A conceptual model for changes in finger photoplethysmograph signals caused by hand posture and isothermic regulation

Objective. To observe changes in baseline position and pulsatile light absorbance (photoplethysmograph, PPG) in the finger-tip, by raising the hand above the horizontal plane in recumbent subjects. We applied current knowledge of the circulation to the finger-tip, particularly arteriovenous anastomoses (AVAs), and the physiology of the venous circulation. Approach.We studied healthy young volunteers in a quiet thermoneutral environment. A finger plethysmograph on the non-dominant hand recorded transmission of red and infra-red light, with observations expressed as absorbance to allow comparisons within and between subjects. Breathing movements were recorded unobtrusively to assess any effect on absorbance and the pulse amplitude of the signals. All body movements were passive: the study arm was elevated in a trough to about 40° above the horizontal plane. The following conditions were studied, each for 15 min, using the last 10 min for analysis: recumbent, study arm elevated, study arm horizontal, and both legs elevated by 40°. Main results. We found a substantial time-related effect, and considerable variation between subjects. Arm elevation reduced red light absorbance and increased the range of amplitudes of the PPG waveform: only in subjects with large absorbances, did waveform amplitude increase. Spontaneous, thermoregulatory decreases in absorbance were large and associated with decreases in waveform amplitude. Significance. Finger-tip vessels distend with blood and light absorbance increases when AVAs open. The vessels pulsate more strongly when the hand is raised: venous collapse allows the vessels to become more compliant. The postcapillary circulation is likely to be an important source of pulsation.