Staff member


Raimon Jané Campos

Group Leader
Biomedical Signal Processing and Interpretation
rjane@ibecbarcelona.eu
+34 934 039 977/934 017
CV Summary

Prof. Raimon Jané received his PhD from the Universitat Politècnica de Catalunya (UPC) in 1989, after which he became a visiting researcher at the Université de Nice-Sophia Antipolis (France). Since 1994, he has been co-director of the Biomedical Signal and System Group of the Biomedical Engineering Research Center (CREB) at the UPC and coordinator of the PhD Programme on Biomedical Engineering. He is professor of the UPC-UB's Master in Bioengineering and vice-president of the Spanish Society of Biomedical Engineering. He received the Barcelona City Award in Technology Research in 2005, and since 2010 has been a member of the International Advisory Board for the journal Physiological Measurement.

Staff member publications

Estrada, L., Torres, A., Sarlabous, L., Jané, R., (2017). Onset and offset estimation of the neural inspiratory time in surface diaphragm electromyography: A pilot study in healthy subjects IEEE Journal of Biomedical and Health Informatics Epub ahead of print

This study evaluates the onset and offset of neural inspiratory time estimated from surface diaphragm electromyographic (EMGdi) recordings. EMGdi and airflow signals were recorded in ten healthy subjects according to two respiratory protocols based on respiratory rate (RR) increments, from 15 to 40 breaths per minute (bpm), and fractional inspiratory time (Ti/Ttot) decrements, from 0.54 to 0.18. The analysis of diaphragm electromyographic (EMGdi) signal amplitude is an alternative approach for the quantification of neural respiratory drive (NRD). The EMGdi amplitude was estimated using the fixed sample entropy computed over a 250 ms moving window of the EMGdi signal (EMGdifse). The neural onset was detected through a dynamic threshold over the EMGdifse using the kernel density estimation method, while neural offset was detected by finding when the EMGdifse had decreased to 70 % of the peak value reached during inspiration. The Bland-Altman analysis between airflow and neural onsets showed a global bias of 46 ms in the RR protocol and 22 ms in the Ti/Ttot protocol. The Bland-Altman analysis between airflow and neural offsets reveals a global bias of 11 ms in the RR protocol and -2 ms in the Ti/Ttot protocol. The relationship between pairs of RR values (Pearson’s correlation coefficient of 0.99, Bland- Altman limits of -2.39 to 2.41 bpm, and mean bias of 0.01 bpm) and between pairs of Ti/Ttot values (Pearson’s correlation coefficient of 0.86, Bland-Altman limits of -0.11 to 0.10, and mean bias of -0.01) showed a good agreement. In conclusion, we propose a method for determining neural onset and neural offset based on non-invasive recordings of the electrical activity of the diaphragm that requires no filtering of cardiac muscle interference.

Keywords: Kernel density estimation (KDE),, Surface diaphragm electromyographic,, (EMGdi) signal,, Inspiratory time,, Neural respiratory drive (NRD),, Neural inspiratory time,, Fixed sample entropy (fSampEn)


Sarlabous, Leonardo, Torres, Abel, Fiz, José A., Martínez-Llorens, Juana M., Gea, Joaquim, Jané, Raimon, (2017). Inspiratory muscle activation increases with COPD severity as confirmed by non-invasive mechanomyographic analysis PLoS ONE 12, (5), e0177730

There is a lack of instruments for assessing respiratory muscle activation during the breathing cycle in clinical conditions. The aim of the present study was to evaluate the usefulness of the respiratory muscle mechanomyogram (MMG) for non-invasively assessing the mechanical activation of the inspiratory muscles of the lower chest wall in both patients with chronic obstructive pulmonary disease (COPD) and healthy subjects, and to investigate the relationship between inspiratory muscle activation and pulmonary function parameters. Both inspiratory mouth pressure and respiratory muscle MMG were simultaneously recorded under two different respiratory conditions, quiet breathing and incremental ventilatory effort, in 13 COPD patients and 7 healthy subjects. The mechanical activation of the inspiratory muscles was characterised by the non-linear multistate Lempel–Ziv index (MLZ) calculated over the inspiratory time of the MMG signal. Subsequently, the efficiency of the inspiratory muscle mechanical activation was expressed as the ratio between the peak inspiratory mouth pressure to the amplitude of the mechanical activation. This activation estimated using the MLZ index correlated strongly with peak inspiratory mouth pressure throughout the respiratory protocol in both COPD patients (r = 0.80, p<0.001) and healthy (r = 0.82, p<0.001). Moreover, the greater the COPD severity in patients, the greater the level of muscle activation (r = -0.68, p = 0.001, between muscle activation at incremental ventilator effort and FEV1). Furthermore, the efficiency of the mechanical activation of inspiratory muscle was lower in COPD patients than healthy subjects (7.61±2.06 vs 20.42±10.81, respectively, p = 0.0002), and decreased with increasing COPD severity (r = 0.78, p<0.001, between efficiency of the mechanical activation at incremental ventilatory effort and FEV1). These results suggest that the respiratory muscle mechanomyogram is a good reflection of inspiratory effort and can be used to estimate the efficiency of the mechanical activation of the inspiratory muscles. Both, inspiratory muscle activation and inspiratory muscle mechanical activation efficiency are strongly correlated with the pulmonary function. Therefore, the use of the respiratory muscle mechanomyogram can improve the assessment of inspiratory muscle activation in clinical conditions, contributing to a better understanding of breathing in COPD patients.


Lozano-García, M., Fiz, J. A., Martínez-Rivera, C., Torrents, A., Ruiz-Manzano, J., Jané, R., (2017). Novel approach to continuous adventitious respiratory sound analysis for the assessment of bronchodilator response PLoS ONE 12, (2), e0171455

Background A thorough analysis of continuous adventitious sounds (CAS) can provide distinct and complementary information about bronchodilator response (BDR), beyond that provided by spirometry. Nevertheless, previous approaches to CAS analysis were limited by certain methodology issues. The aim of this study is to propose a new integrated approach to CAS analysis that contributes to improving the assessment of BDR in clinical practice for asthma patients. Methods Respiratory sounds and flow were recorded in 25 subjects, including 7 asthma patients with positive BDR (BDR+), assessed by spirometry, 13 asthma patients with negative BDR (BDR-), and 5 controls. A total of 5149 acoustic components were characterized using the Hilbert spectrum, and used to train and validate a support vector machine classifier, which distinguished acoustic components corresponding to CAS from those corresponding to other sounds. Once the method was validated, BDR was assessed in all participants by CAS analysis, and compared to BDR assessed by spirometry. Results BDR+ patients had a homogenous high change in the number of CAS after bronchodilation, which agreed with the positive BDR by spirometry, indicating high reversibility of airway obstruction. Nevertheless, we also found an appreciable change in the number of CAS in many BDR- patients, revealing alterations in airway obstruction that were not detected by spirometry. We propose a categorization for the change in the number of CAS, which allowed us to stratify BDR- patients into three consistent groups. From the 13 BDR- patients, 6 had a high response, similar to BDR+ patients, 4 had a noteworthy medium response, and 1 had a low response.Conclusions In this study, a new non-invasive and integrated approach to CAS analysis is proposed as a high-sensitive tool for assessing BDR in terms of acoustic parameters which, together with spirometry parameters, contribute to improving the stratification of BDR levels in patients with obstructive pulmonary diseases.


Garde, A., Sörnmo, L., Laguna, P., Jané, R., Benito, S., Bayés-Genís, A., Giraldo, B. F., (2017). Assessment of respiratory flow cycle morphology in patients with chronic heart failure Medical and Biological Engineering and Computing 55, (2), 245-255

Breathing pattern as periodic breathing (PB) in chronic heart failure (CHF) is associated with poor prognosis and high mortality risk. This work investigates the significance of a number of time domain parameters for characterizing respiratory flow cycle morphology in patients with CHF. Thus, our primary goal is to detect PB pattern and identify patients at higher risk. In addition, differences in respiratory flow cycle morphology between CHF patients (with and without PB) and healthy subjects are studied. Differences between these parameters are assessed by investigating the following three classification issues: CHF patients with PB versus with non-periodic breathing (nPB), CHF patients (both PB and nPB) versus healthy subjects, and nPB patients versus healthy subjects. Twenty-six CHF patients (8/18 with PB/nPB) and 35 healthy subjects are studied. The results show that the maximal expiratory flow interval is shorter and with lower dispersion in CHF patients than in healthy subjects. The flow slopes are much steeper in CHF patients, especially for PB. Both inspiration and expiration durations are reduced in CHF patients, mostly for PB. Using the classification and regression tree technique, the most discriminant parameters are selected. For signals shorter than 1 min, the time domain parameters produce better results than the spectral parameters, with accuracies for each classification of 82/78, 89/85, and 91/89 %, respectively. It is concluded that morphologic analysis in the time domain is useful, especially when short signals are analyzed.

Keywords: Chronic heart failure, Ensemble average, Periodic and non-periodic breathing, Respiratory pattern


Estrada, L., Torres, A., Sarlabous, L., Jané, R., (2017). Influence of parameter selection in fixed sample entropy of surface diaphragm electromyography for estimating respiratory activity Entropy 19, (9), 460

Fixed sample entropy (fSampEn) is a robust technique that allows the evaluation of inspiratory effort in diaphragm electromyography (EMGdi) signals, and has potential utility in sleep studies. To appropriately estimate respiratory effort, fSampEn requires the adjustment of several parameters. The aims of the present study were to evaluate the influence of the embedding dimension m, the tolerance value r, the size of the moving window, and the sampling frequency, and to establish recommendations for estimating the respiratory activity when using the fSampEn on surface EMGdi recorded for different inspiratory efforts. Values of m equal to 1 and r ranging from 0.1 to 0.64, and m equal to 2 and r ranging from 0.13 to 0.45, were found to be suitable for evaluating respiratory activity. fSampEn was less affected by window size than classical amplitude parameters. Finally, variations in sampling frequency could influence fSampEn results. In conclusion, the findings suggest the potential utility of fSampEn for estimating muscle respiratory effort in further sleep studies.

Keywords: Fixed sample entropy (fSampEn), Non-invasive respiratory monitoring, Respiratory activity, Respiratory effort, Surface diaphragm electromyography


Lozano, M., Fiz, J. A., Jané, R., (2016). Automatic differentiation of normal and continuous adventitious respiratory sounds using ensemble empirical mode decomposition and instantaneous frequency IEEE Journal of Biomedical and Health Informatics 20, (2), 486-497

Differentiating normal from adventitious respiratory sounds (RS) is a major challenge in the diagnosis of pulmonary diseases. Particularly, continuous adventitious sounds (CAS) are of clinical interest because they reflect the severity of certain diseases. This study presents a new classifier that automatically distinguishes normal sounds from CAS. It is based on the multi-scale analysis of instantaneous frequency (IF) and envelope (IE) calculated after ensemble empirical mode decomposition (EEMD). These techniques have two major advantages over previous techniques: high temporal resolution is achieved by calculating IF-IE and a priori knowledge of signal characteristics is not required for EEMD. The classifier is based on the fact that the IF dispersion of RS signals markedly decreases when CAS appear in respiratory cycles. Therefore, CAS were detected by using a moving window to calculate the dispersion of IF sequences. The study dataset contained 1494 RS segments extracted from 870 inspiratory cycles recorded from 30 patients with asthma. All cycles and their RS segments were previously classified as containing normal sounds or CAS by a highly experienced physician to obtain a gold standard classification. A support vector machine classifier was trained and tested using an iterative procedure in which the dataset was randomly divided into training (65%) and testing (35%) sets inside a loop. The SVM classifier was also tested on 4592 simulated CAS cycles. High total accuracy was obtained with both recorded (94.6% ± 0.3%) and simulated (92.8% ± 3.6%) signals. We conclude that the proposed method is promising for RS analysis and classification.

Keywords: Diseases, Dispersion, Empirical mode decomposition, Feature extraction, Informatics, Support vector machines


Estrada, L., Torres, A., Sarlabous, L., Jané, R., (2016). Improvement in neural respiratory drive estimation from diaphragm electromyographic signals using fixed sample entropy IEEE Journal of Biomedical and Health Informatics 20, (2), 476-485

Diaphragm electromyography is a valuable technique for the recording of electrical activity of the diaphragm. The analysis of diaphragm electromyographic (EMGdi) signal amplitude is an alternative approach for the quantification of neural respiratory drive (NRD). The EMGdi signal is, however, corrupted by electrocardiographic (ECG) activity, and this presence of cardiac activity can make the EMGdi interpretation more difficult. Traditionally, the EMGdi amplitude has been estimated using the average rectified value (ARV) and the root mean square (RMS). In this work, surface EMGdi signals were analyzed using the fixed sample entropy (fSampEn) algorithm, and compared to traditional ARV and RMS methods. The fSampEn is calculated using a tolerance value fixed and independent of the standard deviation of the analysis window. Thus, this method quantifies the amplitude of the complex components of stochastic signals (such as EMGdi), and being less affected by changes in amplitude due to less complex components (such as ECG). The proposed method was tested in synthetic and recorded EMGdi signals. fSampEn was less sensitive to the effect of cardiac activity on EMGdi signals with different levels of NRD than ARV and RMS amplitude parameters. The mean and standard deviation of the Pearson’s correlation values between inspiratory mouth pressure (an indirect measure of the respiratory muscle activity) and fSampEn, ARV and RMS parameters, estimated in the recorded EMGdi signal at tidal volume (without inspiratory load), were 0.38???0.12, 0.27???0.11 and 0.11???0.13, respectively. Whereas at 33 cmH2O (maximum inspiratory load) were 0.83???0.02, 0.76???0.07 and 0.61???0.19, respectively. Our findings suggest that the proposed method may improve the evaluation of NRD.

Keywords: Electromyography, diaphragm muscle, neural respiratory drive


Lozano, Manuel, Fiz, J. A., Jané, Raimon, (2016). Performance evaluation of the Hilbert–Huang transform for respiratory sound analysis and its application to continuous adventitious sound characterization Signal Processing 120, 99-116

Abstract The use of the Hilbert–Huang transform in the analysis of biomedical signals has increased during the past few years, but its use for respiratory sound (RS) analysis is still limited. The technique includes two steps: empirical mode decomposition (EMD) and instantaneous frequency (IF) estimation. Although the mode mixing (MM) problem of EMD has been widely discussed, this technique continues to be used in many RS analysis algorithms. In this study, we analyzed the MM effect in RS signals recorded from 30 asthmatic patients, and studied the performance of ensemble EMD (EEMD) and noise-assisted multivariate EMD (NA-MEMD) as means for preventing this effect. We propose quantitative parameters for measuring the size, reduction of MM, and residual noise level of each method. These parameters showed that EEMD is a good solution for MM, thus outperforming NA-MEMD. After testing different IF estimators, we propose Kay׳s method to calculate an EEMD-Kay-based Hilbert spectrum that offers high energy concentrations and high time and high frequency resolutions. We also propose an algorithm for the automatic characterization of continuous adventitious sounds (CAS). The tests performed showed that the proposed EEMD-Kay-based Hilbert spectrum makes it possible to determine CAS more precisely than other conventional time-frequency techniques.

Keywords: Hilbert–Huang transform, Ensemble empirical mode decomposition, Instantaneous frequency, Respiratory sounds, Continuous adventitious sounds


Ràfols-de-Urquía, M., Estévez-Piorno, J., Torres, A., Estrada, L., Jané, R., (2016). Evaluación de un dispositivo inalámbrico para el registro de la actividad electromiográfica del músculo diafragma CASEIB Proceedings XXXIV Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB 2016) , Sociedad Española de Ingeniería Biomédica (Valencia, Spain) , 244-247

La evaluación clínica y deportiva requiere el desarrollo de sistemas de adquisición de señales biomédicas de alta calidad. Sin embargo, estos sistemas implican una gran limitación: los datos deben ser registrados en laboratorios. En los últimos años se han desarrollado dispositivos inalámbricos multimodales que pueden poner fin a estos problemas. En este proyecto se han evaluado señales electromiográficas de los músculos respiratorios, en especial del diafragma (EMGdi), obtenidas a partir de un dispositivo inalámbrico. De forma simultánea se han adquirido las mismas señales con un sistema estándar de adquisición de señales biomédicas, para realizar un estudio comparativo de parámetros e información fisiológica extraída de dichas señales. Las señales han sido registradas en 9 sujetos sanos que siguieron un protocolo respiratorio. Estas señales han sido filtradas y procesadas usando técnicas basadas en el dominio frecuencial y temporal. El ritmo cardíaco ha sido estimado tanto a partir de la medida directa del registro ECG, como indirectamente a partir de las señales electromiografícas respiratorias, mientras que el ritmo respiratorio y la fuerza del músculo han sido estimados a partir de la amplitud de las señales EMGdi durante la contracción respiratoria. Los resultados obtenidos de los datos registrados por sistemas inalámbricos son muy similares a los obtenidos mediante sistemas convencionales con cables, demostrando ser una alternativa que permite adquisiciones y estudios fuera de los laboratorios en situaciones mucho más reales.


Estévez-Piorno, J., Ràfols-de-Urquía, M., Torres, A., Estrada, L., Jané, R., (2016). Evaluación del registro y transmisión de señales electromiográficas mediante un dispostivo inalámbrico CASEIB Proceedings XXXIV Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB 2016) , Sociedad Española de Ingeniería Biomédica (Valencia, Spain) , 556-559

Obstructive sleep apnea (OSA) is a highly prevalent chronic disease, especially in elderly and obese population. Despite constituting a huge health and economic problem, most patients remain undiagnosed due to limitations in current strategies. Therefore, it is essential to find cost-effective diagnostic alternatives. One of these novel approaches is the analysis of acoustic snoring signals. Snoring is an early symptom of OSA which carries pathophysiological information of high diagnostic value. For this reason, the main objective of this work is to study the characteristics of single snores of different types, from healthy and OSA subjects. To do that, we analyzed snoring signals from previous databases and developed an experimental protocol to record simulated OSA-related sounds and characterize the response of two commercial tracheal microphones. Automatic programs for filtering, downsampling, event detection and time-frequency analysis were built in MATLAB. We found that time-frequency maps and spectral parameters (central, mean and peak frequency and energy in the 100-500 Hz band) allow distinguishing regular snores of healthy subjects from non-regular snores and snores of OSA subjects. Regarding the two commercial microphones, we found that one of them was a suitable snoring sensor, while the other had a too restricted frequency response. Future work shall include a higher number of episodes and subjects, but our study has contributed to show how important the differences between regular and non-regular snores can be for OSA diagnosis, and how much clinically relevant information can be extracted from time-frequency maps and spectral parameters of single snores.


Estrada, L., Torres, A., Sarlabous, L., Jané, R., (2016). Evaluating respiratory muscle activity using a wireless sensor platform Engineering in Medicine and Biology Society (EMBC) 38th Annual International Conference of the IEEE , IEEE (Orlando, USA) , 5769-5772

Wireless sensors are an emerging technology that allows to assist physicians in the monitoring of patients health status. This approach can be used for the non-invasive recording of the electrical respiratory muscle activity of the diaphragm (EMGdi). In this work, we acquired the EMGdi signal of a healthy subject performing an inspiratory load test. To this end, the EMGdi activity was captured from a single channel of electromyography using a wireless platform which was compared with the EMGdi and the inspiratory mouth pressure (Pmouth) recorded with a conventional lab equipment. From the EMGdi signal we were able to evaluate the neural respiratory drive, a biomarker used for assessing the respiratory muscle function. In addition, we evaluated the breathing movement and the cardiac activity, estimating two cardio-respiratory parameters: the respiratory rate and the heart rate. The correlation between the two EMGdi signals and the Pmouth improved with increasing the respiratory load (Pearson's correlation coefficient ranges from 0.33 to 0.85). The neural respiratory drive estimated from both EMGdi signals showed a positive trend with an increase of the inspiratory load and being higher in the conventional EMGdi recording. The respiratory rate comparison between measurements revealed similar values of around 16 breaths per minute. The heart rate comparison showed a root mean error of less than 0.2 beats per minute which increased when incrementing the inspiratory load. In summary, this preliminary work explores the use of wireless devices to record the muscle respiratory activity to derive several physiological parameters. Its use can be an alternative to conventional measuring systems with the advantage of being portable, lightweight, flexible and operating at low energy. This technology can be attractive for medical staff and may have a positive impact in the way healthcare is being delivered.

Keywords: Biomedical monitoring, Electrodes, Medical services, Monitoring, Muscles, Wireless communication, Wireless sensor networks


Solà-Soler, J., Giraldo, B. F., Fiz, J. A., Jané, R., (2016). Study of phase estimation methods to analyse cardiorespiratory synchronization in OSA patients Engineering in Medicine and Biology Society (EMBC) 38th Annual International Conference of the IEEE , IEEE (Orlando, USA) , 4280-4283

Obstructive Sleep Apnea (OSA) is a sleep disorder highly prevalent in the general population. Cardiorespiratory Phase Synchronization (CRPS) is a form of non-linear interaction between respiratory and cardiovascular systems that was found to be reduced in severe OSA patients. The Hilbert Transform (HT) method was the recommended choice for estimating the respiratory phase in CRPS studies. But we have noticed that HT provides a phase that is aligned to the transition between the exhalation and the inhalation parts of different breathing cycles, instead of being aligned to the breathing onsets. In this work we proposed a Realigned HT phase estimation method (RHT) and we compared it to the conventional HT and to the Linear Phase (LP) approximation for estimating CRPS in a database of 28 patients with different OSA severity levels. RHT provided similar synchronization percentages (%Sync) as HT, and it enhanced the significant differences in %Sync between mild and severe OSA patients. %Sync showed the highest negative correlation with the Apnea-Hypopnea Index (AHI) when using RHT (rAHI=-0.692, p<;0.001), which only had an 10% extra computational cost. On the other hand, LP method significantly overestimated %Sync especially in the more severe patients, because it was unable to track the phase non-linearities that can be observed during sleep disordered breathing. Therefore, the newly proposed RHT can be the preferred alternative over the conventional HT or the LP approximation for estimating CRPS in OSA patients.

Keywords: Correlation, Databases, Electrocardiography, Phase estimation, Sleep apnea, Synchronization, Transforms


Castillo, Y., Blanco, D., Cámara, M.A., Jané, R., (2016). Study of time-frequency characteristics of single snores: extracting new information for sleep apnea diagnosis CASEIB Proceedings XXXIV Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB 2016) , Sociedad Española de Ingeniería Biomédica (Valencia, Spain) , 105-108

Obstructive sleep apnea (OSA) is a highly prevalent chronic disease, especially in elderly and obese population. Despite constituting a huge health and economic problem, most patients remain undiagnosed due to limitations in current strategies. Therefore, it is essential to find cost-effective diagnostic alternatives. One of these novel approaches is the analysis of acoustic snoring signals. Snoring is an early symptom of OSA which carries pathophysiological information of high diagnostic value. For this reason, the main objective of this work is to study the characteristics of single snores of different types, from healthy and OSA subjects. To do that, we analyzed snoring signals from previous databases and developed an experimental protocol to record simulated OSA-related sounds and characterize the response of two commercial tracheal microphones. Automatic programs for filtering, downsampling, event detection and time-frequency analysis were built in MATLAB. We found that time-frequency maps and spectral parameters (central, mean and peak frequency and energy in the 100-500 Hz band) allow distinguishing regular snores of healthy subjects from non-regular snores and snores of OSA subjects. Regarding the two commercial microphones, we found that one of them was a suitable snoring sensor, while the other had a too restricted frequency response. Future work shall include a higher number of episodes and subjects, but our study has contributed to show how important the differences between regular and non-regular snores can be for OSA diagnosis, and how much clinically relevant information can be extracted from time-frequency maps and spectral parameters of single snores.


Estrada, L., Torres, A., Garcia-Casado, J., Sarlabous, L., Prats-Boluda, G., Jané, R., (2016). Time-frequency representations of the sternocleidomastoid muscle electromyographic signal recorded with concentric ring electrodes Engineering in Medicine and Biology Society (EMBC) 38th Annual International Conference of the IEEE , IEEE (Orlando, USA) , 3785-3788

The use of non-invasive methods for the study of respiratory muscle signals can provide clinical information for the evaluation of the respiratory muscle function. The aim of this study was to evaluate time-frequency characteristics of the electrical activity of the sternocleidomastoid muscle recorded superficially by means of concentric ring electrodes (CREs) in a bipolar configuration. The CREs enhance the spatial resolution, attenuate interferences, as the cardiac activity, and also simplify the orientation problem associated to the electrode location. Five healthy subjects underwent a respiratory load test in which an inspiratory load was imposed during the inspiratory phase. During the test, the electromyographic signal of the sternocleidomastoid muscle (EMGsc) and the inspiratory mouth pressure (Pmouth) were acquired. Time-frequency characteristics of the EMGsc signal were analyzed by means of eight time-frequency representations (TFRs): the spectrogram (SPEC), the Morlet scalogram (SCAL), the Wigner-Ville distribution (WVD), the Choi-Williams distribution (CHWD), two generalized exponential distributions (GED1 and GED2), the Born-Jordan distribution (BJD) and the Cone-Kernel distribution (CKD). The instantaneous central frequency of the EMGsc showed an increasing behavior during the inspiratory cycle and with the increase of the inspiratory load. The bilinear TFRs (WVD, CHWD, GEDs and BJD) were less sensitive to cardiac activity interference than classical TFRs (SPEC and SCAL). The GED2 was the TFR that shown the best results for the characterization of the instantaneous central frequency of the EMGsc.

Keywords: Electrodes, Interference, Kernel, Mouth, Muscles, Spectrogram, Time-frequency analysis


Sarlabous, Leonardo, Torres, Abel, Fiz, José A., Gea, Joaquim, Martínez-Llorens, Juana M., Jané, Raimon, (2015). Efficiency of mechanical activation of inspiratory muscles in COPD using sample entropy European Respiratory Journal 46, (6), 1808-1811

Respiratory muscle dysfunction is a common problem in patients with chronic obstructive pulmonary disease (COPD) and has mostly been related to pulmonary hyperinflation [1, 2]. Associated diaphragm shortening and deleterious changes in the muscle force-length relationship cause a reduction in the muscles' capacity to generate pressure, placing them at a mechanical disadvantage [1, 3]. Specifically, both inspiratory muscle strength and mechanical efficiency may be reduced in COPD patients [1, 4–6], although, at isovolume, the contractile strength of the diaphragm in COPD is preserved or may even be improved in some cases [7]. The ratio between transdiaphragmatic pressure and electrical diaphragm activity has been used as a measure of respiratory muscle efficiency [8, 9]. However, in clinical practice, it is complex to measure this parameter directly, as invasive measures are required and these are uncomfortable for patients [4].


Garde, A., Giraldo, B. F., Jané, R., Latshang, T. D., Turk, A. J., Hess, T., Bosch, M-.M., Barthelmes, D., Merz, T. M., Hefti, J. Pichler, Schoch, O. D., Bloch, K. E., (2015). Time-varying signal analysis to detect high-altitude periodic breathing in climbers ascending to extreme altitude Medical & Biological Engineering & Computing 53, (8), 699-712

This work investigates the performance of cardiorespiratory analysis detecting periodic breathing (PB) in chest wall recordings in mountaineers climbing to extreme altitude. The breathing patterns of 34 mountaineers were monitored unobtrusively by inductance plethysmography, ECG and pulse oximetry using a portable recorder during climbs at altitudes between 4497 and 7546 m on Mt. Muztagh Ata. The minute ventilation (VE) and heart rate (HR) signals were studied, to identify visually scored PB, applying time-varying spectral, coherence and entropy analysis. In 411 climbing periods, 30–120 min in duration, high values of mean power (MPVE) and slope (MSlopeVE) of the modulation frequency band of VE, accurately identified PB, with an area under the ROC curve of 88 and 89 %, respectively. Prolonged stay at altitude was associated with an increase in PB. During PB episodes, higher peak power of ventilatory (MPVE) and cardiac (MP LF HR ) oscillations and cardiorespiratory coherence (MP LF Coher ), but reduced ventilation entropy (SampEnVE), was observed. Therefore, the characterization of cardiorespiratory dynamics by the analysis of VE and HR signals accurately identifies PB and effects of altitude acclimatization, providing promising tools for investigating physiologic effects of environmental exposures and diseases.

Keywords: High-altitude periodic breathing, Cardiorespiratory characterization, Time-varying spectral analysis, Acclimatization, Hypoxia


Lozano, M., Fiz, J. A., Jané, R., (2015). Análisis de sonidos adventicios continuos en pacientes asmáticos mediante el espectro de Hilbert CASEIB Proceedings XXXIII Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB 2015) , Sociedad Española de Ingeniería Biomédica (Madrid, Spain) , 179-182

Los sonidos adventicios continuos (CAS) son uno de los principales síntomas del asma. Dada su importancia clínica, el análisis de estas señales requiere del uso de técnicas que permitan segmentarlas y caracterizarlas con una precisión alta. Sin embargo, la mayoría de técnicas propuestas anteriormente estaban basadas en el análisis de Fourier o wavelet, técnicas que tienen una resolución limitada a priori y son altamente dependientes de la amplitud de los CAS. En este estudio se presenta una técnica alternativa para el análisis de CAS basada en el espectro de Hilbert. El método presentado combina la descomposición empírica en modos por conjuntos con el estimador de Kay de la frecuencia instantánea, para obtener una representación tiempo-frecuencia con una alta concentración de energía y una resolución temporal y frecuencial elevada. Con el fin de mostrar las ventajas que ofrece el método presentado, se ha aplicado a cuatro señales de sonidos respiratorios registradas en pacientes asmáticos que contienen distintos tipos de CAS, reforzando la hipótesis confirmada en nuestro estudio previo de que el espectro de Hilbert permite segmentar y caracterizar los CAS con mayor precisión que otras técnicas tradicionales ampliamente utilizadas, como el espectrograma.


Sola-Soler, J., Giraldo, B. F., Fiz, J. A., Jané, R., (2015). Cardiorespiratory Phase Synchronization in OSA subjects during wake and sleep states Engineering in Medicine and Biology Society (EMBC) 37th Annual International Conference of the IEEE , IEEE (Milan, Italy) , 7708-7711

Cardiorespiratory Phase Synchronization (CRPS) is a manifestation of coupling between cardiac and respiratory systems complementary to Respiratory Sinus Arrhythmia. In this work, we investigated CRPS during wake and sleep stages in Polysomnographic (PSG) recordings of 30 subjects suspected from Obstructive Sleep Apnea (OSA). The population was classified into three severity groups according to the Apnea Hypopnea Index (AHI): G1 (AHI<;15), G2 (15<;=AHI<;30) and G3 (AHI>30). The synchrogram between single lead ECG and respiratory abdominal band signals from PSG was computed with the Hilbert transform technique. The different phase locking ratios (PLR) m:n were monitored throughout the night. Ratio 4:1 was the most frequent and it became more dominant as OSA severity increased. CRPS was characterized by the percentage of synchronized time (%Sync) and the average duration of synchronized epochs (AvDurSync) using three different thresholds. Globally, we observed that %Sync significantly decreased and AvDurSync slightly increased with OSA severity. A high synchronization threshold enhanced these population differences. %Sync was significantly higher in NREM than in REM sleep in G2 and G3 groups. Population differences observed during sleep did not translate to the initial wake state. Reduced CRPS could be an early marker of OSA severity during sleep, but further studies are needed to determine whether CRPS is also present during wakefulness.

Keywords: Band-pass filters, Electrocardiography, Heart beat, Sleep apnea, Sociology, Statistics, Synchronization


Estrada, L., Torres, A., Sarlabous, L., Jané, R., (2015). EMG-derived respiration signal using the fixed sample entropy during an Inspiratory load protocol Engineering in Medicine and Biology Society (EMBC) 37th Annual International Conference of the IEEE , IEEE (Milan, Italy) , 1703-1706

Extracting clinical information from one single measurement represents a step forward in the assessment of the respiratory muscle function. This attracting idea entails the reduction of the instrumentation and fosters to develop new medical integrated technologies. We present the use of the fixed sample entropy (fSampEn) as a more direct method to non-invasively derive the breathing activity from the diaphragm electromyographic (EMGdi) signal, and thus to extract the respiratory rate, an important vital sign which is cumbersome and time-consuming to be measured by clinicians. fSampEn is a method to evaluate the EMGdi activity that is less sensitive to the cardiac activity (ECG) and its application has proven to be useful to evaluate the load of the respiratory muscles. The behavior of the proposed method was tested in signals from two subjects that performed an inspiratory load protocol, which consists of increments in the inspiratory mouth pressure (Pmouth). Two respiratory signals were derived and compared to the Pmouth signal: the ECG-derived respiration (EDR) signal from the lead-I configuration, and the EMG-derived respiration (EMGDR) signal by applying the fSampEn method over the EMGdi signal. The similitude and the lag between signals were calculated through the cross-correlation between each derived respiratory signal and the Pmouth. The EMGDR signal showed higher correlation and lower lag values (≥ 0.91 and ≤ 0.70 s, respectively) than the EDR signal (≥ 0.83 and ≤0.99 s, respectively). Additionally, the respiratory rate was estimated with the Pmouth, EDR and EMGDR signals showing very similar values. The results from this preliminary work suggest that the fSampEn method can be used to derive the respiration waveform from the respiratory muscle electrical activity.

Keywords: Band-pass filters, Electrocardiography, Electromyography, Entropy, Mouth, Muscles, Protocols


Estrada, L., Torres, A., Garcia-Casado, J., Sarlabous, L., Prats-Boluda, G., Jané, R., (2015). Evaluation of sternocleidomastoid muscle activity by electromyography recorded with concentric ring electrodes CASEIB Proceedings XXXIII Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB 2015) , Sociedad Española de Ingeniería Biomédica (Madrid, Spain) , 183-186

Los sonidos adventicios continuos (CAS) son uno de los principales síntomas del asma. Dada su importancia clínica, el análisis de estas señales requiere del uso de técnicas que permitan segmentarlas y caracterizarlas con una precisión alta. Sin embargo, la mayoría de técnicas propuestas anteriormente estaban basadas en el análisis de Fourier o wavelet, técnicas que tienen una resolución limitada a priori y son altamente dependientes de la amplitud de los CAS. En este estudio se presenta una técnica alternativa para el análisis de CAS basada en el espectro de Hilbert. El método presentado combina la descomposición empírica en modos por conjuntos con el estimador de Kay de la frecuencia instantánea, para obtener una representación tiempo-frecuencia con una alta concentración de energía y una resolución temporal y frecuencial elevada. Con el fin de mostrar las ventajas que ofrece el método presentado, se ha aplicado a cuatro señales de sonidos respiratorios registradas en pacientes asmáticos que contienen distintos tipos de CAS, reforzando la hipótesis confirmada en nuestro estudio previo de que el espectro de Hilbert permite segmentar y caracterizar los CAS con mayor precisión que otras técnicas tradicionales ampliamente utilizadas, como el espectrograma.


Urra, O., Casals, A., Jané, R., (2015). The impact of visual feedback on the motor control of the upper-limb Engineering in Medicine and Biology Society (EMBC) 37th Annual International Conference of the IEEE , IEEE (Milan, Italy) , 3945-3948

Stroke is a leading cause of adult disability with upper-limb hemiparesis being one of the most frequent consequences. Given that stroke only affects the paretic arm's control structure (the set of synergies and activation vectors needed to perform a movement), we propose that the control structure of the non-affected arm can serve as a physiological reference to rehabilitate the paretic arm. However, it is unclear how rehabilitation can effectively tune the control structure of a patient. The use of Visual Feedback (VF) is recommended to boost stroke rehabilitation, as it is able to positively modify neural mechanisms and improve motor performance. Thus, in this study we investigate whether VF can effectively modify the control structure of the upper-limb. We asked six neurologically intact subjects to perform a complete upper-limb rehabilitation routine comprised of 12 movements in absence and presence of VF. Our results indicate that VF significantly increases interlimb similarity both in terms of synergies and activation coefficients. However, the magnitude of improvement depended upon each subject. In general, VF brings the control structure of the nondominant side closer to the control structure of dominant side, suggesting that VF modifies the control structure towards more optimized motor patterns. This is especially interesting because stroke mainly affects the activation coefficients of patients and because it has been shown that the control of the affected side resembles that of the nondominant side. In conclusion, VF may enhance motor performance by effectively tuning the control-structure. Notably, this finding offers new insights to design improved stroke rehabilitation.

Keywords: Bars, Biomedical engineering, Electrodes, Electromyography, Mirrors, Muscles, Visualization


Estrada, L., Torres, A., Sarlabous, L., Jané, R., (2015). Respiratory signal derived from the smartphone built-in accelerometer during a Respiratory Load Protocol Engineering in Medicine and Biology Society (EMBC) 37th Annual International Conference of the IEEE , IEEE (Milan, Italy) , 6768-6771

The scope of our work focuses on investigating the potential use of the built-in accelerometer of the smartphones for the recording of the respiratory activity and deriving the respiratory rate. Five healthy subjects performed an inspiratory load protocol. The excursion of the right chest was recorded using the built-in triaxial accelerometer of a smartphone along the x, y and z axes and with an external uniaxial accelerometer. Simultaneously, the respiratory airflow and the inspiratory mouth pressure were recorded, as reference respiratory signals. The chest acceleration signal recorded in the z axis with the smartphone was denoised using a scheme based on the ensemble empirical mode decomposition, a noise data assisted method which decomposes nonstationary and nonlinear signals into intrinsic mode functions. To distinguish noisy oscillatory modes from the relevant modes we use the detrended fluctuation analysis. We reported a very strong correlation between the acceleration of the z axis of the smartphone and the reference accelerometer across the inspiratory load protocol (from 0.80 to 0.97). Furthermore, the evaluation of the respiratory rate showed a very strong correlation (0.98). A good agreement was observed between the respiratory rate estimated with the chest acceleration signal from the z axis of the smartphone and with the respiratory airflow signal: Bland-Altman limits of agreement between -1.44 and 1.46 breaths per minute with a mean bias of -0.01 breaths per minute. This preliminary study provides a valuable insight into the use of the smartphone and its built-in accelerometer for respiratory monitoring.

Keywords: Acceleration, Accelerometers, Correlation, Empirical mode decomposition, Fluctuations, Protocols, Time series analysis


Urra, O., Casals, A., Jané, R., (2015). Visual feedback facilitates intermanual transfer of the motor control of the dominant arm towards the nondominant arm CASEIB Proceedings XXXIII Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB 2015) , Sociedad Española de Ingeniería Biomédica (Madrid, Spain) , 503-506

Visual feedback (VF) is applied to recover motor skills after stroke. However, the exact mechanisms underlying the beneficial effects of VF remain unclear, limiting its optimal use in clinical practice. We previously reported that the effect of neural mechanisms triggered by VF is reflected in the upperlimb at the level of the control structure (the set of synergies/corresponding activation coefficients used to perform a task). Here, we hypothesize that VF may facilitate the transfer of superior motor programs stored in the dominant hemisphere to optimize the nondominant arm’s motor control. In order to test this hypothesis we have quantified the intermanual transfer (IMT) of the dominant control structure to the nondominant arm during the execution of a complete set of standard rehabilitation routines. We demonstrate that IMT is the main mechanism by which VF increases interlimb similarity and we show that the magnitude of IMT can be up to 75% in neurologically intact subjects. Thus, this study provides sound physiological evidence to encourage the use of VF in stroke rehabilitation.


Fiz, J. A., Jané, R., Lozano, M., Gómez, R., Ruiz, J., (2014). Detecting unilateral phrenic paralysis by acoustic respiratory analysis PLoS ONE 9, (4), e93595

The consequences of phrenic nerve paralysis vary from a considerable reduction in respiratory function to an apparently normal state. Acoustic analysis of lung sound intensity (LSI) could be an indirect non-invasive measurement of respiratory muscle function, comparing activity on the two sides of the thoracic cage. Lung sounds and airflow were recorded in ten males with unilateral phrenic paralysis and ten healthy subjects (5 men/5 women), during progressive increasing airflow maneuvers. Subjects were in sitting position and two acoustic sensors were placed on their back, on the left and right sides. LSI was determined from 1.2 to 2.4 L/s between 70 and 2000 Hz. LSI was significantly greater on the normal (19.3±4.0 dB) than the affected (5.7±3.5 dB) side in all patients (p = 0.0002), differences ranging from 9.9 to 21.3 dB (13.5±3.5 dB). In the healthy subjects, the LSI was similar on both left (15.1±6.3 dB) and right (17.4±5.7 dB) sides (p = 0.2730), differences ranging from 0.4 to 4.6 dB (2.3±1.6 dB). There was a positive linear relationship between the LSI and the airflow, with clear differences between the slope of patients (about 5 dB/L/s) and healthy subjects (about 10 dB/L/s). Furthermore, the LSI from the affected side of patients was close to the background noise level, at low airflows. As the airflow increases, the LSI from the affected side did also increase, but never reached the levels seen in healthy subjects. Moreover, the difference in LSI between healthy and paralyzed sides was higher in patients with lower FEV1 (%). The acoustic analysis of LSI is a relevant non-invasive technique to assess respiratory function. This method could reinforce the reliability of the diagnosis of unilateral phrenic paralysis, as well as the monitoring of these patients.


Sarlabous, Leonardo, Torres, Abel, Fiz, J. A., Jané, Raimon, (2014). Evidence towards improved estimation of respiratory muscle effort from diaphragm mechanomyographic signals with cardiac vibration interference using sample entropy with fixed tolerance values PLoS ONE 9, (2), e88902

The analysis of amplitude parameters of the diaphragm mechanomyographic (MMGdi) signal is a non-invasive technique to assess respiratory muscle effort and to detect and quantify the severity of respiratory muscle weakness. The amplitude of the MMGdi signal is usually evaluated using the average rectified value or the root mean square of the signal. However, these estimations are greatly affected by the presence of cardiac vibration or mechanocardiographic (MCG) noise. In this study, we present a method for improving the estimation of the respiratory muscle effort from MMGdi signals that is robust to the presence of MCG. This method is based on the calculation of the sample entropy using fixed tolerance values (fSampEn), that is, with tolerance values that are not normalized by the local standard deviation of the window analyzed. The behavior of the fSampEn parameter was tested in synthesized mechanomyographic signals, with different ratios between the amplitude of the MCG and clean mechanomyographic components. As an example of application of this technique, the use of fSampEn was explored also in recorded MMGdi signals, with different inspiratory loads. The results with both synthetic and recorded signals indicate that the entropy parameter is less affected by the MCG noise, especially at low signal-to-noise ratios. Therefore, we believe that the proposed fSampEn parameter could improve estimates of respiratory muscle effort from MMGdi signals with the presence of MCG interference.


Jané, R., (2014). Engineering Sleep Disorders: From classical CPAP devices toward new intelligent adaptive ventilatory therapy IEEE Pulse 5, (5), 29-32

Among the most common sleep disorders are those related to disruptions in airflow (apnea) or reductions in the breath amplitude (hypopnea) with or without obstruction of the upper airway (UA). One of the most important sleep disorders is obstructive sleep apnea (OSA). This sleep-disordered breathing, quantified by the apnea-hypopnea index (AHI), can produce a significant reduction of oxygen saturation and an abnormal elevation of carbon dioxide levels in the blood. Apnea and hypopnea episodes are associated with arousals and sleep fragmentation during the night and compensatory response of the autonomic nervous system.

Keywords: Biomedical engineering, Biomedical measurements, Biomedical monitoring, Breathing disorders, Medical conditions, Medical treatment, Sleep, Sleep apnea


Lozano, M., Fiz, J., Jané, R., (2014). Análisis de la intensidad de los sonidos respiratorios para el diagnóstico de la parálisis frénica unilateral CASEIB Proceedings XXXII Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB 2014) , Sociedad Española de Ingeniería Biomédica (Barcelona, Spain) , 1-4

(ISR) es una medida indirecta y no invasiva de la función respiratoria, que permite comparar la actividad en los dos hemitórax de los pacientes con parálisis frénica unilateral. Se registraron los sonidos y el flujo respiratorio en 10 hombres con parálisis frénica unilateral y 10 sujetos sanos (5 hombres/5 mujeres) en posición sentada. Se colocaron 2 micrófonos de contacto en la espalda, uno a cada lado de la columna. La ISR se calculó en el rango frecuencial 70-2000 Hz a partir de la densidad espectral de potencia y para flujos entre 1,2 y 2,4 l/s. Se encontró que las diferencias en la ISR media de los dos hemitórax era significativamente mayor en los pacientes (13.5 dB) que en los sujetos sanos (2.3 dB). Además, se comprobó que esa diferencia era mayor en pacientes con un volumen espiratorio forzado en el primer segundo menor. Por lo tanto, el análisis acústico de la ISR es una técnica no invasiva muy útil para valorar la función respiratoria. Esta técnica puede mejorar la fiabilidad en el diagnóstico de la parálisis frénica unilateral así como la monitorización a largo plazo de estos pacientes.


Estrada, Luis, Torres, Abel, Sarlabous, Leonardo, Fiz, Jose A., Gea, Joaquim, Martinez-Llorens, Juana, Jané, Raimon, (2014). Estimation of bilateral asynchrony between diaphragm mechanomyographic signals in patients with Chronic Obstructive Pulmonary Disease Engineering in Medicine and Biology Society (EMBC) 36th Annual International Conference of the IEEE , IEEE (Chicago, USA) , 3813-3816

The aim of the present study was to measure bilateral asynchrony in patients suffering from Chronic Obstructive Pulmonary Disease (COPD) performing an incremental inspiratory load protocol. Bilateral asynchrony was estimated by the comparison of respiratory movements derived from diaphragm mechanomyographic (MMGdi) signals, acquired by means of capacitive accelerometers placed on left and right sides of the rib cage. Three methods were considered for asynchrony evaluation: Lissajous figure, Hilbert transform and Motto's algorithm. Bilateral asynchrony showed an increase at 20, 40 and 60% (values of normalized inspiratory pressure by their maximum value reached in the last inspiratory load) while the very severe group showed and increase at 20, 40, 80, and 100 % during the protocol. These increments in the phase's shift can be due to an increase of the inspiratory load along the protocol, and also as a consequence of distress and fatigue. In summary, this work evidenced the capability to estimate bilateral asynchrony in COPD patients. These preliminary results also showed that the use of capacitive accelerometers can be a suitable sensor for recording of respiratory movement and evaluation of asynchrony in COPD patients.

Keywords: Accelerometers, Diseases, Estimation, Fatigue, IP networks, Protocols, Transforms


Estrada, L., Torres, A., Jané, R., (2014). Evaluación de la asincronía bilateral y toracoabdominal mediante señales mecanomiográficas CASEIB Proceedings XXXII Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB 2014) , Sociedad Española de Ingeniería Biomédica (Barcelona, Spain) , 1-4

Este estudio tiene como objetivo evaluar la asincronía en los compartimientos torácico y abdominal, durante la realización de un protocolo respiratorio incremental de presión. La actividad mecanomiográfica fue registrada en el tronco mediante el uso de acelerómetros colocados en la parte izquierda y derecha del tórax y del abdomen. Para extraer la baja frecuencia de las señales mecanomiograficas se utilizó un método basado en la descomposición empírica en modos. Para estudiar la asincronía entre los compartimientos estudiados se utilizaron tres métodos, basados en la figura de Lissajous, la transformada de Hilbert y el algoritmo de Motto. Se observó un aumento de la asincronía toracoabdominal, con el aumento de la carga inspiratoria. Los valores de asincronía encontrados al evaluar el lado izquierdo con el derecho tanto en el diafragma como en el abdomen fueron menores de 40°, mientras que al comparar tanto el lado izquierdo como el derecho entre el tórax y el abdomen estos exhibieron valores menores a 80°. En conclusión, este trabajo demuestra que con un aumento de la carga inspiratoria puede presentarse un aumento de asincronía entre diferentes regiones del tronco. Además, el uso de acelerómetros para el registro de la dinámica respiratoria puede llegar a ser una herramienta complementaria a las actuales como la pletismografía de inductancia respiratoria, debido a su más sencilla manipulación.


Solà, J., Fiz, J.A., Torres, A., Jané, R., (2014). Evaluación de la vía aérea superior en sujetos con SAHS mediante análisis del sonido respiratorio durante vigilia CASEIB Proceedings XXXII Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB 2014) , Sociedad Española de Ingeniería Biomédica (Barcelona, Spain) , 1-4

El Síndrome de Apnea-Hipopnea del Sueño (SAHS) actualmente se diagnostica mediante la Polisomnografía (PSG), una prueba cara y costosa. Se han propuesto diversas alternativas para ayudar al cribado previo de SAHS. En estudios previos demostramos que los sujetos con SAHS se pueden identificar a partir de las frecuencias de resonancia (formantes) de la respiración nocturna. En este trabajo se extiende el estudio al sonido respiratorio registrado en vigilia. Se seleccionaron diversos ciclos de inspiración y expiración consecutivas en 23 sujetos con diversos grados de SAHS durante el estado de vigilia previo a la PSG. Mediante un modelo autoregresivo (AR) se estimaron los formantes y el área transversal (CSA) de la vía. Se observa que los formantes en determinadas bandas tienen una frecuencia mayor (p<0.04) en sujetos con SAHS levemoderado, con un Índice de Apnea-Hipopnea (AHI) menor que 30, respecto a los sujetos con SAHS severo (AHI≥30). En paralelo, el área promedio de la vía aérea en las zonas con obstrucción muestra una tendencia decreciente (r=-0.498) con la severidad de la patología. Las características de los formantes, combinadas con medidas antropométricas, permiten clasificar a los sujetos con SAHS severo con una sensibilidad (especificidad) de hasta un 84.6% (88.9%). En conclusión, el sonido respiratorio registrado durante vigilia proporciona información valiosa sobre el estado de la vía aérea superior que puede ayudar a identificar un SAHS severo.


Estrada, L., Torres, A., Garcia-Casado, J., Prats-Boluda, G., Yiyao, Ye-Lin, Jané, R., (2014). Evaluation of Laplacian diaphragm electromyographic recording in a dynamic inspiratory maneuver Engineering in Medicine and Biology Society (EMBC) 36th Annual International Conference of the IEEE , IEEE (Chicago, USA) , 2201-2204

The analysis of the electromyographic signal of the diaphragm muscle (EMGdi) can provide important information for evaluating the respiratory muscular function. The EMGdi can be recorded using surface Ag/AgCl disc electrodes in monopolar or bipolar configuration. However, these non-invasive EMGdi recordings are usually contaminated by the electrocardiographic (ECG) signal. EMGdi signal can also be noninvasively recorded using concentric ring electrodes in bipolar configuration (CRE) that estimate Laplacian surface potential. Laplacian recordings increase spatial resolution and attenuate distant bioelectric interferences, such as the ECG. Thus, the objective of this work is to compare and to evaluate CRE and traditional bipolar EMGdi recordings in a healthy subject during a dynamic inspiratory maneuver with incremental inspiratory loads. In the conducted study, it was calculated the cumulative percentage of power spectrum of EMGdi recordings to determine the signal bandwidth, and the power ratio between the EMGdi signal segments with and without cardiac activity. The results of this study suggest that EMGdi acquired with CRE electrodes is less affected by the ECG interference, achieves a wider bandwidth and a higher power ratio between segments without cardiac activity and with cardiac activity.

Keywords: Bandwidth, Electric potential, Electrocardiography, Electrodes, Interference, Laplace equations, Muscles


Solà, J., Fiz, J. A., Torres, A., Jané, R., (2014). Identification of Obstructive Sleep Apnea patients from tracheal breath sound analysis during wakefulness in polysomnographic studies Engineering in Medicine and Biology Society (EMBC) 36th Annual International Conference of the IEEE , IEEE (Chicago, USA) , 4232-4235

Obstructive Sleep Apnea (OSA) is currently diagnosed by a full nocturnal polysomnography (PSG), a very expensive and time-consuming method. In previous studies we were able to distinguish patients with OSA through formant frequencies of breath sound during sleep. In this study we aimed at identifying OSA patients from breath sound analysis during wakefulness. The respiratory sound was acquired by a tracheal microphone simultaneously to PSG recordings. We selected several cycles of consecutive inspiration and exhalation episodes in 10 mild-moderate (AHI<;30) and 13 severe (AHI>=30) OSA patients during their wake state before getting asleep. Each episode's formant frequencies were estimated by linear predictive coding. We studied several formant features, as well as their variability, in consecutive inspiration and exhalation episodes. In most subjects formant frequencies were similar during inspiration and exhalation. Formant features in some specific frequency band were significantly different in mild OSA as compared to severe OSA patients, and showed a decreasing correlation with OSA severity. These formant characteristics, in combination with some anthropometric measures, allowed the classification of OSA subjects between mild-moderate and severe groups with sensitivity (specificity) up to 88.9% (84.6%) and accuracy up to 86.4%. In conclusion, the information provided by formant frequencies of tracheal breath sound recorded during wakefulness may allow identifying subjects with severe OSA.

Keywords: Correlation, Databases, Sensitivity, Sleep apnea, Speech, Synchronization


Sarlabous, L., Torres, A., Fiz, J.A., Gea, J., Martínez-Llorens, J.M., Jané, R., (2014). Relación entre la presión inspiratoria pico y la activación mecánica de los músculos inspiratorios durante respiración tranquila en pacientes con EPOC CASEIB Proceedings XXXII Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB 2014) , Sociedad Española de Ingeniería Biomédica (Barcelona, Spain) , 1-4

En la enfermedad pulmonar obstructiva crónica (EPOC) la fuerza muscular inspiratoria (FMI) y la eficiencia mecánica de los músculos inspiratorios (EMMI) podrían verse reducidas como consecuencia de la hiperinsuflación. En este trabajo se registraron la presión inspiratoria en boca (PIpico) y la activación mecánica de los músculos inspiratorios en 10 pacientes EPOC severos y muy severos, durante respiración tranquila. Para determinar la activación mecánica de los músculos inspiratorios se empleó la señal mecanomiográfica diafragmática: MMGdi. La amplitud de la señal MMGdi fue estimada a través de índices lineales (ARV: valor rectificado medio) y no lineales (MLZ: Lempel-Ziv multiestado, y fSampEn: entropía muestral con valores de tolerancia fijos). Nuestra hipótesis es que el ratio entre PIpico, que refleja la FMI, y la amplitud de la señal MMGdi constituye una expresión de la EMMI. Los resultados obtenidos muestran ligeras diferencias entre la PIpico registrada en EPOC severos y muy severos, así como una correlación débil a moderada con los parámetros de función pulmonar y los índices estudiados. Sin embargo, mientras mayor es el grado de severidad (que supone un mayor grado de hiperinsuflación) mayor es el nivel de activación mecánica de los músculos inspiratorios. La activación mecánica de los músculos inspiratorios y la EMMI estimadas mediante MLZ estuvieron mejor correlacionadas con la función pulmonar que ARV y fSampEn. Por consiguiente, la estimación de la actividad mecánica del diafragma mediante el MLZ de la señal MMGdi podría mejorar la estimación no invasiva de la FMI y la EMMI, incluso para niveles muy bajos de esfuerzo inspiratorio.


Estrada, L., Torres, A., Sarlabous, L., Fiz, J. A., Jané, R., (2014). Respiratory rate detection by empirical mode decomposition method applied to diaphragm mechanomyographic signals Engineering in Medicine and Biology Society (EMBC) 36th Annual International Conference of the IEEE , IEEE (Chicago, USA) , 3204-3207

Non-invasive evaluation of respiratory activity is an area of increasing research interest, resulting in the appearance of new monitoring techniques, ones of these being based on the analysis of the diaphragm mechanomyographic (MMGdi) signal. The MMGdi signal can be decomposed into two parts: (1) a high frequency activity corresponding to lateral vibration of respiratory muscles, and (2) a low frequency activity related to excursion of the thoracic cage. The purpose of this study was to apply the empirical mode decomposition (EMD) method to obtain the low frequency of MMGdi signal and selecting the intrinsic mode functions related to the respiratory movement. With this intention, MMGdi signals were acquired from a healthy subject, during an incremental load respiratory test, by means of two capacitive accelerometers located at left and right sides of rib cage. Subsequently, both signals were combined to obtain a new signal which contains the contribution of both sides of thoracic cage. Respiratory rate (RR) measured from the mechanical activity (RRMmg) was compared with that measured from inspiratory pressure signal (RRP). Results showed a Pearson's correlation coefficient (r = 0.87) and a good agreement (mean bias = -0.21 with lower and upper limits of -2.33 and 1.89 breaths per minute, respectively) between RRmmg and RRP measurements. In conclusion, this study suggests that RR can be estimated using EMD for extracting respiratory movement from low mechanical activity, during an inspiratory test protocol.

Keywords: Accelerometers, Band-pass filters, Biomedical measurement, Empirical mode decomposition, Estimation, IP networks, Muscles


López Picazo, M., Solà, J., Fiz, J.A., Jané, R., (2014). Sincronización de sistemas de monitorización para el estudio de ronquidos en las distintas fases del sueño en pacientes con SAHS CASEIB Proceedings XXXII Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB 2014) , Sociedad Española de Ingeniería Biomédica (Barcelona, Spain) , 1-4

El Síndrome de Apnea-Hipopnea del Sueño (SAHS) tiene una incidencia en sujetos de edad media, del 2-4% en mujeres y 4- 6% en hombres, además de múltiples consecuencias asociadas. Sin embargo, a pesar de su prevalencia, menos de un 10% de la población con este síndrome es diagnosticada. Con el objetivo de identificar qué señales debería emplear un futuro método de diagnóstico para pacientes con sospecha de SAHS más eficaz que los actuales, se sugiere un estudio en detalle de los eventos respiratorios que tienen lugar durante la noche. Para ello se parte de los estudios de monitorización del sueño realizados a pacientes con síntomas de SAHS mediante dos plataformas comerciales distintas. En primer lugar, los registros procedentes de dichos estudios se combinan y sincronizan temporalmente de una forma precisa y robusta. Una vez llevada y sincronizada toda la información a una plataforma común, el presente estudio se centra en la relación del SAHS con una nueva información, el roncograma. El concograma permite estudiar la evolución de los ronquidos según la fase de sueño. Aplicando esta medida sobre nuestra base de datos observamos como el tiempo en fase de vigilia, el tiempo en fase REM o la densidad de ronquidos en fases ligeras presentan diferencias estadísticamente significativas para pacientes con distinta severidad de SAHS.


Urra, O., Casals, A., Jané, R., (2014). Study of synergy patterns during the execution of stroke rehabilitation exercises CASEIB Proceedings XXXII Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB 2014) , Sociedad Española de Ingeniería Biomédica (Barcelona, Spain) , 1-4

Stroke is a leading cause of disability, being motor impairments its major consequence. Despite rehabilitation, more than 60% of the patients report upper-limb motor dysfunction. The design of novel rehabilitation strategies requires objective measures to assess motor impairment and recovery. In a previous study, we proposed to use the synergy components of the unaffected limb as a reference to be targeted by rehabilitation, since they are proven to explain healthy motor control and to be altered after stroke. We demonstrated that healthy subjects have very similar control structures (synergies and activation vectors) in their right and left arms. Here, we investigate the existence of movement-specific control strategies. To do so, we analyze the inter-subject similarity of the healthy control structure in twelve common stroke rehabilitation exercises and we evidence that motor control is movement specific and generalizes across different subjects and their limbs. However, the similarity degree depends on the movement, suggesting that novel training protocols should purposely choose the rehabilitation exercises to ensure maximum control similarity with the reference pattern.


Urra, O., Casals, A., Jané, R., (2014). Synergy analysis as a tool to design and assess an effective stroke rehabilitation Engineering in Medicine and Biology Society (EMBC) 36th Annual International Conference of the IEEE , IEEE (Chicago, USA) , 3550-3553

The poor rehabilitation success rate, including the cases of ineffective and detrimental adaptations, make stroke a leading cause of disability. Thus, it is essential to recognize the mechanisms driving healthy motor recovery to improve such rate. Stroke alters the Synergy Architecture (SA), the modular muscle control system. So SA analysis may constitute a powerful tool to design and assess rehabilitation procedures. However, current impairment scales do not consider the patient's neuromuscular state. To gain insights into this hypothesis, we recorded multiple myoelectric signals from upper-limb muscles, in healthy subjects, while executing a set of common rehabilitation exercises. We found that SA reveals optimized motor control strategies and the positive effects of the use of visual feedback (VF) on motor control. Furthermore we demonstrate that the right and left arm's SA share the basic structure within the same subject, so we propose using the unaffected limb's SA as a reference motion pattern to be reached through rehabilitation.

Keywords: Bars, Electromyography, Motor drives, Neuromuscular, Vectors, Visualization


Lozano, M., Fiz, J. A., Jané, R., (2014). Analysis of normal and continuous adventitious sounds for the assessment of asthma IFMBE Proceedings XIII Mediterranean Conference on Medical and Biological Engineering and Computing 2013 (ed. Roa Romero, Laura M.), Springer International Publishing (London, UK) 41, 981-984

Assessment of asthma is a difficult procedure which is based on the correlation of multiple factors. A major component in the diagnosis of asthma is the assessment of BD response, which is performed by traditional spirometry. In this context, the analysis of respiratory sounds (RS) provides relevant and complementary information about the function of the respiratory system. In particular, continuous adventitious sounds (CAS), such as wheezes, contribute to assess the severity of patients with obstructive diseases. On the other hand, the intensity of normal RS is dependent on airflow level and, therefore, it changes depending on the level of obstruction. This study proposes a new approach to RS analysis for the assessment of asthmatic patients, by combining the quantification of CAS and the analysis of the changes in the normal sound intensity-airflow relationship. According to results obtained from three patients with different characteristics, the proposed technique seems more sensitive and promising for the assessment of asthma.

Keywords: Asthma, Bronchodilator response, Continuous adventitious sound, Respiratory sound intensity, Wheezes


Giraldo, B. F., Calvo, A., Martínez, B., Arcentales, A., Jané, R., Benito, S., (2014). Blood pressure variability analysis in supine and sitting position of healthy subjects IFMBE Proceedings XIII Mediterranean Conference on Medical and Biological Engineering and Computing 2013 (ed. Roa Romero, Laura M.), Springer International Publishing (London, UK) 41, 1021-1024

Blood pressure carries a great deal of information about people’s physical attributes. We analyzed the blood pressure signal in healthy subjects considering two positions, supine and sitting. 44 healthy subjects were studied. Parameters extracted from the blood pressure signal, related to time and frequency domain were used to compare the effect of postural position between supine and sitting. In time domain analysis, the time systolic interval and the time of blood pressure interval were higher in supine than in sitting position (p = 0.001 in both case). Parameters related to frequency peak, interquartile range, in frequency domain presented statistically significant difference (p < 0.0005 in both case). The blood pressure variability parameters presented smaller values in supine than in sitting position (p < 0.0005). In general, the position change of supine to sitting produces an increment in the pressure gradient inside heart, reflected in the blood pressure variability.

Keywords: Blood pressure variability, Systolic time intervals, Diastolic time intervals


Torres, A., Fiz, J. A., Jané, R., (2014). Cancellation of cardiac interference in diaphragm EMG signals using an estimate of ECG reference signal IFMBE Proceedings XIII Mediterranean Conference on Medical and Biological Engineering and Computing 2013 (ed. Roa Romero, Laura M.), Springer International Publishing (London, UK) 41, 1000-1004

The analysis of the electromyographic signal of the diaphragm muscle (EMGdi) can provide important information in order to evaluate the respiratory muscular function. However, EMGdi signals are usually contaminated by the electrocardiographic (ECG) signal. An adaptive noise cancellation (ANC) based on event-synchronous cancellation can be used to reduce the ECG interference in the recorded EMGdi activity. In this paper, it is proposed an ANC scheme for cancelling the ECG interference in EMGdi signals using only the EMGdi signal (without acquiring the ECG signal). In this case the detection of the QRS complex has been performed directly in the EMGdi signal, and the ANC algorithm must be robust to false or missing QRS detections. Furthermore, an automatic criterion to select the adaptive constant of the LMS algorithm has been proposed (

Keywords: Adaptive Canceller, EMG, Diaphragm muscle


Urra, O., Casals, A., Jané, R., (2014). Evaluating spatial characteristics of upper-limb movements from EMG signals IFMBE Proceedings XIII Mediterranean Conference on Medical and Biological Engineering and Computing 2013 (ed. Roa Romero, Laura M.), Springer International Publishing (London, UK) 41, 1795-1798

Stroke is a major cause of disability, usually causing hemiplegic damage on the motor abilities of the patient. Stroke rehabilitation seeks restoring normal motion on the affected limb. However, normality’ of movements is usually assessed by clinical and functional tests, without considering how the motor system responds to therapy. We hypothesized that electromyographic (EMG) recordings could provide useful information for evaluating the outcome of rehabilitation from a neuromuscular perspective. Four healthy subjects were asked to perform 14 different functional movements simulating the action of reaching over a table. Each movement was defined according to the starting and target positions that the subject had to connect using linear trajectories. Bipolar recordings of EMG signals were taken from biceps and triceps muscles, and spectral and temporal characteristics were extracted for each movement. Using pattern recognition techniques we found that only two EMG channels were sufficient to accurately determine the spatial characteristics of motor activity: movement direction, length and execution zone. Our results suggest that muscles may fire in a patterned way depending on the specific characteristics of the movement and that EMG signals may codify such detailed information. These findings may be of great value to quantitatively assess post-stroke rehabilitation and to compare the neuromuscular activity of the affected and unaffected limbs, from a physiological perspective. Furthermore, disturbed movements could be characterized in terms of the muscle function to identify, which is the spatial characteristic that fails, e.g. movement direction, and guide personalized rehabilitation to enhance the training of such characteristic.

Keywords: EMG, Movement spatial characteristics, Pattern recognition, Stroke rehabilitation, Upper-limb


Estrada, L., Torres, A., Garcia-Casado, J., Ye-Lin, Y., Jané, R., (2014). Evaluation of Laplacian diaphragm electromyographic recordings in a static inspiratory maneuver IFMBE Proceedings XIII Mediterranean Conference on Medical and Biological Engineering and Computing 2013 (ed. Roa Romero, Laura M.), Springer International Publishing (London, UK) 41, 977-980

Diaphragm electromyography (EMGdi) provides important information on diaphragm activity, to detect neuromuscular disorders of the most important muscle in the breathing inspiratory phase. EMGdi is habitually recorded using needles or esophageal catheters, with the implication of being invasive for patients. Surface electrodes offer an alternative for the non-invasive assessment of diaphragm activity. Ag/AgCl surface disc electrodes are used in monopolar or bipolar configuration to record EMGdi signals. On the other hand, Laplacian surface potential can be estimated by signal recording through active concentric ring electrodes. This kind of recording could reduce physiological interferences, increase the spatial selectivity and reduce orientation problems in the electrode location. The aim of this work is to compare EMGdi signals recorded simultaneously with disc electrodes in bipolar configuration and a Laplacian ring electrode over chest wall. EMGdi signal was recorded in one healthy subject during a breath hold maneuver and a static inspiratory maneuver based on Mueller’s technique. In order to estimate the covered frequency range and the degree of noise contamination in both bipolar and Laplacian EMGdi signals, the cumulative percentage of the power spectrum and the signal to noise ratio in sub-bands were determined. Furthermore, diaphragm fatigue was evaluated by means of amplitude and frequency parameters. Our findings suggest that Laplacian EMGdi recording covers a broader frequency range although with higher noise contamination compared to bipolar EMGdi recording. Finally, in Laplacian recording fatigue indexes showed a clearer trend for muscle fatigue detection and also a reduced cardiac interference, providing an alternative to bipolar recording for diaphragm fatigue studies.

Keywords: Laplacian electrode, Diaphragm muscle, Fatigue, Surface electromyography


Urra, O., Jané, R., (2014). New sleep transition indexes for describing altered sleep in SAHS IFMBE Proceedings XIII Mediterranean Conference on Medical and Biological Engineering and Computing 2013 (ed. Roa Romero, Laura M.), Springer International Publishing (London, UK) 41, 1017-1020

Traditional Sleep Structure Indexes (TSSIs) are insufficient to identify patterns of altered sleep. TSSIs mainly account for absolute time measures, but different levels of state instability may lead to similar absolute time distribution. Therefore, sleep stability remains beyond the scope of TSSIs. However, recent studies suggest that sleep disorders may be rather influenced by a breakdown in the sleep-stage switching mechanisms. In this study, we propose a set of 11 Sleep Transition Indexes (STIs) that characterize sleep fragmentation and account for the state-stability governed by the ultradian, homeostatic and circadian rhythms. We demonstrate that most of the proposed STIs are potential markers of SAHS severity, while TSSIs are not. In addition, we provide a new framework to analyze sleep disorders from the direct perspective of sleep regulatory mechanisms. In particular, our results indicate that SAHS may be influenced by a dysregulation of homeostatic rhythms but not of ultradian or circadian rhythms.

Keywords: SAHS, Sleep Transitions, Sleep Structure, Polysomnography, Hypnogram


Jané, R., Caminal, P., Giraldo, B., Solà, J., Torres, A., (2014). Libro de Actas del CASEIB 2014 XXXII Congreso Anual de la SEIB , CASEIB-IBEC (Barcelona, Spain) , 20

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Morgenstern, C., Randerath, W. J., Schwaibold, M., Bolz, A., Jané, R., (2013). Feasibility of noninvasive single-channel automated differentiation of obstructive and central hypopneas with nasal airflow Respiration 85, (4), 312-318

Background: The identification of obstructive and central hypopneas is considered challenging in clinical practice. Presently, obstructive and central hypopneas are usually not differentiated or scores lack reliability due to the technical limitations of standard polysomnography. Esophageal pressure measurement is the gold-standard for identifying these events but its invasiveness deters its usage in daily practice. Objectives: To determine the feasibility and efficacy of an automatic noninvasive analysis method for the differentiation of obstructive and central hypopneas based solely on a single-channel nasal airflow signal. The obtained results are compared with gold-standard esophageal pressure scores. Methods: A total of 41 patients underwent full night polysomnography with systematic esophageal pressure recording. Two experts in sleep medicine independently differentiated hypopneas with the gold-standard esophageal pressure signal. Features were automatically extracted from the nasal airflow signal of each annotated hypopnea to train and test the automatic analysis method. Interscorer agreement between automatic and visual scorers was measured with Cohen's kappa statistic (κ). Results: A total of 1,237 hypopneas were visually differentiated. The automatic analysis achieved an interscorer agreement of κ = 0.37 and an accuracy of 69% for scorer A, κ = 0.40 and 70% for scorer B and κ = 0.41 and 71% for the agreed scores of scorers A and B. Conclusions: The promising results obtained in this pilot study demonstrate the feasibility of noninvasive single-channel hypopnea differentiation. Further development of this method may help improving initial diagnosis with home screening devices and offering a means of therapy selection and/or control.

Keywords: Central sleep hypopnea, Esophageal pressure, Home monitoring, Obstructive sleep hypopnea, Sleep disordered breathing


Sarlabous, L., Torres, A., Fiz, J. A., Morera, J., Jané, R., (2013). Index for estimation of muscle force from mechanomyography based on the Lempel-Ziv algorithm Journal of Electromyography and Kinesiology 23, (3), 548-557

The study of the amplitude of respiratory muscle mechanomyographic (MMG) signals could be useful in clinical practice as an alternative non-invasive technique to assess respiratory muscle strength. The MMG signal is stochastic in nature, and its amplitude is usually estimated by means of the average rectified value (ARV) or the root mean square (RMS) of the signal. Both parameters can be used to estimate MMG activity, as they correlate well with muscle force. These estimations are, however, greatly affected by the presence of structured impulsive noise that overlaps in frequency with the MMG signal. In this paper, we present a method for assessing muscle activity based on the Lempel-Ziv algorithm: the Multistate Lempel-Ziv (MLZ) index. The behaviour of the MLZ index was tested with synthesised signals, with various amplitude distributions and degrees of complexity, and with recorded diaphragm MMG signals. We found that this index, like the ARV and RMS parameters, is positively correlated with changes in amplitude of the diaphragm MMG components, but is less affected by components that have non-random behaviour (like structured impulsive noise). Therefore, the MLZ index could provide more information to assess the MMG-force relationship.

Keywords: Diaphragm, Electromyography, Lempel-Ziv, Mechanomyography, Muscle force, Respiratory muscles


Sarlabous, L., Torres, A., Fiz, J. A., Jané, R., (2013). Cardiac interference reduction in diaphragmatic MMG signals during a Maintained Inspiratory Pressure Test Engineering in Medicine and Biology Society (EMBC) 35th Annual International Conference of the IEEE , IEEE (Osaka, Japan) , 3845-3848

A recursive least square (RLS) adaptive filtering algorithm for reduction of cardiac interference in diaphragmatic mecanomyographic (MMGdi) signals is addressed in this paper. MMGdi signals were acquired with a capacitive accelerometer placed between 7th and 8th intercostal spaces, on the right anterior axillary line, during a maintained inspiratory pressure test. Subjects were asked to maintain a constant inspiratory pressure with a mouthpiece connected to a closed tube (without breathing). This maneuver was repeated at five different contraction efforts: apnea (no effort), 20 cmH2O, 40 cmH2O, 60 cmH2O and maximum voluntary contraction. An adaptive noise canceller (ANC) using the RLS algorithm was applied on the MMGdi signals. To evaluate the behavior of the ANC, the MMGdi signals were analyzed in two segments: with and without cardiac interference (WCI and NCI, respectively). In both segments it was analyzed the power spectral density (PSD), and the ARV and RMS amplitude parameters for each contraction effort. With the proposed ANC algorithm the amplitude parameters of the WCI segments were reduced to a level similar to the one of the NCI segments. The obtained results showed that ANC using the RLS algorithm allows to significantly reduce the cardiac interference in MMGdi signals.


Estrada, L., Torres, A., Garcia-Casado, J., Prats-Boluda, G., Jané, R., (2013). Characterization of laplacian surface electromyographic signals during isometric contraction in biceps brachii Engineering in Medicine and Biology Society (EMBC) 35th Annual International Conference of the IEEE , IEEE (Osaka, Japan) , 535-538

Surface electromyography (sEMG) is a noninvasive technique for monitoring the electrical activity produced by the muscles. Usually, sEMG is performed by carrying out monopolar or bipolar recordings by means of conventional Ag/AgCl electrodes. In contrast, Laplacian recordings of sEMG could also be obtained by using coaxial ring electrodes. Laplacian recordings increase spatial resolution and attenuate other distant bioelectric interferences. Nevertheless, the spectral characteristics of this kind of recordings have been scarcely studied. The objective of this paper is to characterize the sEMG signals recorded with a Laplacian ring electrode and to compare them with traditional bipolar recordings with disc electrodes. Both kinds of signals were collected simultaneously in two healthy subjects during resting and sustained isometric voluntary contraction activities in biceps brachii. The conducted study computed the cumulative percentage of the power spectrum of sEMG so as to determine the energy bandwidth of the two kinds of recordings and the signal to noise ratio in different bands of the sEMG spectrum. Also, muscle fatigue, a condition when muscle force is reduced, was assessed using indexes from amplitude and frequency domain. The results of this study suggest that Laplacian sEMG has higher spectral bandwidth but a lower signal to noise ratio in comparison to bipolar sEMG. In addition, frequency fatigue indexes showed that Laplacian recording had better response than bipolar recording, which suggests that Laplacian electrode can be useful to study muscular fatigue due to better spatial resolution.


Lozano, M., Fiz, J. A., Jané, R., (2013). Estimation of instantaneous frequency from empirical mode decomposition on respiratory sounds analysis Engineering in Medicine and Biology Society (EMBC) 35th Annual International Conference of the IEEE , IEEE (Osaka, Japan) , 981-984

Instantaneous frequency (IF) calculated by empirical mode decomposition (EMD) provides a novel approach to analyze respiratory sounds (RS). Traditionally, RS have been analyzed using classical time-frequency distributions, such as short-time Fourier transform (STFT) or wavelet transform (WT). However, EMD has become a powerful tool for nonlinear and non-stationary data analysis. IF estimated by EMD has two major advantages: its high temporal resolution and the fact that a priori knowledge of the signal characteristics is not required. In this study, we have estimated IF by EMD on real RS signals in order to identify continuous adventitious sounds (CAS), such as wheezes, within inspiratory sounds cycles. We show that there are differences in IF distribution among frequency scales of RS signal when CAS are within RS. Therefore, a new method for RS analysis and classification may be developed by combining both EMD and IF.


Jané, R., Lazaro, J., Ruiz, P., Gil, E., Navajas, D., Farre, R., Laguna, P., (2013). Obstructive Sleep Apnea in a rat model: Effects of anesthesia on autonomic evaluation from heart rate variability measures CinC 2013 Computing in Cardiology Conference (CinC) , IEEE (Zaragoza, Spain) , 1011-1014

Rat model of Obstructive Sleep Apnea (OSA) is a realistic approach for studying physiological mechanisms involved in sleep. Rats are usually anesthetized and autonomic nervous system (ANS) could be blocked. This study aimed to assess the effect of anesthesia on ANS activity during OSA episodes. Seven male Sprague-Dawley rats were anesthetized intraperitoneally with urethane (1g/kg). The experiments were conducted applying airway obstructions, simulating 15s-apnea episodes for 15 minutes. Five signals were acquired: respiratory pressure and flow, SaO2, ECG and photoplethysmography (PPG). In total, 210 apnea episodes were studied. Normalized power spectrum of Pulse Rate Variability (PRV) was analyzed in the Low Frequency (LF) and High Frequency (HF) bands, for each episode in consecutive 15s intervals (before, during and after the apnea). All episodes showed changes in respiratory flow and SaO2 signal. Conversely, decreases in the amplitude fluctuations of PPG (DAP) were not observed. Normalized LF presented extremely low values during breathing (median=7,67%), suggesting inhibition of sympathetic system due to anesthetic effect. Subtle increases of LF were observed during apnea. HRV and PPG analysis during apnea could be an indirect tool to assess the effect and deep of anesthesia.

Keywords: electrocardiography, fluctuations, medical disorders, medical signal detection, medical signal processing, neurophysiology, photoplethysmography, pneumodynamics, sleep, ECG, SaO2 flow, SaO2 signal, airway obstructions, amplitude fluctuations, anesthesia effects, anesthetized nervous system, autonomic evaluation, autonomic nervous system, breathing, heart rate variability, high-frequency bands, low-frequency bands, male Sprague-Dawley rats, normalized power spectrum, obstructive sleep apnea, photoplethysmography, physiological mechanisms, pulse rate variability, rat model, respiratory flow, respiratory pressure, signal acquisition, sympathetic system inhibition, time 15 min, time 15 s, Abstracts, Atmospheric modeling, Computational modeling, Electrocardiography, Rats, Resonant frequency


Fiz, J. A., Jané, R., (2012). Snoring Analysis. A Complex Question Journal of Sleep Disorders: Treatment & Care 1, (1), 1-3

The snore is a breathing sound that originates during sleep, either nocturnal or diurnal. Many procedures have been used for its analysis, from simple interrogation, going through acoustic methods that have been developed thanks to the advance of biomedical techniques in recent years. So far a procedure homologated by different laboratories for its study doesn’t exist. The present editorial describes the current state of the art in the snoring analysis procedures.

Keywords: Snoring, Sleep apnea, OSAS


Mesquita, J., Solà, J., Fiz, J. A., Morera, J., Jané, R., (2012). All night analysis of time interval between snores in subjects with sleep apnea hypopnea syndrome Medical and Biological Engineering and Computing 50, (4), 373-381

Sleep apnea-hypopnea syndrome (SAHS) is a serious sleep disorder, and snoring is one of its earliest and most consistent symptoms. We propose a new methodology for identifying two distinct types of snores: the so-called non-regular and regular snores. Respiratory sound signals from 34 subjects with different ranges of Apnea-Hypopnea Index (AHI = 3.7-109.9 h -1) were acquired. A total number of 74,439 snores were examined. The time interval between regular snores in short segments of the all night recordings was analyzed. Severe SAHS subjects show a shorter time interval between regular snores (p = 0.0036, AHI cp: 30 h -1) and less dispersion on the time interval features during all sleep. Conversely, lower intra-segment variability (p = 0.006, AHI cp: 30 h -1) is seen for less severe SAHS subjects. Features derived from the analysis of time interval between regular snores achieved classification accuracies of 88.2 % (with 90 % sensitivity, 75 % specificity) and 94.1 % (with 94.4 % sensitivity, 93.8 % specificity) for AHI cut-points of severity of 5 and 30 h -1, respectively. The features proved to be reliable predictors of the subjects' SAHS severity. Our proposed method, the analysis of time interval between snores, provides promising results and puts forward a valuable aid for the early screening of subjects suspected of having SAHS.

Keywords: Sleep apnea, Snore sounds, Snore time interval


Solà, J., Fiz, J. A., Morera, J., Jané, R., (2012). Multiclass classification of subjects with sleep apnoea-hypopnoea syndrome through snoring analysis Medical Engineering and Physics 34, (9), 1213-1220

The gold standard for diagnosing sleep apnoea-hypopnoea syndrome (SAHS) is polysomnography (PSG), an expensive, labour-intensive and time-consuming procedure. Accordingly, it would be very useful to have a screening method to allow early assessment of the severity of a subject, prior to his/her referral for PSG. Several differences have been reported between simple snorers and SAHS patients in the acoustic characteristics of snoring and its variability. In this paper, snores are fully characterised in the time domain, by their sound intensity and pitch, and in the frequency domain, by their formant frequencies and several shape and energy ratio measurements. We show that accurate multiclass classification of snoring subjects, with three levels of SAHS, can be achieved on the basis of acoustic analysis of snoring alone, without any requiring information on the duration or the number of apnoeas. Several classification methods are examined. The best of the approaches assessed is a Bayes model using a kernel density estimation method, although good results can also be obtained by a suitable combination of two binary logistic regression models. Multiclass snore-based classification allows early stratification of subjects according to their severity. This could be the basis of a single channel, snore-based screening procedure for SAHS.

Keywords: Bayes classifier, Kernel density estimation, Sleep apnoea, Snoring


Lozano, M., Fiz, J.A., Jané, R., (2012). Análisis multicanal de sonidos respiratorios en acústica pulmonar: aplicación clínica en pacientes asmáticos Libro de Actas XXX CASEIB 2012 XXX Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB2012) , Sociedad Española de Ingeniería Biomédica (San Sebastián, Spain) , 1-4

En este trabajo se ha visto que la evaluación de la potencia media de las señales de sonidos respiratorios antes y después de aplicar un fármaco broncodilatador puede reportar información importante sobre el estado y los cambios producidos en el sistema respiratorio. Se ha realizado y puesto a punto un protocolo de registro multicanal de acústica pulmonar mediante la colocación de 5 micrófonos de contacto: uno traqueal y cuatro micrófonos colocados en el tórax posterior. Mediante el análisis de las curvas intensidad-flujo respiratorio se han observado cambios significativos de intensidad a niveles de flujo elevados y en pacientes con una PBD negativa. Es en este grupo de pacientes, no respondedores, donde la técnica propuesta puede aportar información de interés clínico complementaria a la proporcionada por la espirometría clásica.


Urra, O., Fiz, J.A., Abad, J., Jané, R., (2012). Beyond the reach of AHI: identifying key markers for improved systematic diagnosis of SAHS Libro de Actas XXX CASEIB 2012 XXX Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB2012) , Sociedad Española de Ingeniería Biomédica (San Sebastián, Spain) , 1-4

Garde, A., Laguna, P., Giraldo, B.F., Jané, R., Sörnmo, L., (2012). Ensemble-based time alignment of biomedical signals Proceedings BSI 2012 7th International Workshop on Biosignal Interpretation (BSI 2012) , IEEE (Como, Italy) W3: METHODS FOR BIOMEDICAL SIGNAL PROCESSING ENHANCEMENT, 307-310

In this paper, the problem of time alignment is revisited by adopting an ensemble-based approach with all signals jointly aligned. It is shown that the maximization of an eigenvalue ratio is synonymous to maximizing the signal-to-jitter-and-noise ratio. Since optimization of this criterion is extremely time consuming, a relaxed optimization procedure is introduced which converges much more quickly. Using simulations based on respiratory flow signals, the results suggest that the time delay error variance of the new method is much lower than that obtained with the well-known Woody’s method.

Keywords: Time alignment, Signal ensemble, Subsample precision, Eigenvalue decomposition


Garde, A., Giraldo, B.F., Jané, R., Latshang, T.D., Turk, A.J., Hess, T., Bosch, M-.M., Barthelmes, D., Hefti, J.P., Maggiorini, M., Hefti, U., Merz, T.M., Schoch, O.D., Bloch, K.E., (2012). Estudio de la respiración periódica en el ascenso a altitudes extremas a partir de la señal de volumen respiratorio Libro de Actas XXX CASEIB 2012 XXX Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB2012) , Sociedad Española de Ingeniería Biomédica (San Sebastián, Spain) , 1-4

La respiración periódica (PB) a gran altitud comparte aspectos fisiopatológicos con la apnea, la respiración Cheyne-Stokes y la PB en pacientes con insuficiencia cardiaca. Cuantificar las inestabilidades del control respiratorio puede proporcionar información relevante de los mecanismos fisiológicos que las producen, y ayudar en las actuaciones terapéuticas. Bajo la hipótesis de que en altitudes extremas la PB puede aparecer incluso durante actividad física, el objetivo es identificar la PB y evaluar el efecto de aclimatación a partir de la caracterización del patrón respiratorio mediante la señal de volumen respiratorio. Se analizaron los datos obtenidos de 34 montañeros sanos ascendiendo al Muztagh Ata, China (7,546m). Sus señales se etiquetaron visualmente como, respiración periódica (PB=40) y no periódica (nPB=371). El patrón respiratorio se caracterizó a partir de parámetros extraídos de la densidad espectral de potencia de la señal de volumen respiratorio. Los mejores resultados clasificando PB y nPB se obtuvieron con Pm (potencia de modulación) y R (ratio entre potencia de modulación y respiración) con una precisión del 80.3% y un área bajo la curva de 84.5%. SaO2 y el número de ciclos periódicos de respiración aumentaron significativamente con la aclimatación (p-valor<0.05). A menor SaO2 se observó una mayor Pm y frecuencia respiratoria, (correlación negativa, p-valor<0.01), y una mayor Pm en periodos etiquetados como PB con > 5 ciclos respiratorios periódicos, (correlación positiva, p-valor<0.01). Estos resultados demuestran que la caracterización espectral de la señal de volumen respiratorio permite identificar los efectos de la hipoxia hipobárica en el control de la respiración.


Torres, A., Sarlabous, L., Fiz, J.A., Jané, R., (2012). Evaluación de diferentes algoritmos adaptativos para la atenuación de la interferencia cardiaca en señales mecanomiográficas simuladas Libro de Actas XXX CASEIB 2012 XXX Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB2012) , Sociedad Española de Ingeniería Biomédica (San Sebastián, Spain) , 1-4

El estudio de la señal mecanomiográfica del músculo diafragma (MMGdi) es una técnica utilizada para evaluar el esfuerzo muscular respiratorio. El estudio de la relación entre los parámetros de amplitud y frecuencia de esta señal con el esfuerzo respiratorio realizado es de gran interés para investigadores y médicos debido a su potencial de diagnóstico sobre la función muscular respiratoria. Las señales MMGdi se ven afectas por una componente interferente correspondiente a la actividad vibratoria cardíaca o interferencia mecanocardiográfica (MCG). Para reducir o atenuar esta actividad se puede utilizar una cancelación adaptativa de interferencias (CAI). En este trabajo se ha evaluado el esquema de CAI propuesto mediante una señal MMGdi sintética generada con amplitud y frecuencia controlada a la que se le ha añadido ruido MCG real adquirido durante apnea. El coeficiente de correlación de Pearson (r) entre la amplitud y la frecuencia teóricas, y la amplitud y la frecuencia evaluadas mediante el RMS y la frecuencia media del espectro, respectivamente, disminuye considerablemente cuando se añade el ruido cardíaco a la señal MMGdi sintética: pasa de 0.95 a 0.87 para la amplitud, y de 0.97 a 0.76 para la frecuencia. Con los algoritmos de CAI propuestos el efecto del ruido MCG sobre la actividad MMGdi se reduce considerablemente (r de 0.93 para la amplitud y 0.97 para la frecuencia media). El método de CAI propuesto en este trabajo es una técnica adecuada para atenuar la interferencia MCG en señales MMGdi.


Sarlabous, L., Torres, A., Fiz, J. A., Morera, J., Jané, R., (2012). Evaluation and adaptive attenuation of the cardiac vibration interference in mechanomyographic signals Engineering in Medicine and Biology Society (EMBC) 34th Annual International Conference of the IEEE , IEEE (San Diego, USA) , 3400-3403

The study of the mechanomyographic signal of the diaphragm muscle (MMGdi) is a promising technique in order to evaluate the respiratory muscles effort. The relationship between amplitude and frequency parameters of this signal with the respiratory effort performed during respiration is of great interest for researchers and physicians due to its diagnostic potentials. However, MMGdi signals are frequently contaminated by a cardiac vibration or mechanocardiographic (MCG) signal. An adaptive noise cancellation (ANC) can be used to reduce the MCG interference in the recorded MMGdi activity. In this paper, it is evaluated the proposed ANC scheme by means of a synthetic MMGdi signal with a controlled MCG interference. The Pearson's correlation coefficient (PCC) between both root mean square (RMS) and mean frequency (fm) of the synthetic MMGdi signal are considerably reduced with the presence of cardiac vibration noise (from 0.95 to 0.87, and from 0.97 to 0.76, respectively). With the ANC algorithm proposed the effect of the MCG noise on the amplitude and frequency of MMG parameters is reduced considerably (PCC of 0.93 and 0.97 for the RMS and fm, respectively). The ANC method proposed in this work is an interesting technique to attenuate the cardiac interference in respiratory MMG signals. Further investigation should be carried out to evaluate the performance of the ANC algorithm in real MMGdi signals.

Keywords: Adaptive filters, Frequency modulation, Interference, Muscles, Noise cancellation, Vibrations, Cardiology, Medical signal processing, Muscle, Signal denoising, ANC algorithm, MCG interference, Pearson correlation coefficient, Adaptive noise cancellation, Cardiac vibration interference, Cardiac vibration noise, Diaphragm muscle, Mechanocardiographic signal, Mechanomyographic signals, Respiratory muscles effort


Garde, A., Giraldo, B.F., Jané, R., Latshang, T.D., Turk, A.J., Hess, T., Bosch, M-.M., Barthelmes, D., Hefti, J.P., Maggiorini, M., Hefti, U., Merz, T.M., Schoch, O.D., Bloch, K.E., (2012). Periodic breathing during ascent to extreme altitude quantified by spectral analysis of the respiratory volume signal Engineering in Medicine and Biology Society (EMBC) 34th Annual International Conference of the IEEE , IEEE (San Diego, USA) , 707-710

High altitude periodic breathing (PB) shares some common pathophysiologic aspects with sleep apnea, Cheyne-Stokes respiration and PB in heart failure patients. Methods that allow quantifying instabilities of respiratory control provide valuable insights in physiologic mechanisms and help to identify therapeutic targets. Under the hypothesis that high altitude PB appears even during physical activity and can be identified in comparison to visual analysis in conditions of low SNR, this study aims to identify PB by characterizing the respiratory pattern through the respiratory volume signal. A number of spectral parameters are extracted from the power spectral density (PSD) of the volume signal, derived from respiratory inductive plethysmography and evaluated through a linear discriminant analysis. A dataset of 34 healthy mountaineers ascending to Mt. Muztagh Ata, China (7,546 m) visually labeled as PB and non periodic breathing (nPB) is analyzed. All climbing periods within all the ascents are considered (total climbing periods: 371 nPB and 40 PB). The best crossvalidated result classifying PB and nPB is obtained with Pm (power of the modulation frequency band) and R (ratio between modulation and respiration power) with an accuracy of 80.3% and area under the receiver operating characteristic curve of 84.5%. Comparing the subjects from 1st and 2nd ascents (at the same altitudes but the latter more acclimatized) the effect of acclimatization is evaluated. SaO2 and periodic breathing cycles significantly increased with acclimatization (p-value <; 0.05). Higher Pm and higher respiratory frequencies are observed at lower SaO2, through a significant negative correlation (p-value <; 0.01). Higher Pm is observed at climbing periods visually labeled as PB with >; 5 periodic breathing cycles through a significant positive correlation (p-value <; 0.01). Our data demonstrate that quantification of the respiratory volum- signal using spectral analysis is suitable to identify effects of hypobaric hypoxia on control of breathing.

Keywords: Frequency domain analysis, Frequency modulation, Heart, Sleep apnea, Ventilation, Visualization, Cardiology, Medical disorders, Medical signal processing, Plethysmography, Pneumodynamics, Sensitivity analysis, Sleep, Spectral analysis, Cheyne-Stokes respiration, Climbing periods, Dataset, Heart failure patients, High altitude PB, High altitude periodic breathing, Hypobaric hypoxia, Linear discriminant analysis, Pathophysiologic aspects, Physical activity, Physiologic mechanisms, Power spectral density, Receiver operating characteristic curve, Respiratory control, Respiratory frequency, Respiratory inductive plethysmography, Respiratory pattern, Respiratory volume signal, Sleep apnea, Spectral analysis, Spectral parameters


Sarlabous, L., Torres, A., Fiz, J.A., Jané, R., (2012). Reducción de interferencia cardíaca en señales MMG diafragmáticas registradas durante un protocolo de carga incremental sostenida mediante el algoritmo RLS Libro de Actas XXX CASEIB 2012 XXX Congreso Anual de la Sociedad Española de Ingeniería Biomédica (CASEIB2012) , Sociedad Española de Ingeniería Biomédica (San Sebastián, Spain) , 1-4

En este trabajo se aplicó el filtrado adaptativo empleando el algoritmo RLS para reducir la interferencia de origen cardíaco en las señales mecanomiográficas diafragmáticas (MMGdi) registras durante un protocolo de carga incremental sostenida. La señal MMGdi fue dividida en tramos con y sin ruido cardíaco, CRC y SRC, respectivamente. En cada tramo se estudio el comportamiento de la densidad espectral de potencia (DEP), y los parámetros de amplitud RMS y ARV para cada una de las cargas inspiratorias que conforman el test. Los resultados obtenidos, empleando filtro adaptativo de orden =50, con el algoritmo RLS y valores de - = 1, permiten reducir considerablemente la interferencia cardíaca en las señales MMGdi.


Mesquita, J., Poree, F., Carrault, G., Fiz, J. A., Abad, J., Jané, R., (2012). Respiratory and spontaneous arousals in patients with Sleep Apnea Hypopnea Syndrome Engineering in Medicine and Biology Society (EMBC) 34th Annual International Conference of the IEEE , IEEE (San Diego, USA) , 6337-6340

Sleep in patients with Sleep Apnea-Hypopnea Syndrome (SAHS) is frequently interrupted with arousals. Increased amounts of arousals result in shortening total sleep time and repeated sleep-arousal change can result in sleep fragmentation. According to the American Sleep Disorders Association (ASDA) an arousal is a marker of sleep disruption representing a detrimental and harmful feature for sleep. The nature of arousals and its role on the regulation of the sleep process raises controversy and has sparked the debate in the last years. In this work, we analyzed and compared the EEG spectral content of respiratory and spontaneous arousals on a database of 45 SAHS subjects. A total of 3980 arousals (1996 respiratory and 1984 spontaneous) were analyzed. The results showed no differences between the spectral content of the two kinds of arousals. Our findings raise doubt as to whether these two kinds of arousals are truly triggered by different organic mechanisms. Furthermore, they may also challenge the current beliefs regarding the underestimation of the importance of spontaneous arousals and their contribution to sleep fragmentation in patients suffering from SAHS.

Keywords: Adaptive filters, Correlation, Databases, Electroencephalography, Hospitals, Sleep apnea, Electroencephalography, Medical signal processing, Pneumodynamics, Sleep, EEG spectral content, Organic mechanism, Respiratory, Sleep apnea hypopnea syndrome, Sleep fragmentation, Spectral content, Spontaneous arousal


Morgenstern, R., Morgenstern, C., Jané, R., Lee, S. H., (2011). Usefulness of an expandable interbody spacer for the treatment of foraminal stenosis in extremely collapsed disks preliminary clinical experience with endoscopic posterolateral transforaminal approach Journal of Spinal Disorders & Techniques 24, (8), 485-491

Study Design: Clinical series of patients with degenerative disk disease undergoing an endoscopic posterolateral transforaminal procedure that used a reaming foraminoplasty technique to enlarge the foramen coupled with insertion of the B-Twin expandable spacer. Objectives: This retrospective analysis of 107 consecutive patients sought to assess the outcome of this surgical procedure. Summary of Background Data: Reamed endoscopic foraminoplasty under direct endoscopic vision has been shown to be suitable for extremely collapsed disks (> 50% total disk height) despite the difficult access, especially at L5-S1. The authors tried to investigate the efficacy of an expandable spacer being inserted by the endoscopic transforaminal approach to solve foraminal stenosis without bone fusion techniques. Methods: The procedure consists of bone reaming under direct endoscopic control to wide the foramen followed by insertion of the B-Twin expandable device as a disk spacer to restore partially or to maintain the height of the collapsed disk. Outcome measures included visual analog scale (VAS) for pain, the Oswestry Disability Index (ODI) for functional disability, and radioimaging studies. Results: Mean follow-up was 27.2 months. Clinical outcome was considered excellent in 64 patients, good in 25, fair in 10, and poor in 8. Results were similar in single and double B-Twin spacer insertions. Postoperative mean values for VAS and ODI scores improved significantly as compared with preoperative data. Mean VAS and ODI scores were significantly higher in patients with fair or poor results than in those with excellent or good outcome. In 2 cases, clear signs of end plate bone resorption in the control computed tomographic scans at 6 months and 12 months leading to a substantial loss of disk height were documented. Conclusions: This preliminary study has shown the efficacy of an endoscopic surgical technique for the treatment of foraminal stenosis in extremely collapsed disks.

Keywords: Foraminal stenosis, B-twin expandable spacer, Endoscopic foraminoplasty, Minimally invasive surgery, Surgical technique, Spinal spacer, Lumbar, Diskectomy, Fusion, Discectomy


Fiz, José Antonio, Solà, J., Jané, Raimon, (2011). Métodos de análisis del ronquido Medicina Clínica 137, (1), 36-42

El ronquido es un sonido respiratorio que se produce durante el sueño, ya sea nocturno o diurno. El ronquido puede ser inspiratorio, espiratorio o puede ocupar todo el ciclo respiratorio. Tiene su origen en la vibración de los diferentes tejidos de la vía aérea superior. Se han descrito numerosos métodos para analizarlo, desde el simple interrogatorio, pasando por cuestionarios estándares, hasta llegar a los métodos acústicos más sofisticados, que se han desarrollado gracias al gran avance de las técnicas biomédicas en los últimos años. El presente trabajo describe el estado del arte actual en los procedimientos de análisis del ronquido.

Keywords: Ronquido, Apnea del sueño, Síndrome de apnea-hipoapnea del sueño, Snoring, Sleep apnea, Sleep Apnea and Hipoapnea Syndrome


Garde, A., Giraldo, B.F., Sornmo, L., Jané, R., (2011). Analysis of the respiratory flow cycle morphology in chronic heart failure patients applying principal components analysis Engineering in Medicine and Biology Society 33rd Annual International Conference of the IEEE EMBS , IEEE (Boston, USA) Engineering in Medicine and Biology Society, 1725-1728

The study of flow cycle morphology provides new information about the breathing pattern. This study proposes the characterization of cycle morphology in chronic heart failure patients (CHF) patients, with periodic (PB) and non-periodic breathing (nPB) patterns, and healthy subjects. Principal component analysis is applied to extract a respiratory cycle model for each time segment defined by a 30-s moving window. To characterize morphology of the model waveform, a number of parameters are extracted whose significance is evaluated in terms of the following three classification problems: CHF patients with either PB or nPB, CHF patients versus healthy subjects, and nPB patients versus healthy subjects. 26 CHF patients (8 with PB and 18 with non-periodic breathing pattern (nPB)) and 35 healthy subjects are studied. The results show that a respiratory cycle compressed in time characterizes PB patients, i.e., shorter inspiratory and expiratory periods, and higher dispersion of the maximum inspiratory and expiratory flow value (accuracy of 87%). The maximal expiratory flow instant occurs earlier in CHF patients than in healthy subjects (accuracy of 87%), with a steeper slope between inspiration and expiration. It is also found that the standard deviation of the expiratory period, evaluated for each subject, is much lower in CHF patients than in healthy subjects. The maximal expiratory flow instant occurs earlier (accuracy of 84%) in nPB patients, when comparing subjects with similar respiratory pattern like nPB patients and healthy subjects.

Keywords: -----


Solà, J., Fiz, J.A., Morera, J., Jané, R., (2011). Bayes classification of snoring subjects with and without Sleep Apnea Hypopnea Syndrome, using a Kernel method Engineering in Medicine and Biology Society 33rd Annual International Conference of the IEEE EMBS , IEEE (Boston, USA) Engineering in Medicine and Biology Society, 6071-6074

The gold standard for diagnosing Sleep Apnea Hypopnea Syndrome (SAHS) is the Polysomnography (PSG), an expensive, labor-intensive and time-consuming procedure. It would be helpful to have a simple screening method that allowed to early determining the severity of a subject prior to his/her enrolment for a PSG. Several differences have been reported in the acoustic snoring characteristics between simple snorers and SAHS patients. Previous studies usually classify snoring subjects into two groups given a threshold of Apnea-Hypoapnea Index (AHI). Recently, Bayes multi-group classification with Gaussian Probability Density Function (PDF) has been proposed, using snore features in combination with apnea-related information. In this work we show that the Bayes classifier with Kernel PDF estimation outperforms the Gaussian approach and allows the classification of SAHS subjects according to their severity, using only the information obtained from snores. This could be the base of a single

Keywords: -----


Morgenstern, C., Schwaibold, M., Randerath, W., Bolz, A., Jané, R., (2011). Comparison of upper airway respiratory resistance measurements with the esophageal pressure/airflow relationship during sleep Engineering in Medicine and Biology Society 33rd Annual International Conference of the IEEE EMBS , IEEE (Boston, USA) Engineering in Medicine and Biology Society, 3205-3208

Measurement of upper airway resistance is of interest in sleep disordered breathing to estimate upper airway patency. Resistance is calculated with the airflow and respiratory effort signals. However, there is no consensus on a standard for upper airway resistance measurement. This study proposes a new benchmarking method to objectively compare different upper airway resistance measurement methods by objectively differentiating between breaths with inspiratory flow limitation (high resistance) and non-limited breaths (low resistance). Resistance was measured at peak-Pes, at peak-flow, at the linear portion of a polynomial equation, as an area comparative and as average resistance for an inspiration. A total of 20 patients with systematic, gold-standard esophageal pressure and nasal airflow acquisition were analyzed and 109,955 breaths were automatically extracted and evaluated. Relative resistance values in relationship to a reference resistance value obtained during wakefulness were also analyzed. The peak-Pes measurement method obtained the highest separation index with significant (p < 0.001) differences to the other methods, followed by the area comparative and the peak-flow methods. As expected, average resistances were significantly (p < 0.001) lower for the non-IFL than for the IFL group. Hence, we recommend employing the peak-Pes for accurate upper airway resistance estimation.

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Sarlabous, L., Torres, A., Fiz, J.A., Gea, J., Martinez-Llorens, J.M., Morera, J., Jané, R. , (2011). Evaluation of the respiratory muscles efficiency during an incremental flow respiratory test Engineering in Medicine and Biology Society 33rd Annual International Conference of the IEEE EMBS , IEEE (Boston, USA) Engineering in Medicine and Biology Society, 3820-3823

The aim of this study was to evaluate the respiratory muscles efficiency during a progressive incremental flow (IF) respiratory test in healthy and Chronic Obstructive Pulmonary Disease (COPD) subjects. To achieve this, the relationship between mouth Inspiratory Pressure (IP) increment, which is a measure of the force produced by respiratory muscles, and respiratory muscular activity increment, evaluated by means of Mechanomyografic (MMG) signals of the diaphragm muscle, was analyzed. Moreover, the correlation between the respiratory efficiency measure and the obstruction severity of the subjects was also examined. Data from two groups of subjects were analyzed. One group consisted of four female subjects (two healthy subjects and two moderate COPD patients) and the other consisted of ten male subjects (six severe and four very severe COPD patients). All subjects performed an easy IF respiratory test, in which small IP values were reached. We have found that there is an increase of amplitude and a displacement towards low frequencies in the MMG signals when the IP increases. Furthermore, it has also been found that respiratory muscles efficiency is lower when greater the obstructive severity of the patients is, and it is lower in women than in men. These results suggest that the information provided by MMG signals could be used to evaluate the muscular efficiency in healthy and COPD subjects.

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Mesquita, J., Fiz, J.A., Solà, J., Morera, J., Jané, R., (2011). Normal non-regular snores as a tool for screening SAHS severity Engineering in Medicine and Biology Society 33rd Annual International Conference of the IEEE EMBS , IEEE (Boston, USA) Engineering in Medicine and Biology Society, 3197-3200

Snoring is one of the earliest and most consistent sign of upper airway obstruction leading to Sleep Apnea-Hypopnea Syndrome (SAHS). Several studies on post-apneic snores, snores that are emitted immediately after an apnea, have already proven that this type of snoring is most distinct from that of normal snoring. However, post-apneic snores are more unlikely and sometimes even inexistent in simple snorers and mild SAHS subjects. In this work we address that issue by proposing the study of normal non-regular snores. They correspond to successive snores that are separated by normal breathing cycles. The results obtained establish the feasibility of acoustic parameters of normal non-regular snores as a promising tool for a prompt screening of SAHS severity.

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Jané, R., Fiz, J.A., Solà, J., Mesquita, J., Morera, J., (2011). Snoring analysis for the screening of sleep apnea hypopnea syndrome with a single-channel device developed using polysomnographic and snoring databases Engineering in Medicine and Biology Society 33rd Annual International Conference of the IEEE EMBS , IEEE (Boston, USA) Engineering in Medicine and Biology Society, 8331-8333

Several studies have shown differences in acoustic snoring characteristics between patients with Sleep Apnea-Hypopnea Syndrome (SAHS) and simple snorers. Usually a few manually isolated snores are analyzed, with an emphasis on postapneic snores in SAHS patients. Automatic analysis of snores can provide objective information over a longer period of sleep. Although some snore detection methods have recently been proposed, they have not yet been applied to full-night analysis devices for screening purposes. We used a new automatic snoring detection and analysis system to monitor snoring during full-night studies to assess whether the acoustic characteristics of snores differ in relation to the Apnea-Hypopnea Index (AHI) and to classify snoring subjects according to their AHI. A complete procedure for device development was designed, using databases with polysomnography (PSG) and snoring signals. This included annotation of many types of episodes by an expert physician: snores, inspiration and exhalation breath sounds, speech and noise artifacts, The AHI of each subject was estimated with classical PSG analysis, as a gold standard. The system was able to correctly classify 77% of subjects in 4 severity levels, based on snoring analysis and sound-based apnea detection. The sensitivity and specificity of the system, to identify healthy subjects from pathologic patients (mild to severe SAHS), were 83% and 100%, respectively. Besides, the Apnea Index (AI) obtained with the system correlated with the obtained by PSG or Respiratory Polygraphy (RP) (r=0.87, p<0.05).

Keywords: -----


Garde, A., Sörnmo, L., Jané, R., Giraldo, B., (2010). Breathing pattern characterization in chronic heart failure patients using the respiratory flow signal Annals of Biomedical Engineering 38, (12), 3572-3580

This study proposes a method for the characterization of respiratory patterns in chronic heart failure (CHF) patients with periodic breathing (PB) and nonperiodic breathing (nPB), using the flow signal. Autoregressive modeling of the envelope of the respiratory flow signal is the starting point for the pattern characterization. Spectral parameters extracted from the discriminant frequency band (DB) are used to characterize the respiratory patterns. For each classification problem, the most discriminant parameter subset is selected using the leave-one-out cross-validation technique. The power in the right DB provides an accuracy of 84.6% when classifying PB vs. nPB patterns in CHF patients, whereas the power of the DB provides an accuracy of 85.5% when classifying the whole group of CHF patients vs. healthy subjects, and 85.2% when classifying nPB patients vs. healthy subjects.

Keywords: Chronic heart failure, AR modeling, Respiratory pattern, Discriminant band, Periodic and nonperiodic breathing


Fiz, J. A., Jané, R., Solà, J., Abad, J., Garcia, M. A., Morera, J., (2010). Continuous analysis and monitoring of snores and their relationship to the apnea-hypopnea index Laryngoscope 120, (4), 854-862

Objectives/Hypothesis: We used a new automatic snoring detection and analysis system to monitor snoring during full-night polysomnography to assess whether the acoustic characteristics of snores differ in relation to the apnea-hypopnea index (AHI) and to classify subjects according to their AHI Study Design: Individual Case-Control Study. Methods: Thirty-seven snorers (12 females and 25 males, ages 40-65 years; body mass index (BMI), 29.65 +/- 4.7 kg/m(2)) participated Subjects were divided into three groups: G1 (AHI <5), G2 (AHI >= 5, <15) and G3 (AHI >= 15) Snore and breathing sounds were : recorded with a tracheal microphone throughout 6 hours of nighttime polysomnography The snoring episodes identified were automatically and continuously analyzed with a previously trained 2-layer feed-forward neural network. Snore number, average intensity, and power spectral density parameters were computed for every subject and compared among AHI groups. Subjects were classified using different AHI thresholds by means of a logistic regression model. Results: There were significant differences in supine position between G1 and G3 in sound intensity, number of snores; standard deviation of the spectrum, power ratio in bands 0-500, 100-500, and 0-800 Hz, and the symmetry coefficient (P < .03); Patients were classified with thresholds AHI = 5 and AHI = 15 with a sensitivity (specificity) of 87% (71%) and 80% (90%), respectively. Conclusions: A new system for automatic monitoring and analysis of snores during the night is presented. Sound intensity and several snore frequency parameters allow differentiation of snorers according to obstructive sleep apnea syndrome severity (OSAS). Automatic snore intensity and frequency monitoring and analysis could be a promising tool for screening OSAS patients, significantly improving the managing of this pathology.

Keywords: Breathing sounds, Signal interpretation, Sleep apnea syndromes, Snoring


Garde, A., Sörnmo, L., Jané, R., Giraldo, B. F., (2010). Correntropy-based spectral characterization of respiratory patterns in patients with chronic heart failure IEEE Transactions on Biomedical Engineering 57, (8), 1964-1972

A correntropy-based technique is proposed for the characterization and classification of respiratory flow signals in chronic heart failure (CHF) patients with periodic or nonperiodic breathing (PB or nPB, respectively) and healthy subjects. The correntropy is a recently introduced, generalized correlation measure whose properties lend themselves to the definition of a correntropy-based spectral density (CSD). Using this technique, both respiratory and modulation frequencies can be reliably detected at their original positions in the spectrum without prior demodulation of the flow signal. Single-parameter classification of respiratory patterns is investigated for three different parameters extracted from the respiratory and modulation frequency bands of the CSD, and one parameter defined by the correntropy mean. The results show that the ratio between the powers in the modulation and respiratory frequency bands provides the best result when classifying CHF patients with either PB or nPB, yielding an accuracy of 88.9%. The correntropy mean offers excellent performance when classifying CHF patients versus healthy subjects, yielding an accuracy of 95.2% and discriminating nPB patients from healthy subjects with an accuracy of 94.4%.

Keywords: Autoregressive (AR) modeling, Chronic heart failure (CHF), Correntropy spectral density (CSD), Linear classification, Periodic breathing (PB)


Morgenstern, C., Schwaibold, M., Randerath, W. J., Bolz, A., Jané, R., (2010). An invasive and a noninvasive approach for the automatic differentiation of obstructive and central hypopneas IEEE Transactions on Biomedical Engineering 57, (8), 1927-1936

The automatic differentiation of obstructive and central respiratory events is a major challenge in the diagnosis of sleep-disordered breathing. Esophageal pressure (Pes) measurement is the gold-standard method to identify these events. This study presents a new classifier that automatically differentiates obstructive and central hypopneas with the Pes signal and a new approach for an automatic noninvasive classifier with nasal airflow. An overall of 28 patients underwent night polysomnography with Pes recording, and a total of 769 hypopneas were manually scored by human experts to create a gold-standard annotation set. Features were automatically extracted from the Pes signal to train and test the classifiers (discriminant analysis, support vector machines, and adaboost). After a significantly (p < 0.01) higher incidence of inspiratory flow limitation episodes in obstructive hypopneas was objectively, invasively assessed compared to central hypopneas, the feasibility of an automatic noninvasive classifier with features extracted from the airflow signal was demonstrated. The automatic invasive classifier achieved a mean sensitivity, specificity, and accuracy of 0.90 after a 100-fold cross validation. The automatic noninvasive feasibility study obtained similar hypopnea differentiation results as a manual noninvasive classification algorithm. Hence, both systems seem promising for the automatic differentiation of obstructive and central hypopneas.

Keywords: Automatic differentiation, Central hypopnea, Esophageal pressure (Pes), Inspiratory flow limitation (IFL), Noninvasive classification, Obstructive hypopnea


Correa, R., Laciar, E., Arini, P., Jané, R., (2010). Analysis of QRS loop in the Vectorcardiogram of patients with Chagas' disease Engineering in Medicine and Biology Society (EMBC) 32nd Annual International Conference of the IEEE , IEEE (Buenos Aires, Argentina) , 2561-2564

In the present work, we have studied the QRS loop in the Vectorcardiogram (VCG) of 95 chronic chagasic patients classified in different groups (I, II and III) according to their degree of myocardial damage. For comparison, the VCGs of 11 healthy subjects used as control group (Group O) were also examined. The QRS loop was obtained for each patient from the XYZ orthogonal leads of their High-Resolution Electrocardiogram (HRECG) records. In order to analyze the variations of QRS loop in each detected beat, it has been proposed in this study the following vectorcardiographic parameters a) Maximum magnitude of the cardiac depolarization vector, b) Volume, c) Area of QRS loop, d) Ratio between the Area and Perimeter, e) Ratio between the major and minor axes of the QRS loop and f) QRS loop Energy. It has been found that one or more indexes exhibited statistical differences (p<0.05) between groups 0-II, O-III, I-II, I-III and II-III. We concluded that the proposed method could be use as complementary diagnosis technique to evaluate the degree of myocardial damage in chronic chagasic patients.

Keywords: Practical, Experimental/ bioelectric phenomena, Diseases, Electrocardiography, Medical signal, Processing/ QRS loop, Vectorcardiogram, Cardiac depolarization vector, Myocardial damage, Chagas disease, Complementary diagnosis technique, High-resolution electrocardiogram


Morgenstern, C., Schwaibold, M., Randerath, W., Bolz, A., Jané, R., (2010). Automatic non-invasive differentiation of obstructive and central hypopneas with nasal airflow compared to esophageal pressure Engineering in Medicine and Biology Society (EMBC) 32nd Annual International Conference of the IEEE , IEEE (Buenos Aires, Argentina) , 6142-6145

The differentiation of obstructive and central respiratory events is a major challenge in the diagnosis of sleep disordered breathing. Esophageal pressure (Pes) measurement is the gold-standard method to identify these events but its invasiveness deters its usage in clinical routine. Flattening patterns appear in the airflow signal during episodes of inspiratory flow limitation (IFL) and have been shown with invasive techniques to be useful to differentiate between central and obstructive hypopneas. In this study we present a new method for the automatic non-invasive differentiation of obstructive and central hypopneas solely with nasal airflow. An overall of 36 patients underwent full night polysomnography with systematic Pes recording and a total of 1069 hypopneas were manually scored by human experts to create a gold-standard annotation set. Features were automatically extracted from the nasal airflow signal to train and test our automatic classifier (Discriminant Analysis). Flattening patterns were non-invasively assessed in the airflow signal using spectral and time analysis. The automatic non-invasive classifier obtained a sensitivity of 0.71 and an accuracy of 0.69, similar to the results obtained with a manual non-invasive classification algorithm. Hence, flattening airflow patterns seem promising for the non-invasive differentiation of obstructive and central hypopneas.

Keywords: Practical, Experimental/ biomedical measurement, Feature extraction, Flow measurement, Medical disorders, Medical signal processing, Patient diagnosis, Pneumodynamics, Pressure measurement, Signal classification, Sleep, Spectral analysis/ automatic noninvasive differentiation, Obstructive hypopnea, Central hypopnea, Inspiratory flow limitation, Nasal airflow, Esophageal pressure, Polysomnography, Feature extraction, Discriminant analysis, Spectral analysis


Garde, A., Sörnmo, L., Jané, R., Giraldo, B. F., (2010). Correntropy-based nonlinearity test applied to patients with chronic heart failure Engineering in Medicine and Biology Society (EMBC) 32nd Annual International Conference of the IEEE , IEEE (Buenos Aires, Argentina) , 2399-2402

In this study we propose the correntropy function as a discriminative measure for detecting nonlinearities in the respiratory pattern of chronic heart failure (CHF) patients with periodic or nonperiodic breathing pattern (PB or nPB, respectively). The complexity seems to be reduced in CHF patients with higher risk level. Correntropy reflects information on both, statistical distribution and temporal structure of the underlying dataset. It is a suitable measure due to its capability to preserve nonlinear information. The null hypothesis considered is that the analyzed data is generated by a Gaussian linear stochastic process. Correntropy is used in a statistical test to reject the null hypothesis through surrogate data methods. Various parameters, derived from the correntropy and correntropy spectral density (CSD) to characterize the respiratory pattern, presented no significant differences when extracted from the iteratively refined amplitude adjusted Fourier transform (IAAFT) surrogate data. The ratio between the powers in the modulation and respiratory frequency bands R was significantly different in nPB patients, but not in PB patients, which reflects a higher presence of nonlinearities in nPB patients than in PB patients.

Keywords: Practical, Theoretical or Mathematical, Experimental/cardiology diseases, Fourier transforms, Medical signal processing, Pattern classification, Pneumodynamics, Spectral analysis, Statistical analysis, Stochastic processes/ correntropy based nonlinearity test, Chronic heart failure, Correntropy function, Respiratory pattern nonlinearities, CHF patients, Nonperiodic breathing pattern, Dataset statistical distribution, Dataset temporal structure, Nonlinear information, Null hypothesis, Gaussian linear stochastic process, Statistical test, Correntropy spectral density, Iteratively refined amplitude adjusted Fourier transform, Surrogate data, Periodic breathing pattern


Sarlabous, L., Torres, A., Fiz, J. A., Gea, J., Marti nez-Llorens, J. M., Morera, J., Jané, R., (2010). Interpretation of the approximate entropy using fixed tolerance values as a measure of amplitude variations in biomedical signals Engineering in Medicine and Biology Society (EMBC) 32nd Annual International Conference of the IEEE , IEEE (Buenos Aires, Argentina) , 5967-5970

A new method for the quantification of amplitude variations in biomedical signals through moving approximate entropy is presented. Unlike the usual method to calculate the approximate entropy (ApEn), in which the tolerance value (r) varies based on the standard deviation of each moving window, in this work ApEn has been computed using a fixed value of r. We called this method, moving approximate entropy with fixed tolerance values: ApEn/sub f/. The obtained results indicate that ApEn/sub f/ allows determining amplitude variations in biomedical data series. These amplitude variations are better determined when intermediate values of tolerance are used. The study performed in diaphragmatic mechanomyographic signals shows that the ApEn/sub f/ curve is more correlated with the respiratory effort than the standard RMS amplitude parameter. Furthermore, it has been observed that the ApEn/sub f/ parameter is less affected by the existence of impulsive, sinusoidal, constant and Gaussian noises in comparison with the RMS amplitude parameter.

Keywords: Practical, Theoretical or Mathematical/ biomechanics, Entropy, Gaussian noise, Medical signal processing, Muscle, Random processes/ approximate entropy interpretation, Fixed tolerance values, Diaphragmatic mechanomyographic signals, ApEnf curve, Respiratory effort, Gaussian noises


Leder, R. S., Schlotthauer, G., Penzel, T., Jané, R., (2010). The natural history of the sleep and respiratory engineering track at EMBC 1988 to 2010 Engineering in Medicine and Biology Society (EMBC) 32nd Annual International Conference of the IEEE , IEEE (Buenos Aires, Argentina) , 288-291

Sleep science and respiratory engineering as medical subspecialties and research areas grew up side-by-side with biomedical engineering. The formation of EMBS in the 1950's and the discovery of REM sleep in the 1950's led to parallel development and interaction of sleep and biomedical engineering in diagnostics and therapeutics.

Keywords: Practical/ biomedical equipment, Biomedical measurement, Patient diagnosis, Patient monitoring, Patient treatment, Pneumodynamics, Sleep/ sleep engineering, Respiratory engineering, Automatic sleep analysis, Automatic sleep interpretation systems, Breathing, Biomedical, Engineering, Diagnostics, Therapeutics, REM sleep, Portable, Measurement, Ambulatory measurement, Monitoring


Torres, A., Sarlabous, L., Fiz, j A., Gea, J., Marti nez-Llorens, J. M., Morera, J., Jané, R., (2010). Noninvasive measurement of inspiratory muscle performance by means of diaphragm muscle mechanomyographic signals in COPD patients during an incremental load respiratory test Engineering in Medicine and Biology Society (EMBC) 32nd Annual International Conference of the IEEE , IEEE (Buenos Aires, Argentina) , 2493-2496

The study of mechanomyographic (MMG) signals of respiratory muscles is a promising noninvasive technique in order to evaluate the respiratory muscular effort and efficiency. In this work, the MMG signal of the diaphragm muscle it is evaluated in order to assess the respiratory muscular function in Chronic Obstructive Pulmonary Disease (COPD) patients. The MMG signals from left and right hemidiaphragm were acquired using two capacitive accelerometers placed on both left and right sides of the costal wall surface. The MMG signals and the inspiratory pressure signal were acquired while the COPD patients carried out an inspiratory load respiratory test. The population of study is composed of a group of 6 patients with severe COPD (FEV1>50% ref and DLCO<50% ref). We have found high positive correlation coefficients between the maximum inspiratory pressure (IPmax) developed in a respiratory cycle and different amplitude parameters of both left and right MMG signals (RMS, left: 0.68+/-0.11 - right: 0.69+/-0.12; Re nyi entropy, left: - 0.73+/-0.10 - right: 0.77+/-0.08; Multistate Lempel-Ziv, left: 0.73+/-0.17 - right: 0.74+/-0.08), and negative correlation between the Pmax and the maximum frequency of the MMG signal spectrum (left: -0.39+/-0.19 - right: -0.65+/-0.09). Furthermore, we found that the slope of the evolution of the MMG amplitude parameters, as the load increases during the respiratory test, has positive correlation with the %FEV1/FVC pulmonary function test parameter of the six COPD patients analyzed (RMS, left: 0.38 - right: 0.41; Re nyi entropy, left: 0.45 - right: 0.63; Multistate Lempel-Ziv, left: 0.39 - right: 0.64). These results suggest that the information provided by MMG signals could be used in order to evaluate the respiratory effort and the muscular efficiency in COPD patients.

Keywords: Accelerometers, Biomechanics, Biomedical measurement, Diseases, Medical signal processing, Muscle


Mesquita, J., Fiz, J. A., Solà, J., Morera, J., Jané, R., (2010). Regular and non regular snore features as markers of SAHS Engineering in Medicine and Biology Society (EMBC) 32nd Annual International Conference of the IEEE , IEEE (Buenos Aires, Argentina) , 6138-6141

Sleep Apnea-Hypopnea Syndrome (SAHS) diagnosis is still done with an overnight multi-channel polysomnography. Several efforts are being made to study profoundly the snore mechanism and discover how it can provide an opportunity to diagnose the disease. This work introduces the concept of regular snores, defined as the ones produced in consecutive respiratory cycles, since they are produced in a regular way, without interruptions. We applied 2 thresholds (TH/sub adaptive/ and TH/sub median/) to the time interval between successive snores of 34 subjects in order to select regular snores from the whole all-night snore sequence. Afterwards, we studied the effectiveness that parameters, such as time interval between successive snores and the mean intensity of snores, have on distinguishing between different levels of SAHS severity (AHI (Apnea-Hypopnea Index)<5h/sup -1/, AHI<10 h/sup -1/, AHI<15h/sup -1/, AHI<30h/sup -1/). Results showed that TH/sub adaptive/ outperformed TH/sub median/ on selecting regular snores. Moreover, the outcome achieved with non-regular snores intensity features suggests that these carry key information on SAHS severity.

Keywords: Practical, Experimental/ acoustic signal processing, Bioacoustics, Biomedical measurement, Diseases, Feature extraction, Medical signal processing, Patient diagnosis, Pneumodynamics, Sleep/ nonregular snore features, SAHS markers, Sleep apnea hypopnea syndrome, Overnight multichannel polysomnography, Snore mechanism


Fiz, J. A., Morera Prat, J., Jané, R., (2009). Treatment of patients with simple snoring Archivos de Bronconeumología 45, (10), 508-515

Management of snoring is part of the treatment offered to patients with obstructive sleep apnea syndrome. In patients who do not have this syndrome, however, snoring should be treated according to the severity of the condition. General or specific therapeutic measures should be applied to snorers that have concomitant cardiovascular disease or unrefreshing sleep and in cases in which an individual's snoring disturbs his/her partner's sleep. The present review examines the treatments currently available for snorers and the current state of knowledge regarding each option. It will also focus on the possible indications of these treatments and evaluate their effectiveness.

Keywords: Simple snoring, Treatment, General measures, Surgery


Morgenstern, C., Schwaibold, M., Randerath, W. J., Bolz, A., Jané, R., (2009). Assessment of changes in upper airway obstruction by automatic identification of inspiratory flow limitation during sleep IEEE Transactions on Biomedical Engineering 56, (8), 2006-2015

New techniques for automatic invasive and noninvasive identification of inspiratory flow limitation (IFL) are presented. Data were collected from 11 patients with full nocturnal polysomnography and gold-standard esophageal pressure (Pes) measurement. A total of 38,782 breaths were extracted and automatically analyzed. An exponential model is proposed to reproduce the relationship between Pes and airflow of an inspiration and achieve an objective assessment of changes in upper airway obstruction. The characterization performance of the model is appraised with three evaluation parameters: mean-squared error when estimating resistance at peak pressure, coefficient of determination, and assessment of IFL episodes. The model's results are compared to the two best-performing models in the literature. The obtained gold-standard IFL annotations were then employed to train, test, and validate a new noninvasive automatic IFL classification system. Discriminant analysis, support vector machines, and Adaboost algorithms were employed to objectively classify breaths noninvasively with features extracted from the time and frequency domains of the breaths' flowpatterns. The results indicated that the exponential model characterizes IFL and subtle relative changes in upper airway obstruction with the highest accuracy and objectivity. The new noninvasive automatic classification system also succeeded in identifying IFL episodes, achieving a sensitivity of 0.87 and a specificity of 0.85.

Keywords: Esophageal pressure, Exponential model, Inspiratory flow limitation, Noninvasive, Classification, Upper airway obstruction


Correa, R., Laciar, E., Arini, P., Jané, R., (2009). Analysis of QRS loop changes in the beat-to-beat vectocardiogram of ischemic patients undergoing PTCA Engineering in Medicine and Biology Society (EMBC) 31st Annual International Conference of the IEEE , IEEE (Minneapolis, USA) , 1750-1753

In the present work, we have studied dynamic changes of QRS loop in the Vectocardiogram (VCG) of 80 patients that underwent Percutaneous Transluminal Coronary Angioplasty (PTCA). The VCG was obtained for each patient using the XYZ orthogonal leads of their electrocardiographic (ECG) records acquired before, during and after PTCA procedure. In order to analyze the variations of VCG, it has been proposed in this study the following parameters a) Maximum module of the cardiac depolarization vector, b) Volume, c) and Area of vectocardiographic loop corresponding to the QRS complex of each beat, d) Maximum distance between Centroid and the Loop, e) Angle between the XY plane and the Optimum Plane, f) Relation between the Area and Perimeter. The results obtained indicate that the parameters proposed show significant statistics differences (p-value<0.05) before, during (with some exceptions at the first minute of balloon inflation) and after PTCA. We conclude that the variations observed in the proposed parameters correctly represent not only the morphological changes in the depolarization VCG but also they reflect the modifications in the levels of cardiac ischemia induced by PTCA.

Keywords: -----


Morgenstern, C., Schwaibold, M., Randerath, W., Bolz, A., Jané, R., (2009). Automatic differentiation of obstructive and central hypopneas with esophageal pressure measurement during sleep Engineering in Medicine and Biology Society (EMBC) 31st Annual International Conference of the IEEE , IEEE (Minneapolis, USA) 2009, 7102-7105

The differentiation between obstructive and central respiratory events is one of the most recurrent tasks in the diagnosis of sleep disordered breathing. Esophageal pressure measurement is the gold-standard method to assess respiratory effort and identify these events. But as its invasiveness discourages its use in clinical routine, non-invasisve systems have been proposed for differentiation. However, their adoption has been slow due to their limited clinical validation, as the creation of manual, gold-standard validation sets by human experts is a cumbersome procedure. In this study, a new system is proposed for an objective automatic, gold-standard differentiation between obstructive and central hypopneas with the esophageal pressure signal. First, an overall of 356 hypopneas of 16 patients were manually scored by a human expert to create a gold-standard validation set. Then, features were extracted from each hypopnea to train and test classifiers (Discriminant Analysis, Support Vector Machines and adaboost classifiers) to differentiate between central and obstructive hypopneas with the gold-standard esophageal pressure signal. The automatic differentiation system achieved promising results, with a sensitivity of 0.88, a specificity of 0.93 and an accuracy of 0.90. Hence, this system seems promising for an automatic, gold-standard differentiation between obstructive and central hypopneas.

Keywords: -----


Garde, A., Sornmo, L., Jané, R., Giraldo, B. F., (2009). Correntropy-based analysis of respiratory patterns in patients with chronic heart failure Engineering in Medicine and Biology Society (EMBC) 31st Annual International Conference of the IEEE , IEEE (Minneapolis, USA) , 4687-4690

A correntropy-based technique is proposed for the analysis and characterization of respiratory flow signals in chronic heart failure (CHF) patients with both periodic and nonperiodic breathing (PB and nPB), and healthy subjects. Correntropy is a novel similarity measure which provides information on temporal structure and statistical distribution simultaneously. Its properties lend itself to the definition of the correntropy spectral density (CSD). An interesting result from CSD-based spectral analysis is that both the respiratory frequency and modulation frequency can be detected at their original positions in the spectrum without prior demodulation of the flow signal. The respiratory pattern is characterized by a number of spectral parameters extracted from the respiratory and modulation frequency bands. The results show that the power of the modulation frequency band offers excellent performance when classifying CHF patients versus healthy subjects, with an accuracy of 95.3%, and nPB patients versus healthy subjects with 90.7%. The ratio between the power in the modulation and respiration frequency bands provides the best results classifying CHF patients into PB and nPB, with an accuracy of 88.9%.

Keywords: -----


Sarlabous, L., Torres, A., Fiz, J. A., Gea, J., Martinez-Llorens, J. M., Jané, R., (2009). Evaluation of the respiratory muscular function by means of diaphragmatic mechanomyographic signals in COPD patients Engineering in Medicine and Biology Society (EMBC) 31st Annual International Conference of the IEEE , IEEE (Minneapolis, USA) , 3925-3928

The study of mechanomyographic (MMG) signals of respiratory muscles is a promising technique in order to evaluate the respiratory muscular effort. In this work MMG signals from left and right hemidiaphragm (MMGl and MMGr, respectively) acquired during a respiratory protocol have been analyzed. The acquisition of both MMG signals was carried out by means of two capacitive accelerometers placed on both left and right sides of the costal wall. The signals were recorded in a group of six patients with Chronic Obstructive Pulmonary Disease (COPD). It has been observed that with the increase of inspiratory pressure it takes place an increase of the amplitude and a displacement toward low frequencies in both left and right MMG signals. Furthermore, it has been seen that the increase of amplitude and the decrease of frequency in MMG signals are more pronounced in severe COPD patients. This behaviour is similar for both MMGl and MMGr signals. Results suggest that the use of MMG signals could be potentially useful for the evaluation of the respiratory muscular function in COPD patients.

Keywords: -----


Sarlabous, L., Torres, A., Fiz, J. A., Gea, J., Galdiz, J. B., Jané, R., (2009). Multistate Lempel-Ziv (MLZ) index interpretation as a measure of amplitude and complexity changes Engineering in Medicine and Biology Society (EMBC) 31st Annual International Conference of the IEEE , IEEE (Minneapolis, USA) , 4375-4378

The Lempel-Ziv complexity (LZ) has been widely used to evaluate the randomness of finite sequences. In general, the LZ complexity has been used to determine the complexity grade present in biomedical signals. The LZ complexity is not able to discern between signals with different amplitude variations and similar random components. On the other hand, amplitude parameters, as the root mean square (RMS), are not able to discern between signals with similar power distributions and different random components. In this work, we present a novel method to quantify amplitude and complexity variations in biomedical signals by means of the computation of the LZ coefficient using more than two quantification states, and with thresholds fixed and independent of the dynamic range or standard deviation of the analyzed signal: the Multistate Lempel-Ziv (MLZ) index. Our results indicate that MLZ index with few quantification levels only evaluate the complexity changes of the signal, with high number of levels, the amplitude variations, and with an intermediate number of levels informs about both amplitude and complexity variations. The study performed in diaphragmatic mechanomyographic signals shows that the amplitude variations of this signal are more correlated with the respiratory effort than the complexity variations. Furthermore, it has been observed that the MLZ index with high number of levels practically is not affected by the existence of impulsive, sinusoidal, constant and Gaussian noises compared with the RMS amplitude parameter.

Keywords: -----


Correa, L. S., Laciar, E., Mut, V., Torres, A., Jané, R., (2009). Sleep apnea detection based on spectral analysis of three ECG - Derived respiratory signals Engineering in Medicine and Biology Society (EMBC) 31st Annual International Conference of the IEEE , IEEE (Minneapolis, USA) , 4723-4726

An apnea detection method based on spectral analysis was used to assess the performance of three ECG derived respiratory (EDR) signals. They were obtained on R wave area (EDR1), heart rate variability (EDR2) and R peak amplitude (EDR3) of ECG record in 8 patients with sleep apnea syndrome. The mean, central, peak and first quartile frequencies were computed from the spectrum every 1 min for each EDR. For each frequency parameter a threshold-based decision was carried out on every 1 min segment of the three EDR, classifying it as 'apnea' when its frequency value was below a determined threshold or as 'not apnea' in other cases. Results indicated that EDR1, based on R wave area has better performance in detecting apnea episodes with values of specificity (Sp) and sensitivity (Se) near 90%; EDR2 showed similar Sp but lower Se (78%); whereas EDR3 based on R peak amplitude did not detect appropriately the apneas episodes reaching Sp and Se values near 60%.

Keywords: -----


Correa, R., Arini, P. D., Laciar, E., Laguna, P., Jané, R., (2009). Study of morphological parameters of QRS loop using singular value decomposition during ischemia induced by coronary angioplasty 36th Annual Computers in Cardiology Conference (CinC) 36th Annual Computers in Cardiology Conference (CinC) , IEEE (Park City, USA) 36, 693-696

In this work we studied dynamic changes of ventricular depolarization loop evolution based on the Singular Value Decomposition (SVD) technique of 80 patients that underwent Percutaneous Transluminal Coronary Angioplasty (PTCA). The 8 independent ECG leads are subjected to SVD technique and are used to construct a new representation of QRS-SVD loops. In order to analyze the variations of QRS-SVD loops before, during and after PTCA, we proposed the following parameters: Maximum Module of the Depolarization Vector, Planar Area, Maximum Distance between Centroid and the Loop, Angle between the S1S2 plane and the Optimum Plane and Ratio between the Area and Perimeter. The results indicated that the parameters proposed show significant statistics differences during and after PTCA procedure vs. control. We concluded that the variations in the QRS-SVD loop before, during and after PTCA at ventricular depolarization can be described correctly through the proposed parameters.

Keywords: -----


Garde, A., Giraldo, B. F., Jané, R., Sornmo, L., (2009). Time-varying respiratory pattern characterization in chronic heart failure patients and healthy subjects Engineering in Medicine and Biology Society (EMBC) 31st Annual International Conference of the IEEE , IEEE (Minneapolis, USA) , 4007-4010

Patients with chronic heart failure (CHF) with periodic breathing (PB) and Cheyne-Stokes respiration (CSR) tend to exhibit higher mortality and poor prognosis. This study proposes the characterization of respiratory patterns in CHF patients and healthy subjects using the envelope of the respiratory flow signal, and autoregressive (AR) time-frequency analysis. In time-varying respiratory patterns, the statistical distribution of the AR coefficients, pole locations, and the spectral parameters that characterize the discriminant band are evaluated to identify typical breathing patterns. In order to evaluate the accuracy of this characterization, a feature selection process followed by linear discriminant analysis is applied. 26 CHF patients (8 patients with PB pattern and 18 with non-periodic breathing pattern (nPB)) are studied. The results show an accuracy of 83.9% with the mean of the main pole magnitude and the mean of the total power, when classifying CHF patients versus healthy subjects, and 83.3% for nPB versus healthy subjects. The best result when classifying CHF patients into PB and nPB was an accuracy of 88.9%, using the coefficient of variation of the first AR coefficient and the mean of the total power.

Keywords: -----


Morgenstern, C., Jané, R., Schwaibold, M., Randerath, W., (2008). Automatic classification of inspiratory flow limitation assessed non-invasively during sleep IEEE Engineering in Medicine and Biology Society Conference Proceedings 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (ed. IEEE), IEEE (Vancouver, Canada) 1-8, 1132-1135

Detection of inspiratory flow limitation (IFL) is being recognized of increasing importance in order to diagnose pathologies related to sleep disordered breathing. Currently, IFL is usually identified with the help of invasive esophageal pressure measurement, still considered the gold-standard reference to assess respiratory effort. But the invasiveness of esophageal pressure measurement and its impact on sleep discourages its use in clinical routine. In this study, a new non-invasive automatic system is proposed for objective IFL classification. First, an automatic annotation system for IFL based on pressure/flow relationship was developed. Then, classifiers (Support Vector Machines and adaboost classifiers) were trained with these gold-standard references in order to objectively classify breaths non-invasively, solely based on the breaths' flow contours. The new non-invasive automatic classification system seems to be promising, as it achieved a sensitivity of 0.92 and a specificity of 0.89, outperforming prior classification results obtained by human experts.

Keywords: Upper airway-resistance


Morgenstern, C., Jané, R., Schwaibold, M., Randerath, W., (2008). Characterization of inspiratory flow limitation during sleep with an exponential model IEEE Engineering in Medicine and Biology Society Conference Proceedings 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (ed. IEEE), IEEE (Vancouver, Canada) 1-8, 2439-2442

Assessing incidence and severity of inspiratory flow limitation (TFL) is of importance for patients suffering of sleep disordered breathing (SDB) in order to diagnose a spectrum of different pathologies. In this study a new exponential equation is proposed to characterize the pressure/flow relationship of IFL and non-TFL breaths. Classical and alternative criteria are applied on the model's predictions in order to assess TFL, and its outcome is compared to the outcome of other models. The newly proposed exponential model seems to be promising, as it outperforms other models by achieving a global average sensitivity of 93% and specificity of 91%, and the lowest mean square error when estimating resistance at peak pressure. Additional statistical tests were performed on the exponential model's coefficients in order to determine if a coefficient based classification is possible.

Keywords: Resistance


Garde, A., Giraldo, B. F., Jané, R., Diaz, I., Herrera, S., Benito, S., Domingo, M., Bayes-Genis, A., (2008). Characterization of periodic and non-periodic breathing pattern in chronic heart failure patients IEEE Engineering in Medicine and Biology Society Conference Proceedings 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (ed. IEEE), IEEE (Vancouver, Canada) 1-8, 3227-3230

Periodic breathing (PB) has a high prevalence in chronic heart failure (CHF) patients with mild to moderate symptoms and poor ventricular function. This work proposes the analysis and characterization of the respiratory pattern to identify periodic breathing pattern (PB) and non-periodic breathing pattern (nPB) through the respiratory flow signal. The respiratory pattern analysis is based on the extraction and the study of the flow envelope signal. The flow envelope signal is modelled by an autoregressive model (AR) whose coefficients would characterize the respiratory pattern of each group. The goodness of the characterization is evaluated through a linear and non linear classifier applied to the AR coefficients. An adaptive feature selection is used before the linear and non linear classification, employing leave-one-out cross validation technique. With linear classification the percentage of well classified patients (8 PB and 18 nPB patients) is 84.6% using the statistically significant coefficients whereas with non linear classification, the percentage of well classified patients increase to more than 92% applying the best subset of coefficients extracted by a forward selection algorithm.

Keywords: Clinical-implications, Sleep


Solà, J., Jané, R., Fiz, J. A., Morera, J., (2008). Formant frequencies of normal breath sounds of snorers may indicate the risk of obstructive sleep apnea syndrome IEEE Engineering in Medicine and Biology Society Conference Proceedings 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (ed. IEEE), IEEE (Vancouver, Canada) 1-8, 3500-3503

Several differences between the airway of normal subjects and those with OSAS are well known. The characteristics of the upper airway may be indirectly studied through the formant frequencies of breathing sounds. In this work we analyze the formants of inspiration and exhalation sounds in snoring subjects with and without OSAS. Formant frequencies of inspiration and exhalation appear in the same bands as snores. Formant F1 is significantly lower in inspiration episodes of OSAS patients (p=0.008) with a decreasing tendency as the AHI increases (r=0.705). In addition, this formant has a significantly higher variability SF1 in pathological subjects, for both inspiration (p=0.022) and exhalation (p=0.038) episodes, as was previously found in snores. A higher variability of formant frequencies seems to be an indicator of the presence of OSAS. The proposed technique could allow the identification of OSAS patients from normal breathing alone.

Keywords: Upper airway


Correa, L. S., Laciar, E., Torres, A., Jané, R., (2008). Performance evaluation of three methods for respiratory signal estimation from the electrocardiogram IEEE Engineering in Medicine and Biology Society Conference Proceedings 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (ed. IEEE), IEEE (Vancouver, Canada) 1-8, 4760-4763

A comparative study of three methods for estimating respiratory signal through electrocardiogram (ECG) was carried out. The three methods analyzed were based on R wave area, R peak amplitude and heart rate variability (HRV). For each method, cross-correlation coefficient and spectral coherence in a range of frequencies up to 0.5 Hz were computed between the ECG derived respiratory signals (EDR) and the three real respiratory signals: oronasal, and two inductance plethysmographies recordings (chest and abdominal). Results indicate that EDR methods based on R wave area and HRV are better correlated and show a wider spectral coherence with real respiratory signals than the other EDR method based on R peak amplitude.

Keywords: Obstructive sleep-apnea


Torres, A., Fiz, J. A., Jané, R., Laciar, E., Galdiz, J. B., Gea, J., Morera, J., (2008). Renyi entropy and Lempel-Ziv complexity of mechanomyographic recordings of diaphragm muscle as indexes of respiratory effort IEEE Engineering in Medicine and Biology Society Conference Proceedings 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (ed. IEEE), IEEE (Vancouver, Canada) 1-8, 2112-2115

The study of the mechanomyographic (MMG) signals of respiratory muscles is a promising technique in order to evaluate the respiratory muscles effort. A new approach for quantifying the relationship between respiratory MMG signals and respiratory effort is presented by analyzing the spatiotemporal patterns in the MMG signal using two non-linear methods: Renyi entropy and Lempel-Ziv (LZ) complexity analysis. Both methods are well suited to the analysis of non-stationary biomedical signals of short length. In this study, MMG signals of the diaphragm muscle acquired by means of a capacitive accelerometer applied on the costal wall were analyzed. The method was tested on an animal model (dogs), and the diaphragmatic MMG signal was recorded continuously while two non anesthetized mongrel dogs performed a spontaneous ventilation protocol with an incremental inspiratory load. The performance in discriminating high and low respiratory effort levels with these two methods was analyzed with the evaluation of the Pearson correlation coefficient between the MMG parameters and respiratory effort parameters extracted from the inspiratory pressure signal. The results obtained show an increase of the MMG signal Renyi entropy and LZ complexity values with the increase of the respiratory effort. Compared with other parameters analyzed in previous works, both Renyi entropy and LZ complexity indexes demonstrates better performance in all the signals analyzed. Our results suggest that these non-linear techniques are useful to detect and quantify changes in the respiratory effort by analyzing MMG respiratory signals.

Keywords: Sound, Force


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