The use of pulse transit time in pediatric sleep studies: A systematic review
Abstract
As a surrogate measure of blood pressure, pulse transit time (PTT) is commonly used in studies investigating arterial function and respiratory sleep disturbance. A systematic search of the literature was conducted with the aim of reviewing the usefulness of the technique within pediatric sleep studies. All studies that used PTT as a diagnostic tool during sleep in infants, children or adolescents were considered. The search yielded 425 articles, of which 21 full-text articles met inclusion criteria, the majority reporting on obstructive sleep apnea (OSA). PTT was used alongside polysomnography (PSG) in all studies. Several studies supported the potential of PTT to detect central apneic events in both infants and children and obstructive events in children, with implications for use as a screening tool for OSA, albeit with some limitations. Only one study validated PTT against blood pressure (BP), and only against systolic arterial pressure (SAP), showing significant negative correlations between PTT and SAP. PTT tracked well against BP and heart rate (HR) over acute cardiovascular perturbations in several studies. PTT is simple to execute, cost-efficient to run, and more tolerable than alternatives to measuring continuous BP in children. However its potential as a core clinical tool remains to be determined.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
PAT correlates with blood pressure in infants.
“with prior reports providing evidence that PAT correlates with blood pressure in infants (35–37).”
From Binodal, wireless epidermal electronic systems with in-sensor analytics for neonatal intensive care (2019) · cites this paper as [35]
Cites
Standards and Indications for Cardiopulmonary Sleep Studies in Children. American Thoracic Society
(1996) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.153.2.8564147 · Cited by 1,178 · see citing works
Toward ubiquitous blood pressure monitoring via pulse transit time: Theory and practice
Mukkamala, R., Hahn, J.-O., Inan, O. T., Mestha, L. K., Kim, C.-S., Toreyin, H., & Kyal, S. (2015) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2015.2441951 · Cited by 935 · see citing works
Chen, W., Kobayashi, T., Ichikawa, S., Takeuchi, Y., & Togawa, T. (2000) · Medical & Biological Engineering & Computing · doi:10.1007/bf02345755 · Cited by 425 · see citing works
Pulse transit time measured from the ECG: an unreliable marker of beat-to-beat blood pressure
Payne, R. A., Symeonides, C. N., Webb, D. J., & Maxwell, S. R. J. (2006) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00657.2005 · Cited by 418 · see citing works
Ding, X., Zhang, Y., Liu, J., Dai, W., & Tsang, H. K. (2015) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2015.2480679 · Cited by 327 · see citing works
Pulse transit time: an appraisal of potential clinical applications
Smith, R., ARGOD, J., Pépin, J., & Levy, P. A. (1999) · Thorax · doi:10.1136/thx.54.5.452 · Cited by 318 · see citing works
The Effect of Nonvisible Sleep Fragmentation on Daytime Function
Martin, S. E., WRAITH, P. K., Deary, I. J., & Douglas, N. J. (1997) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.155.5.9154863 · Cited by 274 · see citing works
Katz, E. S., Lutz, J., Black, C., & Marcus, C. L. (2003) · Pediatric Research · doi:10.1203/01.pdr.0000057206.14698.47 · Cited by 215 · see citing works
Wong, M. Y. M., Poon, C. C. Y., & Zhang, Y. (2009) · Cardiovascular Engineering An International Journal · doi:10.1007/s10558-009-9070-7 · Cited by 191 · see citing works
BENNETT, L. S., Langford, B., Stradling, J. R., & Davies, R. J. O. (1998) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.158.3.9711033 · Cited by 189 · see citing works
Pitson, D., & Stradling, J. R. (1998) · Journal of Sleep Research · doi:10.1046/j.1365-2869.1998.00092.x · Cited by 185 · see citing works
Changes in Pulse Transit Time and Pulse Rate as Markers of Arousal from Sleep in Normal Subjects
Pitson, D., Chhina, N., Knijn, S., van Herwaaden, M., & Stradling, J. R. (1994) · Clinical Science · doi:10.1042/cs0870269 · Cited by 172 · see citing works
Pitson, D., Sandell, A., van den Hout, R., & Stradling (1995) · European Respiratory Journal · doi:10.1183/09031936.95.08101669 · Cited by 167 · see citing works
Clinical Diagnosis of Pediatric Obstructive Sleep Apnea Validated by Polysomnography
Goldstein, N. A., Sculerati, N., Walsleben, J. A., BHATIA, N., FRIEDMAN, D. M., & Rapoport, D. M. (1994) · Otolaryngology · doi:10.1177/019459989411100512 · Cited by 159 · see citing works
Clinical Assessment of Pediatric Obstructive Sleep Apnea
Goldstein, N. A., Pugazhendhi, V., Rao, S. M., Weedon, J., Campbell, T. F., Goldman, A. C., Post, J. C., & Rao, M. (2004) · PEDIATRICS · doi:10.1542/peds.114.1.33 · Cited by 151 · see citing works
Differentiating Obstructive and Central Sleep Respiratory Events through Pulse Transit Time
ARGOD, J., Pépin, J., & Levy, P. A. (1998) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.158.6.9804157 · Cited by 149 · see citing works
A survey on signals and systems in ambulatory blood pressure monitoring using pulse transit time
Buxi, D., Redouté, J., & Yuce, M. R. (2015) · Physiological Measurement · doi:10.1088/0967-3334/36/3/r1 · Cited by 140 · see citing works
Muehlsteff, J., Aubert, X. L., & Schuett, M. (2006) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/iembs.2006.260275 · Cited by 137 · see citing works
Pitson, D., & Stradling (1998) · European Respiratory Journal · doi:10.1183/09031936.98.12030685 · Cited by 123 · see citing works
Pulse Transit Time Improves Detection of Sleep Respiratory Events and Microarousals in Children
Pépin, J., Delavie, N., Pin, I., Deschaux, C., Argod, J., Bost, M., & Levy, P. A. (2005) · CHEST Journal · doi:10.1378/chest.127.3.722 · Cited by 121 · see citing works
Noninvasive and Nonocclusive Blood Pressure Estimation Via a Chest Sensor
Solà, J., Proença, M., Ferrario, D., Porchet, J.-A., Falhi, A., Grossenbacher, O., Allemann, Y., Rimoldi, S. F., & Sartori, C. S. (2013) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2013.2272699 · Cited by 117 · see citing works
Chen, Y., Wen, C., Tao, G., Bi, M., & Li, G. (2009) · Annals of Biomedical Engineering · doi:10.1007/s10439-009-9759-1 · Cited by 115 · see citing works
Naschitz, J. E., Bezobchuk, S., Priselac, R. M., Sundick, S., Dreyfuss, D., Khorshidi, I., Karidis, A., Manor, H., Nagar, M., Peck, E. R., et al. (2004) · Journal of Clinical Monitoring and Computing · doi:10.1007/s10877-005-4300-z · Cited by 114 · see citing works
ARGOD, J., Pépin, J., Smith, R. P., & Levy, P. A. (2000) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.162.1.9907086 · Cited by 105 · see citing works
Non-invasive beat-to-beat blood pressure monitoring: new developments
Parati, G., Ongaro, G., Bilo, G., Glavina, F., Castiglioni, P., Rienzo, M. D., & Mancia, G. (2003) · Blood Pressure Monitoring · doi:10.1097/00126097-200302000-00007 · Cited by 101 · see citing works
Gil, E., Bailón, R., Vergara, J. M., & Laguna, P. (2010) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2009.2037734 · Cited by 88 · see citing works
Pulse Transit Time and Blood Pressure During Cardiopulmonary Exercise Tests
Wibmer, T., DOERING, K., Kropf-Sanchen, C., RÜDIGER, S., Blanta, I., Stoiber, K., Rottbauer, W., & SCHUMANN, C. (2014) · Physiological Research · doi:10.33549/physiolres.932581 · Cited by 81 · see citing works
Arousal, EEG spectral power and pulse transit time in UARS and mild OSAS subjects
Poyares, D. R. (2002) · Clinical Neurophysiology · doi:10.1016/s1388-2457(02)00214-6 · Cited by 80 · see citing works
Vandenbussche, N., Overeem, S., van Dijk, J. P., Simons, P. J., & Pevernagie, D. (2014) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.12.006 · Cited by 66 · see citing works
Pulse Transit Time as a Screening Test for Pediatric Sleep-Related Breathing Disorders
Brietzke, S. E., Katz, E. S., & Roberson, D. W. (2007) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archotol.133.10.980 · Cited by 55 · see citing works
Effect of confounding factors on blood pressure estimation using pulse arrival time
Kim, J. S., Kim, K. K., Baek, H. J., & Park, K. S. (2008) · Physiological Measurement · doi:10.1088/0967-3334/29/5/007 · Cited by 44 · see citing works
O’Brien, L. M., & Gozal, D. (2007) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.26744 · Cited by 39 · see citing works
Vlahandonis, A., Biggs, S. N., Nixon, G. M., Davey, M. J., Walter, L. M., & Horne, R. S. C. (2014) · Journal of Sleep Research · doi:10.1111/jsr.12140 · Cited by 38 · see citing works
Nisbet, L. C., Yiallourou, S. R., Nixon, G. M., Biggs, S. N., Davey, M. J., Trinder, J. C., Walter, L. M., & Horne, R. S. C. (2013) · Sleep Medicine · doi:10.1016/j.sleep.2013.06.010 · Cited by 36 · see citing works
Pulse transit time in paediatric respiratory sleep studies
Foo, J. Y. A. (2006) · Medical Engineering & Physics · doi:10.1016/j.medengphy.2006.01.006 · Cited by 34 · see citing works
Galland, B. C., Tan, E., & Taylor, B. J. (2007) · Sleep · doi:10.1093/sleep/30.7.891 · Cited by 34 · see citing works
Self-citationThe effect of growth hormone on sleep‐related cardio‐respiratory control in Prader–Willi syndrome
Katz‐Salamon, M., Lindgren, A., & Cohen, G. (2012) · Acta Paediatrica · doi:10.1111/j.1651-2227.2012.02638.x · Cited by 34 · see citing works
Foo, J. Y. A., Wilson, S. J., Bradley, A. P., Williams, G. R., Harris, M., & Cooper, D. M. (2005) · CHEST Journal · doi:10.1378/chest.128.4.3013 · Cited by 32 · see citing works
Mehendale, F. V., Lane, R., Laverty, A., Dinwiddie, R., & Sommerlad, B. C. (2012) · The Cleft Palate-Craniofacial Journal · doi:10.1597/11-198 · Cited by 30 · see citing works
Foo, J. Y. A., Bradley, A. P., Wilson, S. J., Williams, G., Dakin, C., & Cooper, D. M. (2006) · Acta Paediatrica · doi:10.1080/08035250500477552 · Cited by 29 · see citing works
Walter, L. M., Biggs, S. N., Nisbet, L. C., Weichard, A. J., Hollis, S. L., Davey, M. J., Anderson, V. A., Nixon, G. M., & Horne, R. S. C. (2015) · Sleep And Breathing · doi:10.1007/s11325-015-1268-x · Cited by 27 · see citing works
Foo, J. Y. A., Wilson, S. J., Williams, G. M., Harris, M., & Cooper, D. M. L. (2005) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001891 · Cited by 25 · see citing works
Foo, J. Y. A., Wilson, S. J., Williams, G. R., Coates, A. J. S., Harris, M.-A., & Cooper, D. M. (2005) · Physiological Measurement · doi:10.1088/0967-3334/26/3/015 · Cited by 23 · see citing works
Galland, B. C. (2012) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archoto.2012.86 · Cited by 21 · see citing works
Self-citationAge-related factors that confound peripheral pulse timing characteristics in Caucasian children
Foo, J. Y. A., Wilson, S. J., Williams, G. M., Harris, M., & Cooper, D. M. L. (2005) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001846 · Cited by 20 · see citing works
Physiological relationship between autonomic reactions and arousals in infancy
Franco, P., van de Borne, P., Chabanski, S., Sawaguchi, T., Horne, R. S. C., Verheulpen, D., Groswasser, J., & Kahn, A. (2002) · Sleep Medicine · doi:10.1016/s1389-9457(02)00165-x · Cited by 18 · see citing works
Foo, J. Y. A., Lim, C. S., Wilson, S. J., Williams, G. R., Harris, M., & Cooper, D. M. L. (2007) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1002139 · Cited by 15 · see citing works
Markström, A., Cohen, G., & Katz‐Salamon, M. (2010) · Sleep Medicine · doi:10.1016/j.sleep.2009.08.014 · Cited by 14 · see citing works
Detection of Central Respiratory Events Using Pulse Transit Time in Infants
Foo, J. Y. A., Parsley, C., Wilson, S. J., Williams, G. R., Harris, M., & Cooper, D. M. L. (2005) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/iembs.2005.1616996 · Cited by 11 · see citing works
Normalized peripheral transit time to monitor hypertensionin children
Foo, J. Y. A., & Wilson, S. J. (2006) · Journal of Medical Engineering & Technology · doi:10.1080/03091900500422253 · Cited by 8 · see citing works
Foo, J. Y. A., & Lim, C. S. (2008) · Journal of Medical Engineering & Technology · doi:10.1080/03091900600632694 · Cited by 8 · see citing works
Foo, J. Y. A., Wilson, S. J., & Bradley, A. P. (2006) · Journal of Human Hypertension · doi:10.1038/sj.jhh.1001973 · Cited by 7 · see citing works
Pulse transit time for scoring subcortical arousal in infants with obstructive sleep apnea
Rizzoli, A., Urschitz, M. S., Sautermeister, J., Miano, S., Pagani, J., Villa, M. P., & Poets, C. F. (2008) · Sleep And Breathing · doi:10.1007/s11325-008-0224-4 · Cited by 6 · see citing works
Normality of Upper and Lower Peripheral Pulse Transit Time of Normotensive and Hypertensive Children
Foo, J. Y. A. (2007) · Journal of Clinical Monitoring and Computing · doi:10.1007/s10877-007-9080-1 · Cited by 6 · see citing works
A Computational Approach to Predict Pulse Transit Time Variations During Postural Change
Foo, J. Y. A. (2007) · Cardiovascular Engineering An International Journal · doi:10.1007/s10558-007-9034-8 · Cited by 4 · see citing works
Foo, J. Y. A., Wilson, S. J., Williams, G. R., Harris, M.-A., & Cooper, D. M. (2008) · Journal of Clinical Monitoring and Computing · doi:10.1007/s10877-008-9137-9 · Cited by 4 · see citing works
An investigation on pulse transit time in respiratory sleep studies for infants
Foo, J. Y. A., & Lim, C. S. (2008) · Journal of Medical Engineering & Technology · doi:10.1080/03091900600863463 · Cited by 2 · see citing works
Foo, J. Y. A., Wilson, S. J., Williams, G. R., Harris, M., & Cooper, D. M. L. (2008) · Acta Cardiologica · doi:10.2143/ac.63.3.1020315 · Cited by 2 · see citing works
The role of primary care physicans in sleep medicine
Netzer, N. C. (1997) · Sleep And Breathing · doi:10.1007/bf03038851 · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Binodal, wireless epidermal electronic systems with in-sensor analytics for neonatal intensive care
Chung, H. U., Kim, B. H., Lee, J. Y., Lee, J., Xie, Z., Ibler, E. M., Lee, K., Banks, A., Jeong, J. Y., Kim, J., et al. (2019) · Science · doi:10.1126/science.aau0780 · Cited by 807 · see citing works
Dynamic coupling between the central and autonomic nervous systems during sleep: a review
de Zambotti, M., Trinder, J., Silvani, A., Colrain, I. M., & Baker, F. C. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.03.027 · Cited by 194 · see citing works
Printing Flexible and Hybrid Electronics for Human Skin and Eye‐Interfaced Health Monitoring Systems
Kim, K., Kim, B., & Lee, C. H. (2019) · Advanced Materials · doi:10.1002/adma.201902051 · Cited by 146 · see citing works
Maiolino, G., Bisogni, V., Soranna, D., Pengo, M. F., Pucci, G., Vettor, R., Fava, C., Colussi, G., Bilo, G., Lombardi, C., et al. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101497 · Cited by 46 · see citing works
Ranger, A., Helmert, E., Bott, T. S., Ostermann, T., Als, H., Bassler, D., Hautzinger, M., & Vagedes, J. (2018) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2018.07.009 · Cited by 42 · see citing works
Vandi, S., Rodolfi, S., Pizza, F., Moresco, M., Antelmi, E., Ferri, R., Mignot, E. J.-M., Plazzi, G., & Silvani, A. (2019) · SLEEP · doi:10.1093/sleep/zsz169 · Cited by 39 · see citing works
Cornelis, B. F. (2020) · doi:10.26481/dis.20201113fb · Cited by 18 · see citing works
Altered Nocturnal Cardiovascular Control in Children With Sleep-Disordered Breathing
El-Hamad, F., Immanuel, S. A., Liu, X., Pamula, Y., Kontos, A., Martin, J. M., Kennedy, D., Kohler, M. J., Porta, A., & Baumert, M. (2017) · SLEEP · doi:10.1093/sleep/zsx127 · Cited by 11 · see citing works
Artifacts in pulse transit time measurements using standard patient monitoring equipment
Bennis, F. C., van Pul, C., Bogaart, J. J. L. V. D., Andriessen, P., Kramer, B. W. W., & Delhaas, T. (2019) · PLoS ONE · doi:10.1371/journal.pone.0218784 · Cited by 10 · see citing works
Sleep Measurement in Children—Are We on the Right Track?
Stražišar, B. G. (2021) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2021.08.004 · Cited by 11 · see citing works
Akkari, M., Yildiz, S., Marianowski, R., Monteyrol, P.-J., Chalumeau, F., Fayoux, P., Leboulanger, N., Franco, P., Couloigner, V., & Mondain, M. (2020) · European Annals of Otorhinolaryngology Head and Neck Diseases · doi:10.1016/j.anorl.2020.02.001 · Cited by 9 · see citing works
Cheung, T. W. Y., Lam, D. S. Y., Chan, P. C., Yau, P. S., & Yeung, K. W. A. (2021) · Sleep Medicine · doi:10.1016/j.sleep.2021.02.048 · Cited by 9 · see citing works
Ambulatory blood pressure monitoring in children with obstructive sleep apnea syndrome
Geng, X., Wu, Y., Ge, W., Feng, G., Li, Z., Xu, Z., & Ni, X. (2019) · Pediatric Investigation · doi:10.1002/ped4.12163 · Cited by 8 · see citing works
Observational Study of Pulse Transit Time in Children With Sleep Disordered Breathing
Yanney, M. P., Prayle, A., Rowbotham, N. J., Kurc, M., Tilbrook, S., & Ali, N. J. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.00316 · Cited by 7 · see citing works
Wu, Y., Geng, X., Xu, Z., & Ni, X. (2022) · Nature and Science of Sleep · doi:10.2147/nss.s370334 · Cited by 5 · see citing works
Technologies in the Pediatric Sleep Lab: Present and Future
Etzioni, T., & Pillar, G. (2021) · Springer eBooks · doi:10.1007/978-3-030-65574-7_15 · Cited by 2 · see citing works
TAMURA, T. (2017) · Springer eBooks · doi:10.1007/978-3-319-69362-0_4 · Cited by 1 · see citing works
The use of pulse transit time in diagnostics of sleep-disordered breathing in children
Kawalski, M., Ścierski, P., Marków, M., Tażbirek, M., Morawiec, B., Kawalski, H., Namysłowski, G., Misiołek, M., & Ścierski, W. (2024) · Otolaryngologia Polska · doi:10.5604/01.3001.0054.4170 · Cited by 1 · see citing works
Yanney, M. P., Essiam, A., Rowbotham, N. J., & Prayle, A. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1632919 · Cited by 1 · see citing works
Zagrada, E., Krickau, T., & Rascher, W. (2018) · Klinische Pädiatrie · doi:10.1055/a-0747-6253 · Cited by 1 · see citing works
Akkari, M., YILDIZ, Ş., Marianowski, R., Monteyrol, P.-J., Chalumeau, F., Fayoux, P., Leboulanger, N., Franco, P., Couloigner, V., & Mondain, M. (2020) · Annales françaises d Oto-rhino-laryngologie et de Pathologie Cervico-faciale · doi:10.1016/j.aforl.2019.09.010
Yang, S., van Twist, E., van Heesch, G. G. M., de Jonge, R. C. J., Louter, M., Tasker, R. C., Mathijssen, I. M. J., & Joosten, K. (2024) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.11112
- Authors
- Smith, L. A., Dawes, P. J., & Galland, B. C.
- Affiliations
- University of Otago (NZ)
- Corresponding author
- Galland, Barbara C.
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 37
- Pages
- 4-13
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W2559310683
- Cited by
- 22
- References
- 59
- Citations by year
- 2025: 1 · 2024: 2 · 2022: 1 · 2021: 4 · 2020: 4 · 2019: 5 · 2018: 3 · 2017: 2
- FWCI
- 0.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Linsell Richards Education Trust
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- pulse transit time, children's sleep, obstructive sleep apnea, arterial function, sleep apnea screening, infants, children, adolescents, heart rate
- MeSH terms
- Arousal, Blood Pressure, Humans, Pediatrics, Sleep, Polysomnography, Sleep Apnea, Obstructive, Pulse Wave Analysis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review