Sleep Apnea Home Monitoring and Analysis

System

Jagdeesh Patil S
Information Science and Engineering Kshitija Chavi Singh
Department Information Science and Engineering Information Science and Engineering
Nitte Meenakshi Institute of Technology Department Department
Bangalore, India Nitte Meenakshi Institute of Technology Nitte Meenakshi Institute of Technology
jagadish.patil@nmit.ac.in Bangalore, India Bangalore, India
kshithijar098@gmail.com chavisingh@gmail.com

Faizah Ali
Information Science and Engineering Department Bhyravi C
Nitte Meenakshi Institute of Technology Information Science and Engineering Department
Bangalore, India Nitte Meenakshi Institute of Technology
faizah2000@gmail.com Bangalore, India
bhyravi.cs@gmail.com

978-1-6654-9790-9/22/$31.00 ©2022 IEEE

 Abstract— Obstructive Sleep Apnea (OSA) is a serious
sleep disorder if left unmonitored it can lead to multiple organ
disorders, hypoxia, and increases the risk of high blood
pressure, recurrent heart attack, and atrial fibrillation. Our
project aims at using a clinical-grade biosensor to design an
HRV monitor system with CSV output files for research and
analysis. Arduino is used for AFE initialization. After
initialization the ECG and RR interval data is read from the
MAX30003. The valid range of RR interval is checked before
transmitting the data via Bluetooth. The application receives
ECG and RR data via Bluetooth receiver and it is further
processed by HRV activity. As HRV is a sensitive metric which
varies from person to person based on biological age, gender
and stress, we have given the provision to set the alert level of
HRV as prescribed by the doctor. This at-home tele-monitor
Heart Rate Variability (HRV) system collects, stores, and
presents data to the sleep clinician. This HRV system is used as
a precursor to a detailed diagnosis by the sleep clinician. It is
helpful to the sleep clinician to assess the patient's condition as
quickly and precisely as possible. This system also effectively
reduces the overall cost which is incurred by patients in sleep
labs.
Keywords— Heart Rate Variability, hackers, legitimate,
sensitive data.
I. INTRODUCTION
Heart Rate Variability (HRV) is the physiological
phenomenon of variation in the time interval between heart-
beats [1]. There is research going on in various fields of
health and sports to make use of this natural indicator of
health which is the HRV. There are many HRV devices
available which are either not clinical grade or very
expensive. Many mobile watches which provide HRV for
shorter duration to help sports activities and this does not
need accuracy for research and durability for longer storage.
Our project aims in bridging this gap and we built a clinical
grade HRV device and ability of a longer and reliable
monitor with open CSV output file generated from the
android application for research and analysis. We also used
python to deduce sample HRV using ECG data. After trying
AFE MAX86150 and MAX30003 from Maxim, we chose
MAX30003 biosensor because it is having inbuilt Pan–
Tompkins algorithm for noise filtering and amplified peak
detection.
The paper focusing on helping sleep apnea patients to use
our device as they need longer observation. Generally, in
sleep labs complicated devices and many types of equipment
are connected to the patient's body for longer observation. It
is really hard for the patients to sleep with many biosensors
connected to the body from a practical point of view. Sleep
labs are expensive for longer duration observation. Since
HRV is giving greater hope of identifying the sleep apnea
markers with various research done across the globe and our
efforts of providing a clinical level HRV will help enhance
the researcher’s efforts for more accurate observation and aid
in further research. The main challenge we faced in this
project was reducing noise of the ECG signal and
programming the digital filter. The analysis using Python
helped us to cross verify the accuracy from this device. The
future expansion through usage of cloud databases and
machine learning will lead to infinite possibilities to exactly
identify sleep apnea markers and other heart and mental
conditions
II. RELATED WORK
Sleep apnea is a standard sleep problem that meddles
with the breathing of an individual on the walls of the throat
and is loose and limited while sleeping. While resting, the
muscles of the throat become loose and frail. There are 3
kinds of sleep apnea, that is obstructive sleep apnea caused
by the shrinking of the respiratory tract, central sleep apnea
caused by the unstable respiratory control communities that
outcome in the brain neglecting to flag the breathing
muscles [2],[3], and mixed complex which is a mix of
obstructive and central apnea. Sleep apnea is extremely
normal, generally found more in men than in women. This
condition can happen in patients of all ages, however, is
more normal in the moderately aged patient. Sleep apnea
can be treated by knowing the side effects or indications of
sleep apnea, decreasing the danger factors, and being talked
about with the specialist for additional action. The reason
for this review is to build a classification model to recognize
sleep problems from the Heart Rate Variability (HRV)
features that can be acquired with Electrocardiogram (ECG)
signals. In this review, HRV features were handled utilizing
a few classification techniques, for example, N-Bayes, SVM
linear methods, ANN, and KNN. The classification is
performed utilizing a subject-independent scheme and
subject-specific schema. The simulation results show that
the SVM strategy achieves higher precision other than three
different techniques in recognizing sleep apnea. While, time
domain highlights show the most prevailing exhibition
among the HRV features [4]. P. M. Mohan et.al. explored
the ideas of Heart Rate Variability using
Photoplethysmography (PPG) optical sensors. During this
we have likewise attempted to see the stress amount of the
subject from the HRV information. 25 years of clinical
examination has shown that heart rate variability (HRV) is
the most substantial measure of stress. Stress can be
estimated utilizing respiratory capabilities yet with scaling
down the PPG sensors HRV is turning out to be more
demandable on the wearable market. At present no one has
time and money to spend on clinical checks to measure
stress subsequently innovation has made it simple and cost-
effective PPG sensors. By using running algorithms, it is
reasonable to evaluate pulse and HR related specification
like HRV. To precisely decide the HRV the heart signal has
to be cleaned and improved positively. So in the review of
this paper they track down how to get HRV from the PPG
signals and figure out the areas under different frequency
regions [5]. Obstructive sleep apnea is a customary
respiratory issue portrayed by regular intervals of breathing
discontinuation because of incomplete or complete blockage
of upper airways. In this paper the principal aim was to
evaluate whether heart rate fluctuation changed in patients
with obstructive sleep apnea. Obstructive sleep apnea leads
to hypoxia, intermittent hypercapnia which regulate
autonomic nervous system of sleep apnea patients. Major
consequence of sleep apnea patient is that they have reduced
vagal tone and expanded sympathetic reaction which gives
way to sympathetic-parasympathetic irregularity [6].
Whether Heart rate variability (HRV) is the straightforward
solution to recognize sleep apnea. Assigned devices were
developed over 15 years to observe sleep apnea at early
phase utilizing the recordings of oxygen saturation, body
position, heart rate and snoring. These devices were utilized
to identify the individual threat of patients enduring sleep
disorder breathing issues which will be then referred to get a
polysomnography. Sleep labs have restricted size for
polysomnography and are very expensive in terms of cost
due to repeated presence of the patient through the night. In
the European Respiratory Journal, it is found that we can
work on the acknowledgment of sleep apnea in view of the
noninvasive simple recording of electrocardiography (ECG)
and heart rate. Inspection confirmed that from HRV changes
alone sleep apnea can be recognized at greater extent [7].
There is a prototyped wireless ECG (electrocardiogram)
sensor for continuous heart rate variability (HRV)
observation, in view of an economically accessible sensor
node. There is an ECG amplifier circuit that is designed on a
PCB board that is of comparative size to the sensor node
that achieves a minimum system size. In this execution, the
ECG is identified from both a patient test and a healthy
body. The ECG signal here is bandlimited to 0.05Hz and
100Hz and enhanced multiple times before ADC alteration.
A continuous HRV detection calculation is executed on the
ECG sensor. The object is to decrease the throughput of
wireless information, and subsequently draw out battery
duration. Because of the high examining rate necessity (e.g
200Hz) of ECG identification [8].
In patients who suffer from a acute myocardial infarction
and chronic heart failure it is accepted that the prognostic
information is of two methods in time domain: the standard
deviation of the intervals between the NN adjacent intervals
and pNN50 which differs by 50ms there is certain factor in
the percentage that shows whether the patient is suffering
from the disease or whether he is normal. A SDNN value
that is less than 50ms or the pNN50 lower than 3% is being
considered that the patient is at high risk, a SDNN of
between 50-100 is indicated as moderate risk, while a value
that is over 100ms or the pNN50 greater than 3% is being
considered as normal. In this paper there was a analysis of
heart rate variability between different parameters like
physical workout, age, weight, lifestyle but not between
genders.[9]. ECG record of Sleep Apnea patients available
on Physionet for Research records fluctuate long from
somewhat under 7 hours to almost 10 hours each. Each
recording incorporates a persistent digitized ECG signal, a
bunch of sleep apnea explanations (inferred by human
specialists based on all the while recorded breath and related
signals). The information comprises of 70 records, divided
into a learning set of 35 standards (a01 through a20, b01
through b05, and c01 through c10), and a test set of 35
standards (x01 through x35), which may all be downloaded
from this current page. [10]
Fig 1. Equations to compute time domain measures
In figure 1 it explains as follows mHR is mean of RR
intervals; mHRV heart rate variability and it is the aggregate
sum of deviations of both HR and RR spans; SDNN:
standard deviation of all NN spans and a characteristic of all
HRV;RMSSD: the Square root mean of the amount of the
squares of contrasts between neighboring NN stretches and
it mirrors the short recurrent changeability in the autonomic
tone that is to a great extent vagally mediated; CVRR:
coefficient of varieties of RR interval and mirroring the
parasympathetic sensory system activity is utilized[11].
A Real time QRS Detection Algorithm is a reliable
method which recognizes QRS complexes in a view of
digitized analyses of amplitude, width and slope. A unique
computerized bandpass filter which lessens the false
detection that has been caused by different types of
interference that is present in ECG signals. There is a
filtering that permits use of low threshold which therein
increases detection sensitivity. The algorithm naturally
adjusts its parameters and limits intermittently that adapts to
such ECG changes as heart rate and QRS morphology [12].
III. FRAMEWORK AND DESIGN
A. System Design
Python Biosensor MAX30003 is used to obtain the
ECG sensor data. This data is sent to the Arduino which
further sends the ECG and RR data to the HC-05 Bluetooth
module. ECG and RR data is received by the android app
from the HC-05 bluetooth module. The ECG and RR data is
processed to get HRV and the same is displayed. The ECG,
RR and HRV data are stored in two csv files by the android
app. These two files are used for further analysis and
research in our project. In the figure below there is a
working design flow diagram of the Sleep Apnea Home
Monitor and Analysis System
 Fig 2. Sleep Apnea Home Monitor and Analysis System diagram

B. Methodology
The medical grade HRV monitor supporting long
duration observation has been designed from an economical
and practical point of view. This is achieved using
Max30003 initialization, Arduino programming and
Android application.

1. MAX30003 Initialization

The Max30003 to be initialized for ECG and RR interval

interrupts. On receiving interrupts, the ECG data and RR
interval data will be read the respective registers and it will
be plotted against time. There is a flowchart of MAX30003
Initialization below Fig 3. MAX30003 Initialization Flowchart

2. Arduino Programming

Arduino is used for AFE initialization. After

initialization the ECG and RR interval data is read from the
MAX30003. The valid range of RR interval is checked
before transmitting the data via Bluetooth. This figure below
shows the algorithm of Arduino Programming
 IV. IMPLEMENTATION

A. AFE
This project needs clinical grade measurement of Heart
Rate Variability (HRV). Most aspects of HRv for sleep
apnea are still under research. We have narrowed two
clinical grade Analog Front End (AFE) from MAXIM
MAX86150 and MAX30003 based on cost, clinical grade
accuracy and longer duration measurements. We started
with MAX86150 initially and we faced many challenges to
filter noise in the ECG signals which is the basis for HRV
measurements. Hence, we migrated to MAX30003 in the
final design.

B. MCU
Found that ATmega328P MCU is capable of receiving
data from AFE MAX30003 through serial peripheral
interface (SPI) protocol or MAX86150 through I2C. We
finalized Arduino UNO during development.

C. Blutooth
We finalized on HC05 serial to Bluetooth module which
Fig 4. Arduino Programming Algorithm converts serial communication to Bluetooth communication.
3. Android Modules

D. Android App
The application receives ECG and RR data via Bluetooth
receiver and it is further processed by HRV activity module.
This HRV is plotted against time in either portrait or
landscape view. Provision to display RR, Heart rate and  Login
HRV values in text format based on radio button clicked by
user. Provision provided to set the alert level of HRV as
prescribed by doctor. The Android application module is
shown below in the figure 5 depicting top level modules and  Receive data on Bluetooth
their interactions.

 Process data for RR interval and calculate HRV

 Store HRV in CSV format with start date and time

as file name. Optionally there is a provision for
ECG storage in CSV format.

 Display

Fig 5. Android Application Modules

 i. HRV
ii. R2R Interval
iii. ECG
E. Battery Charger
Lipo(Lithium Polymer) battery with a USB charger is
used for powering the hardware. Since the device is
connected to the patient body, it should never be used when
it is connected to mains charging. It should always be
disconnected from mains in actual use. We are also using an
LDO (Load Drop Out) regulator from the battery to reduce
noise instead of switching the regulator.
F. Max30003 Expansion Board
Fig 6. MAX30003 Expansion Board
1. Key Specification
 MAX30003 Biopotential AFE Clinical-Grade ECG
AFE with High-Resolution Data Converter 15.5
Bits Effective Resolution with 5µVP-P Noise.
 Longer Battery Life Compared to Competing
Solutions 85µW at 1.1V Supply Voltage.
 Built-In Heart Rate Detection with Interrupt
Feature Eliminates the Need to Run HR Algorithm
on the Microcontroller.
 Robust R-R Detection in High-Motion
Environment at Extremely Low Power.
 32-Word FIFO Allows You to Wake Up
Microcontroller Every 256ms with Full ECG
Acquisition.
G. Circuit Diagram
Figure 7 depicts the circuit diagram of MAX30003
Evaluation kit. Externally electrode pads are connected to
the patient’s body. The potential difference between the two
corresponding attachments will be measured by a pair of
electrodes.
Fig 7. MAX30003 circuit diagram
H. ECG and RR data communication over Bluetooth
ECG is a continuous data with 125 samples per
second. RR detections happens between two ECG peaks.
The RR value will be obtained from MAX30003 after peak
detection with minimum of a pair of peak detection. The
ECG and RR data is sent over Bluetooth. The differentiation
of RR and ECG is done by the value of 0X7AAA. This
means after the 0X7AAA the next value expected by the
android application is the RR value. This is depicted in
below Figure 8. V. RESULT ANALYSIS

Tested the Sleep Apnea Home Monitor and Analysis

system to display the HRV, R2R Intervals and ECG of the
following test subjects of different age groups:

Fig 8. ECG and RR data communication over Bluetooth

I. Hardware Bring-up  Test Subject 1: 18-year-old female

The proper functioning and initialization of hardware is
basis for the entire project success. To program MAX 30003
complete understanding of datasheet and programming
sequence is required for intended functioning. Following  Test Subject 2: 49-year-old male
sequence of chip initialization programming is done to bring
up the board.

 SW(Software) Reset

 Configuration General

 Configuration EMUX (Electronic Multiplexer)

Fig 9. Test Subject 2: 18-year-old female

 Configuration ECG

 Configuration RTOR1

 Configuration RTOR2
Fig 10. Test Subject 2: 49-year-old male

A. Display
 Enable Interrupts
1. ECG Display
When the user opens the app where he can see four radio
 Manage Interrupts buttons namely ECG, Saved HRV, RR and HRV after the
Bluetooth device is connected. We have provided the option
to click on the ECG radio button and we can see the ECG
display as shown below.
 Read ECG

 Read RR interval
 RR display as shown in the figure 14.

Fig 11. Detected and Recognized License Plate

2. HRV Display
On clicking HRV radio button, we can see the HRV
display as shown in figure 12. We have given the provision
to set the HRV alert level by the sleep physician as shown in
figure 13.HRV alert level means there will different
measurement of heart rate based on certain criteria such as
age, weight, physical activity, fitness thus we keep a
measurement as prescribed by the doctor and check the heart
rate of the patient
Fig 14. RR Display
B. Analysis using python in jupyter notebook from the
ECG csv file and HRV and RR csv file
After extracting the dataset that we have got from the
ECG csv, HRV csv and RR csv file we are going to import
this dataset in the jupyter notebook and make some analysis
like ECG signals with found peaks which is shown in figure
15

Fig 15. ECG signals with found peaks)

We find multiple samples for single peak and finding

RR interval would be difficult thus, to get a single value for
each peak we will have to group those sample as one as
shown in figure 16 and find RR interval against time(ms) to
the grouped peak as shown in figure 17

Fig 12. HRV Display

Fig 16. Grouping similar peaks together

Fig 17. RR intervals against time(ms)

Fig 13. HRV Alert level Display
Plotted the HRV graph which we loaded from HRV csv
3. RR Display file plotted against time(sec) shown in the figure 18
The patient or sleep clinician can also view the RR
values by clicking on RR radio button and we can see the

Fig 18. HRV plotted against time(sec)
VI. CONCLUSION AND FUTURE WORK
A. Conclusion
The project developed a home based sleep apnea
monitoring system by monitoring heart rate variability
which involves development of cost effective hardware by
using sensors ICs which is close to clinical level to measure
HRV ,embedded coding for sensors including Bluetooth
communication to Android, developed an Android app to
collect ,store ,present and analyze HRV data to physician
and patient along with providing provision for setting alert
level as prescribed by sleep clinician .We have also explored
HRV using python in Jupyter notebook. There is a lot of
ongoing research in knowing better applicability of HRV for
diagnosing present and future health issues.
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