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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

Sleep and Breathing volume 24, pages 221–230 (2020)Cite this article

A Correction to this article was published on 06 June 2020

This article has been updated

Abstract

Purpose

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.

Methods

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).

Results

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).

Conclusions

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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Acknowledgements

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

Funding

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.

Author information

Author notes

  1. First authors Sara Becker and Jens Spiesshoefer contributed equally to this work.

  2. Senior authors Matthias Boentert and Alberto Giannoni contributed equally to this work.

Authors and Affiliations

  1. Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany

    Sara Becker, Jens Spiesshoefer & Matthias Boentert

  2. Institute of Medical Informatics, University of Muenster, Muenster, Germany

    Tobias Brix

  3. Department of Cardiology I, University Hospital Muenster, Muenster, Germany

    Izabela Tuleta

  4. Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany

    Michael Mohr

  5. Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, National Research Council, CNR-Regione Toscana, Scuola Superiore San’t Anna, Pisa, Italy

    Michele Emdin & Alberto Giannoni

  6. Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy

    Michele Emdin & Alberto Giannoni

Authors
  1. Sara Becker
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Corresponding author

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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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)

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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). https://doi.org/10.1007/s11325-019-01848-w

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Keywords

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