In obstructive sleep apnea patients, automatic determination of respiratory arrests by photoplethysmography signal and heart rate variability

  • Mehmet Recep Bozkurt
  • Muhammed Kürşad UçarEmail author
  • Ferda Bozkurt
  • Cahit Bilgin
Scientific Paper


Obstructive sleep apnea is a disease that occurs in connection to pauses in respiration during sleep. Detection of the disease is achieved using a polysomnography device, which is the gold standard in diagnosis. Diagnosis is made by the steps of sleep staging and respiration scoring. Respiration scoring is performed with at least four signals. Technical knowledge is required for attaching the electrodes. Additionally, the electrodes are disturbing to an extent that will delay the patient’s sleep. It is needed to have systems as alternatives for polysomnography devices that will bring a solution to these issues. This study proposes a new approach for the process of respiration scoring which is one of the diagnostic steps for the disease. A machine-learning-based apnea detection algorithm was developed for the process of respiration scoring. The study used Photoplethysmography (PPG) signal and Heart Rate Variability (HRV) that is derived from this signal. The PPG records obtained from the patient and control groups were cleaned out using a digital filter. Then, the HRV parameter was derived from the PPG signal. Later, 46 features were derived from the PPG signal and 40 features were derived from the HRV. The derived features were classified with reduced machine-learning techniques using the F-score feature-selection algorithm. The evaluation was made in a multifaceted manner. Besides, Principal Component Analysis was performed to reduce system input (features). According to the results, if a real-time embedded system is designed, the system can operate with 16 PPG feature 95%, four PPG feature 93.81% accuracy rate. These success rates are highly sufficient for the system to work. Considering all these values, it is possible to realize a practical respiration scoring system. With this study, it was agreed upon that PPG signal may be used in the diagnosis of this disease by processing it with machine learning and signal processing techniques.


Biomedical signal processing Respiratory arrests Photoplethysmography Obstructive sleep apnea Automatic respiratory staging Apnea detection Heart rate variability Ensemble classification 



This research was supported by The Scientific and Technical Research Council of Turkey (TUBITAK) through The Research Support Programs Directorate (ARDEB) with project number of 115E657, and project name of “A New System for Diagnosing Obstructive Sleep Apnea Syndrome by Automatic Sleep Staging Using Photoplethysmography (PPG) Signals and Breathing Scoring” and by The Coordination Unit of Scientific Research Projects of Sakarya University.

Compliance with ethical standards

Conflict of interest

There is no conflict of interest between the authors.

Ethical approval

The ethics committee report numbered 16214662/050.01.04/70 from Sakarya University Deanship of Faculty of Medicine, and the data use permission numbered 94556916/904/151.5815 from T.C. Ministry of Health Turkey Public Hospitals Authority Sakarya Province General Secretariat of Association of Public Hospitals were received to perform the study. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Australasian College of Physical Scientists and Engineers in Medicine 2019

Authors and Affiliations

  1. 1.Electrical-Electronics Engineering, Faculty of EngineeringSakarya UniversitySakaryaTurkey
  2. 2.Computer Programming, Vocational School of AdapazarıSakarya University of Applied SciencesSakaryaTurkey
  3. 3.Faculty of MedicineSakarya UniversitySakaryaTurkey

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