Determinants of photoplethysmography signal quality at the wrist

Wrist photoplethysmogram (PPG) signals are widely used for physiological monitoring in consumer devices. However, the PPG is highly susceptible to noise, which can reduce the accuracy of monitored parameters. The aim of this study was to identify factors which influence PPG signal quality. Data from the Aurora-BP dataset were used, consisting of reflectance wrist PPG signals measured from 1,142 subjects of varying ages and health statuses. Measurements were acquired in supine, sitting, and standing postures, and with the sensor held at different heights. Three signal quality metrics were calculated: the signal-to-noise ratio (SNR), the perfusion index (PI), and the template-matching correlation coefficient (TMCC). When comparing between postures with the sensor held at a natural height, quality was greatest in the supine position (SNR: 18.6 dB), followed by sitting with the arm resting in the lap (13.7 dB), and lowest whilst standing with the arm hanging alongside (9.0 dB) (p < 0.001). Signal quality increased as the arm was raised to heart height: whilst sitting, quality was lowest with the arm alongside the body (10.5 dB), and increased when the sensor was held in the lap (13.7 dB) and at heart height (15.5 dB) (p < 0.001). Similar trends were observed for the TMCC and PI. Findings were mixed for the influence of participant characteristics on signal quality. The SNR and TMCC, but not the PI, increased with age. The SNR either decreased or remained constant at darker skin tones when controlling for PPG DC amplitude, compared to constant or increased when allowing DC amplitude to vary. In conclusion, this study identified the impacts of posture and sensor height on signal quality, with highest qualities observed in the supine posture and with the sensor at heart height. It also highlights the importance of adjusting LED light intensity to maintain signal quality across skin tones.