PhysCL: Knowledge-Aware Contrastive Learning of Physiological Signal Models for Cuff-Less Blood Pressure Estimation

Training deep learning models for photoplethysmography(PPG)-based cuff-less blood pressure estimation often requires a substantial amount of labeled data collected through sophisticated medical instruments, posing significant challenges in practical applications. To address this issue, we propose Physiological Knowledge-Aware Contrastive Learning (PhysCL), a novel approach designed to reduce the dependence on labeled PPG data while improving blood pressure estimation accuracy. Specifically, PhysCL tackles the semantic consistency problem in contrastive learning by introducing a knowledge-aware augmentation bank, which generates positive physiological signal pairs using knowledge-based constraints during the contrastive pair generation. Additionally, we propose a contrastive feature reconstruction method to enhance feature diversity and prevent model collapse through feature re-sampling and re-weighting. We evaluate PhysCL on data from 106 subjects across the MIMIC III, MIMIC IV, and UQVS datasets under cross-dataset validation settings, comparing it against state-of-the-art contrastive learning methods and blood pressure estimation models. PhysCL achieves an average mean absolute error of 9.5/5.9 mmHg (systolic/diastolic) across the three datasets, using only 2% labeled data combined with 98% unlabeled data for pre-training and 5 samples for personalization, which represents a 6.2% /4.3% improvement, respectively, over the current best supervised methods. The ablation study provides further convincing evidence that the unlabeled data can be utilized to improve the existing cuff-less blood pressure estimation models and shed light on unsupervised contrastive learning for physiological signals.