Unconstrained and Non-Invasive Respiration

Monitoring for Obstructive Sleep Apnea Prevention

Jonathan R. Waters, John R. LaCourse
Electrical and Computer Engineering Department, University of New Hampshire, Durham, NH03824
Abstract - This project demonstrates the usefulness of an
unconstrained and completely non-invasive respiration
monitoring system. With the system implemented in this
project, patients that suffer from obstructive sleep apnea
(OSA) can sleep without any apnea monitoring devices
connected to them, and by means of a pressure sensor
attached to an air mattress, be under constant monitoring
for apneas. This project extends the usefulness of the
monitoring system by connecting the monitoring device
with an advanced hospital bed. The two devices are
communicating to one another through the use of the
CANopen communication protocol. This protocol enables
automated event based control. Some research has shown
that apneas can be prevented, and the problems caused by
apneas can be alleviated, by altering the patients sleeping
position. With this project's respiration monitoring
system, and the communication with the advanced
hospital bed, a bed adjustment can be automatically
triggered when respiration has been detected to have
ceased for more than ten seconds. This project enables a
patient suffering from obstructive sleep apnea to rest
without any monitoring devices physically attached to
their body, and can also alleviate apneas as well as help
prevent other side effects caused by suffering from apneas.
I.

INTRODUCTION

Vital signs monitoring is an important aspect of nearly all

medical problems and treatments. Respiration measurement is
a critical vital sign that can be detected in a number of
different ways. Most of the methods used in practice today
are somewhat constrained and/or invasive to the patient. With
the advancements in technology, there are emerging methods
that are able to detect respiration in an unconstrained and
noninvasive way.
Detecting respiration in a noninvasive and unconstrained
way is beneficial for a number of reasons. The most obvious
benefit of such a detection system is improved patient
comfort. The detection systems in place currently require that
the patient be connected to electrodes, cuffs, IVs and/or other
constrictive and invasive devices. A second benefit to
unconstrained and noninvasive monitoring is the ability for a
health care professional to remotely monitor their patients.
Detection devices today require that a health care professional

be in the room checking a number of different devices. An

unconstrained and noninvasive monitoring system would
allow for the health care professional to be removed from the
room. Remote patient monitoring also allows for multiple
patient monitoring.
With the health care professional
removed from the patient's room, they are able to monitor
more patients quickly and efficiently, and then tend to those
requiring immediate attention.
Of the numerous conditions related to respiration, one such
condition is obstructive sleep apnea syndrome. Obstructive
sleep apnea is one of the most common syndromes in
America, affecting about 18 million Americans. Obstructive
sleep apnea is a respiratory condition that causes a patient to
stop breathing while they are asleep.
Left untreated,
obstructive sleep apnea can lead to a number of health
problems, including sudden death. There are a number of
methods for detecting obstructive sleep apnea, but due to the
invasive and constricting nature of respiration monitoring,
they can be unpleasant. A noninvasive and unconstrained
respiration monitor could be beneficial for people with
obstructive sleep apnea.
This project proposes an unconstrained and noninvasive
system that will measure a person's respiration period while
lying in a hospital bed. The system will be able to detect
apneas in the person's respiration pattern, and furthermore,
when connected to an advanced medical bed, will be able to
utilize the bed to provide a first response positional treatment
to the apneas.
II.

MATERIALS

The Bioengineering Lab at the University of New

Hampshire has an advanced hospital bed with an air mattress,
and because of this, a pneumatics approach to respiration
monitoring was chosen. A pressure transducer was used to
interface to the air mattress which converts air pressure
changes in the mattress to voltage levels. This pressure
transducer is able to detect miniscule changes in pressure.
The sensitivity of the transducer is more than sufficient in
measuring the slight pressure changes caused by the
respiration pattern of a normal adult.
Prior research at the University of New Hampshire has
shown that CANopen is a sufficient technology for
communicating information between medical devices, and a

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viable solution for establishing interoperability between

medical devices. For this reason, CANopen was chosen as the
communication protocol between the measured respiration
pattern and the hospital bed movements. The CANopen
protocol stack was implemented in a Motorola HCS12
microcontroller. The HCS12 also has an analog to digital
converter which is needed for interfacing with the pressure
transducer.

III.

METHODS

The pressure transducer outputs an analog voltage reading,

which must be converted to a digital signal for storage and
analysis. The HCS12 processor has a 10 bit analog to digital
convertor, and accepts analog voltages in the range of 0 to
5.12V. The voltage output from the transducer must be
amplified and biased around 2.5V to work in the HCS12, so
an operational amplifier circuit was designed to convert the
pressure transducer voltage to acceptable values.
The pressure transducer is highly sensitive so that it can
detect the slight respiration patterns in humans, but it will also
be susceptible to noise factors. Therefore, a 4th order
Butterworth band pass filter was designed to filter the
respiration waveform from the pressure transducer output. A
typical adults respiration rate is anywhere from 12 to 20
breaths per minute, so a band pass range of 0.1 to 0.4 Hz was
selected.
The filtered data was continuously stored in the HCS12
microprocessor, and a peak detection algorithm was
implemented to count the peaks in the filtered respiration
waveform. The time between peaks was calculated and used
to represent the instantaneous respiration rate. When a
subjects respiration rate ceased, the peak detection algorithm
detected no peaks, and if no peaks were detected for 10
seconds, a bed adjustment was issued.
The bed adjustment is a command issued by the CANopen
protocol. Specifically for this project, a command was
configured to be issued automatically upon a 10 second timer
in which no respiration peaks were detected in the filtered
respiration waveform.
IV.

RESULTS AND DISCUSSION

A system was developed that can detect a patient's

respiration rate without the need for any physically attached
equipment. The patient must only be lying in the hospital bed
for the system to accurately detect their respiration rate.
Furthermore, the system is able to automatically respond to
respiration failure by triggering a bed adjustment that alters
the patients sleeping posture.
Due to the nature of the monitoring method, the respiration
measurements can be slightly impacted by the weight and
position of the patient. The peak detection algorithm might
need to be customized to the specific patient attributes.
Because of limited access to bed functions, the bed
adjustment method employed in this project was a
modification in the overall tilt of the hospital bed. Other
adjustments are possible, like the ability to roll the patient to

one side, but are not implemented in this project. While not
necessary for the project, more in-depth access to the various
bed adjustment functions could provide a more beneficial
treatment to obstructive sleep apnea.
V. CONCLUSIONS
In conclusion, this project demonstrates the possibility to
monitor a patient's respiration rate in an advanced hospital
bed with no need for constraining or invasive medical
equipment. Additionally, with the use of a medical device
communication protocol, a further benefit can be realized by
providing an automated first response to a patient suffering
from obstructive sleep apnea.
ACKNOWLEDGMENTS

This study was supported by the University of New

Hampshire. The authors gratefully thank Mr. Frank Hludik
from UNH, Mr. Wayne Smith from UNH, and Mr. William
Seitz, President of IXXAT for their help and support.
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[I]

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