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APG: Audioplethysmography for Cardiac Monitoring in Hearables

David Pearl
Rich Howard
Longfei Shangguan
Trausti Thormundsson
Proceedings of the 29th Annual International Conference on Mobile Computing and Networking (MobiCom), Association for Computing Machinery (ACM) (2023) (to appear)


This paper presents Audioplethysmography (APG), a novel cardiac monitoring modality for active noise cancellation (ANC) headphones. APG sends a low intensity ultrasound probing signal using an ANC headphone's speakers and receives the echoes via the on-board feedback microphones. We observed that, as the volume of ear canals slightly changes with blood vessel deformations, the heartbeats will modulate these ultrasound echoes. We built mathematical models to analyze the underlying physics and propose a multi-tone APG signal processing pipeline to derive the heart rate and heart rate variability in both constrained and unconstrained settings. APG enables robust monitoring of cardiac activities using mass-market ANC headphones in the presence of music playback and body motion such as running. We conducted an eight-month field study with 153 participants to evaluate APG in various conditions. Our studies conform to the (Institutional Review Board) IRB policies from our company. The presented technology, experimental design, and results have been reviewed and further improved by feedback garnered from our internal Health Team, Product Team, User Experience (UX) Team and Legal team. Our results demonstrate that APG achieves consistently high HR (3.21% median error across 153 participants in all scenarios) and HRV (2.70% median error in interbeat interval, IBI) measurement accuracy. Our UX study further shows that APG is resilient to variation in: skin tone, sub-optimal seal conditions, and ear canal size.