IJEEMI, Vol. 1, No.

2, November 2019, pp:50-56

DOI: 10.35882/ijeeemi.v1i2.1 ISSN:2656-8624

Apnea Monitor based on Bluetooth with Android

Interface
I Dewa Made Wirayuda, I Dewa Gede Hari Wisana , Priyambada Cahya Nugraha
Department of Electromedical Engineering Poltekkes Kemenkes,
Surabaya Jl. Pucang Jajar Timur No. 10, Surabaya, 60245, Indonesia
[email protected] , [email protected] , [email protected]

Abstract— Apnea monitor is a device that is used to give a warning if there is stop breathing. Stop breathing while sleeping is one
form of obstructive sleep apnea. This cessation of breath cannot be underestimated, this is related to the main risk factors for health
implications and increased cardiovascular disease and sudden death. The purpose of this study is to design an apnea monitor with the
Android interface. This device allows the users to get how many times sleep apnea happens while sleeping and got data to analysis
before continuing with a more expensive and advanced sleep test. This device used a flex sensor to detect the respiration rate, the sensor
placed on the abdomen or belly so it can measure expand and deflate while breathing. The microcontroller uses an Arduino chip called
AT-Mega328. Bluetooth HC-05 used to send respiration data to Android, MIT app inventor used for the android programmer, and on
the android, there are plotting of respiration value and when the device detected apnea so the android also gives a warning to the user.
Based on the results of testing and measurement then compare with another device, the results of the average% error were 3.61%. This
apnea monitor design is portable but there are needs some improvement by using another sensor for detected respiration and using a
module other than Bluetooth.

Keywords—Sleep Apnea, Apnea Monitor, Flex Sensor

I. INTRODUCTION Medicine (AASM), the apnea-hypopnea index (AHI) is used

to describe the complete number and incidence of apnea per
Apnea monitor is a device that is used to give a warning if hour of sleep to assess the severity of OSA syndrome. OSA
there is cessation of breath (apnea) in infants or adults who severity is usually determined as follows, AHI 5-15 shows a
have the risk of respiratory failure and make parents or alert mild risk level, 15-30 shows moderate, and more than 30
companion for the condition [1]. shows severe OSA syndrome [2]. One factor in the occurrence
Sleep apnea (SA) is form of obstructive sleep apnea (OSA) of OSA is Obesity. The researchers concluded that obese
in the respiratory disorder that most commonly occurs during people should be evaluated to determine the occurrence of
sleep (sleep apnea). Sleep apnea is characterized by the cessation OSA even though no symptoms were felt [6].
of air flow to the lungs, it called sleep apnea when breathing In premature infants apnea occurs because the immature
stops more than 10 seconds. Sleep apnea cannot be respiratory system is called apnea of prematurity (AOP). Other
underestimated, this is because it is associated with the main risk things that can cause apnea are unstable temperature,
factors for health implications and increased cardiovascular pneumonia, asphyxia and anemia. All infants born less than 34
disease and sudden death [2]. When sleep apnea occurs, there weeks should be monitored or monitored at least the first week
will be oxygen desaturation or hypoxia so the body didn’t get or until the absence of apnea episodes that occur in premature
enough oxygen [3]. infants again [7].
Sleep apnea has a serious impact for patients, especially Based on the results of the identification of the above
can cause heart problems (hypertension, coronary artery disease, problems to diagnose sleep apnea so that it can prevent the
and arrhythmias). In addition, sleep disorders can also have a risk of cardiovascular disease and complications of other
negative impact on quality of life. This often causes diseases such as hypoxia and sudden death (author death),
depression, fatigue during the day and drowsiness. Sleep Therefore, the objective of this study is to develop apnea
apnea events are divided into 3 classes: obstructive sleep monitor based on Bluetooth with android interface.
apnea (OSA), central sleep apnea (CSA), and mixed sleep
apnea (MSA). This disease can occur at any age and sleep II. MATERIALS AND METHODS
apnea is often undiagnosed [4]. Hypoxia caused by OSA can
A. Experimental Setup
result in hypertension in the lungs, cardiac dysfunction, and
even kidney disorders [5]. This study uses male and female as a subjects aged 17-40
years. Sampling is randomly by taking data 5 times with a
Statistics show that around 100 million people worldwide, total of 10 samples.
where in the US from 18 to 50 million people, are suspected of
having OSA, and among them more than 80% remain 1) Materials and Apparatus
undiagnosed. According to the American Academy of Sleep

Indonesian Journal of Electronics, Electromedical, and Medical Informatics (IJEEEMI)

50
 IJEEMI, Vol. 1, No. 2, November 2019, pp:50-56
DOI: 10.35882/ijeeemi.v1i2.1 ISSN:2656-8624

This study uses a flex sensor which will be placed on the Start
patient's abdomen to detect the patient's breathing. Using
ATMega328 as a microcontroller, and Bluetooth to send data
to android.. Initialization

2) Experiment
No
In this study the researchers measured subject’s respiration
who were randomly selected and compared the results of
respiration with standard. Bluetooth
Connected?
B. The Diagram Block
In this research, flexible sensors were used to identify the Yes
swelling and deflection of the abdomen of the patient during
breathing as seen in Figure 1. The output sensor that is still in Received Data
the form of resistance will enter the analog signal conditioning from
circuit so that it can be processed by the microcontroller.
While the breathing detected, the microcontroller will send Plotting of Respiration Value
data for respiration value counters to android via Bluetooth.
When sleep apnea occurs, the module will activate the alarm
on the device and also on android. On the Android display No
there is also a patient's respiration value in the form of plotting
the graph of respiration value. Apnea?

Patient's Belly Breathing Indicator

Yes

Low Battery Indicator Alarm

Flex Sensor
Mikrokontroller
Atmega 328
Stop
Analog Signal Conditioning Alarm
Fig. 3. The flowchart of the android program

C. The Flowchart
Bluetooth HC-05
The Arduino program is based on the flowchart in Fig. 2.
After initializing the microcontroller will detect changes in input
Fig. 1. The diagram block of the apnea monitor voltage produced by the flex sensor. Furthermore, this data
Alarm will be sent via Bluetooth to Android.
Start Handphone
The Android program flowchart can be seen in Figure
Plotting of respiration rate Fig.3, where after initializing, the operator needs to connect
Initialization Android to Bluetooth from the device. When breathing occurs,
the value of the patient's respiration will appear, and when its
Fig. 2. The flowchart of the arduino program
one minute there will be an update to plot the graph of
Detecting Respiration respiration value on the android display.
by Flex Sensor
D. The Analog Circuit
The most important part of the design is the analog signal
Sending Data via
Blueooth to Android
conditioning circuit, as shown in figure 4 which is a voltage
divider circuit, the difference amplifier circuit and filter in
Figure 5. This circuit serves to process analog signals so that
Stop the output is ready to be processed by a microcontroller.
1) Voltage Divider
The circuit shown in Figure 4 is a voltage divider circuit,
where this circuit will experience a change in output voltage
when the flex sensor changes the curve caused by the
breathing process of the patient.

Indonesian Journal of Electronics, Electromedical, and Medical Informatics (IJEEEMI)

51
 IJEEMI, Vol. 1, No. 2, November 2019, pp:50-56
DOI: 10.35882/ijeeemi.v1i2.1 ISSN:2656-8624

Fig. 6. Bluetooth connection

III. RESULTS
In this study, a trial has been carried out on the tool
module by measuring breathing in patients directly and taking
measurements to determine the accuracy of the module
Fig. 4. Voltage divider

2) Difference Amplifier adn Filter

The difference amplifier circuit shown in Figure 5 using
LM358 as the OP-Amp, is a circuit that serves to amplify the
output from voltage divider, so that the difference in voltage
when the patient is breathing can be seen more clearly,
difference amplifier also used to setting sensitivity from the
sensor to detected breathing. Furthermore, there is a low pass
filter with frequency cut off 1 Hz. The function of low pass
filter is to eliminate noise that does not originate from
breathing.

Fig. 7. Apnea monitor design

Fig. 5. Difference amplifier

For the reinforcement of the difference amplifier it can be

calculated using the formula:
If (R6=R9, R4=R3) then,
𝑅6
Vout = (− ) ∗ (𝑉𝑖𝑛𝑣𝑒𝑟𝑡𝑖𝑛𝑔 − 𝑉𝑛𝑜𝑛𝑛𝑣𝑒𝑟𝑡𝑖𝑛𝑔) (1)
𝑅3
𝑅𝑓 𝑅6
Gain = (− ) = (− ) (2)
𝑅𝑖𝑛 𝑅3
Fig. 8. Result of apnea monitor design
3) Bluetooth Connection
The Bluetooth circuit is connected to the ATMega328
microcontroller by connecting the AT-Mega 328 TX pin to the
RX Bluetooth pin, and the RX AT-Mega 328 pin to the
SSSSSSSSBluetooth TX pin.

Indonesian Journal of Electronics, Electromedical, and Medical Informatics (IJEEEMI)

52
 IJEEMI, Vol. 1, No. 2, November 2019, pp:50-56
DOI: 10.35882/ijeeemi.v1i2.1 ISSN:2656-8624

Serial.println
(nafasmanual); beat=0; }
}}

//======mengirim data RR setelah 1

menit========== if (milidetik3>60003){
nafasmenit=nafasmanual;
Serial.print
("b");Serial.println(nafasmenit);
nafasmanual=0;
milidetik3=0; }
Fig. 9. Display mit app for apnea monitor
//================deteksi
1) The Apnea Monitor Design apnea============ if(flex<hold){
The analog signal conditioning circuit and microcontroller if
for Apnea Monitor are shown in figure 7. This design consists (detik>10000){
of a series of voltage dividers, a difference amplifier circuit, if (kirim==0){
and an LPF filter. The difference amplifier circuit uses the Serial.print("c");Serial.println(1);
LM358 IC which has two op-amp. In the voltage distribution digitalWrite (buzzer,HIGH);
circuit there is multi-turn (50k) which serves to adjust the kirim=1;}}
sensitivity of the flex sensor readings. For the microcontroller
this tool uses ATMega328 as a control and uses the Bluetooth if(flex>hold){
HC-05 module as the sender of data through the if (milidetik>10000)
microcontroller to android. { if (kirim==0){
Serial.print("c");Serial.println(1);
2) The Listing Program for ATMega328 Apnea Monitor
digitalWrite (buzzer,HIGH);
In this study, the software was divided into two parts, 3) The Listing Program for Mit App Inventor
namely for ATMega328 and for MIT APP Inventor. For the In Listing Program 2 it explains the program for receiving
ATMega328 listing program shown in the Program Listing 1. data sent Bluetooth from the microcontroller by android.
It contains a sensor reading program and sending data to Where the data is divided into 3 parts. The first part beginning
android via Bluetooth HC-05. with the letter "a" is the counter value data for RR. Data
Listing program 1. Program to send the RR data To Android beginning with the letter "b" is data for plotting graphics, and
data beginning with the letter "c" to trigger an alarm in the
//=======pencarianReferensi MIT App Inventor.
(Autoreferensi)======== Flex = AnalogRead (A0);
if(ref<=flex) {ref=flex;} Listing Program 2. Program for MIT App Inventor
else {ref=ref; hold=(ref*0.8);}

//===========pembacaan nilai
respirasi=========== if (flex>hold){
beat=1; detik=0; kirim=0;
digitalWrite (buzzer,LOW);
digitalWrite (ledPernapasan,
LOW); }

//=============mengirim data Counter

RR========= if (flex<(hold*0.8)) {
milidetik=0;

if
(beat==1
){
kirim=0;
digitalWrite (ledPernapasan, HIGH);
if
(waktumonostabil>delayMonostabil){

Indonesian Journal of Electronics, Electromedical, and Medical Informatics (IJEEEMI)

53
 IJEEMI, Vol. 1, No. 2, November 2019, pp:50-56
DOI: 10.35882/ijeeemi.v1i2.1 ISSN:2656-8624

5. The Respiration Signal

Respiration signal are measured two times with two
difference point from the placement of flex sensor first point
on right of umbilical region and the second point on the left of
umbilical region. This measurement is done to find out the
point that produces a signal with a higher amplitude.

(a) (b)
Fig. 10. Sensor placement to measured the respiration (a) left (b) right
side

Fig. 11. Respiration signal on the right of umblical region (Subject 1)

Fig. 12. Respiration signal on the left of umblical region (Subject 1)

4. Timer
The timer is used to calculate the time of stopping the breath,
and when the breath stops more than 10 seconds the tool will
give a warning by activating the alarm.

TABLE I. THE DIFFERENCE BETWEEN TIMER AND STANDARD

Design Standard Difference

(Second) (Second) (Second)
10 10.22 0.22 Fig. 13. Respiration signal on the right of umblical region (Subject 2)

10 10.20 0.20
s1 10.08 0.08
0
10 10.16 0.16
10 10.20 0.20

After testing the timer there are the difference between

timer and standard. The biggest difference is 0.22 seconds and
the smallest difference is 0.08.

Indonesian Journal of Electronics, Electromedical, and Medical Informatics (IJEEEMI)

54
 IJEEMI, Vol. 1, No. 2, November 2019, pp:50-56
DOI: 10.35882/ijeeemi.v1i2.1 ISSN:2656-8624

Fig. 14. Respiration signal on the left of umblical region (Subject 2)

Fig. 20. Respiration signal on the left of umblical region (Subject 5)

TABLE II. THE AMPLITUDE OF THE RESPIRATION SIGNAL

Fig. 15. Respiration signal on the right of umblical region (Subject 3)
Right Side Left Side
No
(Volt) (Volt)
1 2.56 2.16
2 1.92 1.16
3 2.4 2.24
4 3.24 2.36
5 2.88 1.64
Fig. 16. Respiration signal on the left of umblical region (Subject 3) 6 1.60 0.76
7 1.80 1.44
8 3.04 2.24
9 3.60 2.88
10 2.16 1.24
Average 2.52 1.812
6. The Error of Respiration Rate
Accuracy of the respiration rate value on the MIT app
inventor display with the standard comparison apparatus.
Fig. 17. Respiration signal on the right of umblical region (Subject 4)

TABLE III. THE ERROR OF RESPIRATION RATE ON DESIG

Average
Number Device
(RR) STDEV Ua Error
Standard 11.2 0.45 0.20
1
Design 10.8 0.84 0.37 3.57%
Standard 19.6 0.89 0.40
Fig. 18. Respiration signal on the left of umblical region (Subject 4) 2 5.10%
Design 18.6 2.07 0.93
Standard 12.6 0.89 0.40
3 4.76%
Design 12.0 1.00 0.45
Standard 17.2 1.30 0.58
4 6.98%
Design 16.0 2.35 1.05
Standard 13.0 2.00 0.89
5 3.08%
Design 12.6 1.95 0.87
Fig. 19. Respiration signal on the right of umblical region (Subject 5)
6 Standard 18.8 2.17 0.97 2.13%

Indonesian Journal of Electronics, Electromedical, and Medical Informatics (IJEEEMI)

55
 IJEEMI, Vol. 1, No. 2, November 2019, pp:50-56
DOI: 10.35882/ijeeemi.v1i2.1 ISSN:2656-8624

Design 18.4 2.88 1.29 [7] S. Sunit, R. Pallab, J. L. Mathew, M. Jayashree, and Dhanalakshmi,
Standard 15.0 2.00 0.89 “Apnea in New Born,” Indian J. Pediatr., vol. 75, no. 1, p. 57, 2008.
7
Design 14.8 2.17 0.97 1.33%
Standard 23.4 2.30 1.03
8
Design 22.0 2.55 1.14 5.98%
Standard 18.8 1.48 0.66
9
Design 18.2 1.92 0.86 3,.19%
Standard 19.0 1.41 0.63
10
Design 19.0 1.41 0.63 0.00%
The measurement results from the patient's Respiration
Rate compared to the standard. The results are shown in table
2.
IV. DISCUSSION
The apnea monitor design has been examined and tested
completely in this study. Based on the result after measuring
respiration signal from 10 subject, as seen above in the table
can be conclude that the average of amplitude from the right
side is
2.52 Volt and the average from the left side is 1.812, so the
right side is better to place the sensor.
Furthermore, based on the results after compared
measurement using standard there are differences in the
measurement results. The biggest error value is 6.98% and the
smallest is 0.00%. The average error is 3.61%. The uncertainty
value is obtained because there are still other factors that
influence the measurement results, such as the location of the
flex sensor at the time of measurement, and respiration from
the respondent is not always stable. So the value of uncertainty
must also be calculated. The biggest value is 1.29 and the
smallest value is 0.20.
V. CONCLUSION
This study has demonstrated the development of the apnea
monitor to monitoring the respiration of the patient’s while
sleeping. This study was built based on Bluetooth with
android interface. After testing the design, there are needs to
improvement by using other sensor for detected respiration
and using module other than Bluetooth.
REFERENCES
[1] Kementerian Kesehatan, “Keputusan Menteri Kesehatan Republik
Indonesia Nomor 118/MENKES/SK/IV/2014,” pp. 33–34, 2014.
[2] N. Maske and A. Gaikwad, “Monitoring Of Obstructive Sleep Apnea
Using Mobile,” Int. J. Ind. Electron. Electr. Eng. ISSN, vol. 4, no. 4, pp.
71–75, 2016.
[3] K. Sneha, “Detection of Sleep Apnea using Pressure Sensor,” Int. Res. J.
Eng. Technol., vol. 03, no. 10, pp. 709–712, 2016.
[4] Dipti Patil, V. M. Wadhai, S. Gujar, K. Surana, P. Devkate, and S.
Waghmare, “APNEA Detection on Smart Phone,” Int. J. Comput. Appl.,
vol. 59, no. 7, pp. 15–19, 2012.
[5] R. M. Taylor-Gjevre, “Obstructive sleep apnea, hypoxia and
inflammatory arthritis: How may they be linked?,” Int. J. Clin.
Rheumtol., vol. 10, no. 4, pp. 219–222, 2015.
[6] G. J. Rossini, “O bstructive S leep A pnea A nd O besity,” J. Lancaster
Gen. Hosp., vol. 4, no. 4, pp. 139–142, 2009.

Indonesian Journal of Electronics, Electromedical, and Medical Informatics (IJEEEMI)

56