics of PPG signals, our approach demonstrates promising results. Our models are pre-trained on our extensive dataset that contains more than 200 million 30s PPG samples. We explored different supervised fine-tuning techniques to adapt our model to downstream tasks, resulting in performance comparable to or surpassing current state-of-the-art (SOTA) methods in tasks like atrial fibrillation detection. A standout feature of our GPT model is its inherent capability to perform generative tasks such as signal denoising effectively, without the need for further fine-tuning. This success is attributed to the generative nature of the GPT framework.

Machine-learning for photoplethysmography analysis: Benchmarking feature, image, and signal-based approaches

Photoplethysmography (PPG) is a widely used non-invasive physiological sensing technique, suitable for various clinical applications. Such clinical applications are increasingly supported by machine learning methods, raising the question of the most appropriate input representation and model choice. Comprehensive comparisons, in particular across different input representations, are scarce. We address this gap in the research landscape by a comprehensive benchmarking study covering three kinds of input representations, interpretable features, image representations and raw waveforms, across prototypical regression and classification use cases: blood pressure and atrial fibrillation prediction. In both cases, the best results are achieved by deep neural networks operating on raw time series as input representations. Within this model class, best results are achieved by modern convolutional neural networks (CNNs). but depending on the task setup, shallow CNNs are often also very competitive. We envision that these results will be insightful for researchers to guide their choice on machine learning tasks for PPG data, even beyond the use cases presented in this work.

Generalizable deep learning for photoplethysmography-based blood pressure estimation -- A Benchmarking Study

Photoplethysmography (PPG)-based blood pressure (BP) estimation represents a promising alternative to cuff-based BP measurements. Recently, an increasing number of deep learning models have been proposed to infer BP from the raw PPG waveform. However, these models have been predominantly evaluated on in-distribution test sets, which immediately raises the question of the generalizability of these models to external datasets. To investigate this question, we trained five deep learning models on the recently released PulseDB dataset, provided in-distribution benchmarking results on this dataset, and then assessed out-of-distribution performance on several external datasets. The best model (XResNet1d101) achieved in-distribution MAEs of 9.4 and 6.0 mmHg for systolic and diastolic BP respectively on PulseDB (with subject-specific calibration), and 14.0 and 8.5 mmHg respectively without calibration. Equivalent MAEs on external test datasets without calibration ranged from 15.0 to 25.1 mmHg (SBP) and 7.0 to 10.4 mmHg (DBP). Our results indicate that the performance is strongly influenced by the differences in BP distributions between datasets. We investigated a simple way of improving performance through sample-based domain adaptation and put forward recommendations for training models with good generalization properties. With this work, we hope to educate more researchers for the importance and challenges of out-of-distribution generalization.

Artificial Intelligence-derived Vascular Age from Photoplethysmography: A Novel Digital Biomarker for Cardiovascular Health

With the increasing availability of wearable devices, photoplethysmography (PPG) has emerged as a promising non-invasive tool for monitoring human hemodynamics. We propose a deep learning framework to estimate vascular age (AI-vascular age) from PPG signals, incorporating a distribution-aware loss to address biases caused by imbalanced data. The model was developed using data from the UK Biobank (UKB), with 98,672 participants in the development cohort and 113,559 participants (144,683 data pairs) for clinical evaluation. After adjusting for key confounders, individuals with a vascular age gap (AI-vascular age minus calendar age) exceeding 9 years had a significantly higher risk of major adverse cardiovascular and cerebrovascular events (MACCE) (HR = 2.37, p < 0.005) and secondary outcomes, including diabetes (HR = 2.69, p < 0.005), hypertension (HR = 2.88, p < 0.005), coronary heart disease (HR = 2.20, p < 0.005), heart failure (HR = 2.15, p < 0.005), myocardial infarction (HR = 2.51, p < 0.005), stroke (HR = 2.55, p < 0.005), and all-cause mortality (HR = 2.51, p < 0.005). Conversely, participants with a vascular age gap below -9 years exhibited a significantly lower incidence of these outcomes. We further evaluated the longitudinal applicability of AI-vascular age using serial PPG data from the UKB, demonstrating its value in risk stratification by leveraging AI-vascular age at two distinct time points to predict future MACCE incidence. External validation was performed on a MIMIC-III-derived cohort (n = 2,343), where each one-year increase in vascular age gap was significantly associated with elevated in-hospital mortality risk (OR = 1.02, p < 0.005). In conclusion, our study establishes AI-vascular age as a novel, non-invasive digital biomarker for cardiovascular health assessment.

Continuous Cardiac Arrest Prediction in ICU using PPG Foundation Model

Non-invasive patient monitoring for tracking and predicting adverse acute health events is an emerging area of research. We pursue in-hospital cardiac arrest (IHCA) prediction using only single-channel finger photoplethysmography (PPG) signals. Our proposed two-stage model Feature Extractor-Aggregator Network (FEAN) leverages powerful representations from pre-trained PPG foundation models (PPG-GPT of size up to 1 Billion) stacked with sequential classification models. We propose two FEAN variants ("1H", "FH") which use the latest one-hour and (max) 24-hour history to make decisions respectively. Our study is the first to present IHCA prediction results in ICU patients using only unimodal (continuous PPG signal) waveform deep representations. With our best model, we obtain an average of 0.79 AUROC over 24~h prediction window before CA event onset with our model peaking performance at 0.82 one hour before CA. We also provide a comprehensive analysis of our model through architectural tuning and PaCMAP visualization of patient health trajectory in latent space.

Joint Attention Mechanism Learning to Facilitate Opto-physiological Monitoring during Physical Activity

Opto-physiological monitoring is a non-contact technique for measuring cardiac signals, i.e., photoplethysmography (PPG). Quality PPG signals directly lead to reliable physiological readings. However, PPG signal acquisition procedures are often accompanied by spurious motion artefacts (MAs), especially during low-to-high-intensity physical activity. This study proposes a practical adversarial learning approach for opto-physiological monitoring by using a generative adversarial network with an attention mechanism (AM-GAN) to model motion noise and to allow MA removal. The AM-GAN learns an MA-resistant mapping from raw and noisy signals to clear PPG signals in an adversarial manner, guided by an attention mechanism to directly translate the motion reference of triaxial acceleration to the MAs appearing in the raw signal. The AM-GAN was experimented with three various protocols engaged with 39 subjects in various physical activities. The average absolute error for heart rate (HR) derived from the MA-free PPG signal via the AM-GAN, is 1.81 beats/min for the IEEE-SPC dataset and 3.86 beats/min for the PPGDalia dataset. The same procedure applied to an in-house LU dataset resulted in average absolute errors for HR and respiratory rate (RR) of less than 1.37 beats/min and 2.49 breaths/min, respectively. The study demonstrates the robustness and resilience of AM-GAN, particularly during low-to-high-intensity physical activities.