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      Wearable Finger Pulse Oximetry for Continuous Oxygen Saturation Measurements During Daily Home Routines of Patients With Chronic Obstructive Pulmonary Disease (COPD) Over One Week: Observational Study

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          Abstract

          Background

          Chronic obstructive pulmonary disease (COPD) patients can suffer from low blood oxygen concentrations. Peripheral blood oxygen saturation (SpO 2), as assessed by pulse oximetry, is commonly measured during the day using a spot check, or continuously during one or two nights to estimate nocturnal desaturation. Sampling at this frequency may overlook natural fluctuations in SpO 2.

          Objective

          This study used wearable finger pulse oximeters to continuously measure SpO 2 during daily home routines of COPD patients and assess natural SpO 2 fluctuations.

          Methods

          A total of 20 COPD patients wore a WristOx 2 pulse oximeter for 1 week to collect continuous SpO 2 measurements. A SenseWear Armband simultaneously collected actigraphy measurements to provide contextual information. SpO 2 time series were preprocessed and data quality was assessed afterward. Mean SpO 2, SpO 2 SD, and cumulative time spent with SpO 2 below 90% (CT90) were calculated for every (1) day, (2) day in rest, and (3) night to assess SpO 2 fluctuations.

          Results

          A high percentage of valid SpO 2 data (daytime: 93.27%; nocturnal: 99.31%) could be obtained during a 7-day monitoring period, except during moderate-to-vigorous physical activity (MVPA) (67.86%). Mean nocturnal SpO 2 (89.9%, SD 3.4) was lower than mean daytime SpO 2 in rest (92.1%, SD 2.9; P<.001). On average, SpO 2 in rest ranged over 10.8% (SD 4.4) within one day. Highly varying CT90 values between different nights led to 50% (10/20) of the included patients changing categories between desaturator and nondesaturator over the course of 1 week.

          Conclusions

          Continuous SpO 2 measurements with wearable finger pulse oximeters identified significant SpO 2 fluctuations between and within multiple days and nights of patients with COPD. Continuous SpO 2 measurements during daily home routines of patients with COPD generally had high amounts of valid data, except for motion artifacts during MVPA. The identified fluctuations can have implications for telemonitoring applications that are based on daily SpO 2 spot checks. CT90 values can vary greatly from night to night in patients with a nocturnal mean SpO 2 around 90%, indicating that these patients cannot be consistently categorized as desaturators or nondesaturators. We recommend using wearable sensors for continuous SpO 2 measurements over longer time periods to determine the clinical relevance of the identified SpO 2 fluctuations.

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          Most cited references31

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          Physical inactivity in patients with COPD, a controlled multi-center pilot-study.

          Physical activity (PA) has been reported to be reduced in severe chronic obstructive pulmonary disease (COPD). Studies in moderate COPD are currently scarce. The aim of the present study was to investigate physical activity in daily life in patients with COPD (n=70) and controls (n=30). A multi-center controlled study was conducted. PA was assessed using a multisensor armband device (SenseWear, BodyMedia, Pittsburgh, PA) and is reported as the average number of steps per day, and the time spent in mild and moderate physical activity. Patients suffered from mild (n=9), moderate (n=28), severe (n=23) and very severe (n=10) COPD. The time spent in activities with mild (80 + or - 69 min vs 160 + or - 89 min, p<0.0001) and moderate intensity (24 + or - 29 min vs 65 + or - 70 min; p<0.0036) was reduced in patients compared to controls. The number of steps reached 87 + or - 34%, 71 + or - 32%, 49 + or - 34% and 29 + or - 20% of control values in GOLD-stages I to IV respectively. The time spent in activities at moderate intensity was 53 + or - 47%, 41 + or - 45%, 31 + or - 47% and 22 + or - 34% of the values obtained in controls respectively with increasing GOLD-stage. These differences reached statistical significance as of GOLD stage II (p<0.05). No differences were observed among centers. Physical activity is reduced early in the disease progression (as of GOLD-stage II). Reductions in physical activities at moderate intensity seem to precede the reduction in the amount of physical activities at lower intensity. Copyright 2010 Elsevier Ltd. All rights reserved.
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            Validity of Six Activity Monitors in Chronic Obstructive Pulmonary Disease: A Comparison with Indirect Calorimetry

            Reduced physical activity is an important feature of Chronic Obstructive Pulmonary Disease (COPD). Various activity monitors are available but their validity is poorly established. The aim was to evaluate the validity of six monitors in patients with COPD. We hypothesized triaxial monitors to be more valid compared to uniaxial monitors. Thirty-nine patients (age 68±7years, FEV1 54±18%predicted) performed a one-hour standardized activity protocol. Patients wore 6 monitors (Kenz Lifecorder (Kenz), Actiwatch, RT3, Actigraph GT3X (Actigraph), Dynaport MiniMod (MiniMod), and SenseWear Armband (SenseWear)) as well as a portable metabolic system (Oxycon Mobile). Validity was evaluated by correlation analysis between indirect calorimetry (VO2) and the monitor outputs: Metabolic Equivalent of Task [METs] (SenseWear, MiniMod), activity counts (Actiwatch), vector magnitude units (Actigraph, RT3) and arbitrary units (Kenz) over the whole protocol and slow versus fast walking. Minute-by-minute correlations were highest for the MiniMod (r = 0.82), Actigraph (r = 0.79), SenseWear (r = 0.73) and RT3 (r = 0.73). Over the whole protocol, the mean correlations were best for the SenseWear (r = 0.76), Kenz (r = 0.52), Actigraph (r = 0.49) and MiniMod (r = 0.45). The MiniMod (r = 0.94) and Actigraph (r = 0.88) performed better in detecting different walking speeds. The Dynaport MiniMod, Actigraph GT3X and SenseWear Armband (all triaxial monitors) are the most valid monitors during standardized physical activities. The Dynaport MiniMod and Actigraph GT3X discriminate best between different walking speeds.
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              Hypoxemia in patients with COPD: cause, effects, and disease progression

              Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability internationally. Alveolar hypoxia and consequent hypoxemia increase in prevalence as disease severity increases. Ventilation/perfusion mismatch resulting from progressive airflow limitation and emphysema is the key driver of this hypoxia, which may be exacerbated by sleep and exercise. Uncorrected chronic hypoxemia is associated with the development of adverse sequelae of COPD, including pulmonary hypertension, secondary polycythemia, systemic inflammation, and skeletal muscle dysfunction. A combination of these factors leads to diminished quality of life, reduced exercise tolerance, increased risk of cardiovascular morbidity, and greater risk of death. Concomitant sleep-disordered breathing may place a small but significant subset of COPD patients at increased risk of these complications. Long-term oxygen therapy has been shown to improve pulmonary hemodynamics, reduce erythrocytosis, and improve survival in selected patients with severe hypoxemic respiratory failure. However, the optimal treatment for patients with exertional oxyhemoglobin desaturation, isolated nocturnal hypoxemia, or mild-to-moderate resting daytime hypoxemia remains uncertain.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                June 2019
                6 June 2019
                : 7
                : 6
                Affiliations
                [1 ] Health Unit Flemish Institute for Technological Research (VITO) Mol Belgium
                [2 ] Measure, Model & Manage Bioresponses Department of Biosystems KU Leuven Leuven Belgium
                [3 ] Centre for Environmental Sciences Hasselt University Diepenbeek Belgium
                [4 ] Department of Research and Education Centre of Expertise for Chronic Organ Failure (CIRO) Horn Netherlands
                [5 ] Department of Respiratory Medicine Maastricht University Medical Centre Maastricht Netherlands
                [6 ] Rehabilitation Research Center (REVAL), Biomedical Research Institute (BIOMED) Faculty of Rehabilitation Sciences Hasselt University Diepenbeek Belgium
                [7 ] School of Nutrition and Translational Research in Metabolism (NUTRIM) Maastricht University Medical Centre Maastricht Netherlands
                Author notes
                Corresponding Author: Jean-Marie Aerts jean-marie.aerts@ 123456kuleuven.be
                Article
                v7i6e12866
                10.2196/12866
                6594211
                31199331
                9f6892b6-2800-4fe1-884e-caff3717689f
                ©Joren Buekers, Jan Theunis, Patrick De Boever, Anouk W Vaes, Maud Koopman, Eefje VM Janssen, Emiel FM Wouters, Martijn A Spruit, Jean-Marie Aerts. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 06.06.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/.as well as this copyright and license information must be included.

                Categories
                Original Paper
                Original Paper

                copd,oxygen saturation,finger pulse oximeter,wearable sensor,nocturnal desaturation,telemonitoring

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