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Validity of transit time–based blood pressure measurements in patients with and without heart failure or pulmonary arterial hypertension across different breathing maneuvers

A Correction to this article was published on 06 June 2020

This article has been updated



Pulse transit time (PTT) derived by ECG and plethysmographic signal can be a promising alternative to invasive or oscillometry-based blood pressure (BP) monitoring in sleep laboratories because it does not cause arousals from sleep. Therefore, this study assessed the validity of PTT for BP monitoring under sleep laboratory-like conditions.


Ten volunteers (55.8 ± 19.6 years), 12 patients with heart failure with reduced ejection fraction (HFrEF; 67.3 ± 8.6 years), and 14 patients with Nizza class I pulmonary arterial hypertension (PAH; 59.5 ± 13.4 years) performed different breathing patterns to simulate nocturnal sleep-disordered breathing (SDB). BP was measured at least every 15 min over 1 h using oscillometry (Task Force Monitor) and PTT (SOMNOscreen™) devices in free breathing conditions and during SDB simulation (alternating phases of hyperventilation and apneas).


One hundred forty-two points of measurements were collected. No difference was found in both mean systolic BP (SBP) and diastolic BP (DBP) between oscillometric PTT-based BP measurements in the whole population and throughout the whole recording (SBP 111.3 ± 15.1 mmHg versus 110.0 ± 14.7 mmHg, p = 0.051; DBP 69.9 ± 12.2 versus 69.9 ± 14.2 mmHg, p = 0.701). Likewise, no significant difference in SBP and DBP was found between the two methods in the subgroups of healthy subjects, HFrEF patients and PAH patients, both in free breathing conditions (p > 0.05) and during SDB simulation (p > 0.05).


When monitoring BP in healthy subjects, and in patients with HFrEF or PAH, PTT provides a BP estimation comparable with oscillometric measurement, though slightly inaccurate, both in the condition of regular and unstable breathing.

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Change history

  • 06 June 2020

    After the publication of the original manuscript we found that the calculation of the supplemental data regarding the capacity of PTT-based blood pressure (BP) recordings to detect changes in systolic and diastolic BP in different cohorts of patients was incorrect. These errors occured when data were transformed from MS Excel to Sigma-Plot tables. In this correction, the affected data and the respective figures were now revised.


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We gratefully acknowledge Mister Christian Glatz’s and Mister Salvador Perez’s kind technical help in collecting our data.


This study has been supported by Else-Kröner-Fresenius Stiftung (Grant A109). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Correspondence to Jens Spiesshoefer.

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Conflict of interest

JS is supported by the Else-Kröner-Fresenius Stiftung (Grant A109) for this work and by Kommission für Innovative Medizinische Forschung an der Medizinischen Fakultät Münster (IMF Grant SP 11 18 15) outside this work. MB is supported by Sanofi Genzyme and Löwenstein Medical outside this work. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Ethical approval

The study protocol was approved by the local ethics committee (Ethikkommission der Ärtzekammer Westfalen Lippe) and the study was carried out in accordance with the Declaration of Helsinki.

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All patients gave written informed consent to participate in the study.

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Supplemental Fig. S1
figure 6

Differences in detecting changes in systolic blood pressure (BP) in healthy volunteers [A], patients with HFrEF [B] and patients with pulmonary artery hypertension (PAH) [C] (OM, oscillometric measurement; PTT, pulse transit time) (PNG 1557 kb)

Supplemental Fig. S2
figure 7

Differences in detecting changes in diastolic blood pressure (BP) in healthy volunteers [A], patients with HFrEF [B] and patients with PAH [C] (OM, oscillometric measurement; PTT, pulse transit time) (PNG 488 kb)

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Becker, S., Spiesshoefer, J., Brix, T. et al. Validity of transit time–based blood pressure measurements in patients with and without heart failure or pulmonary arterial hypertension across different breathing maneuvers. Sleep Breath 24, 221–230 (2020).

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  • Blood pressure monitoring
  • Heart failure
  • Pulse transit time
  • Sleep-disordered breathing