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Design of a Real-Time User Feedback for Mitigating Spurious SpO₂ Readings in Pulse Oximetry for Outpatient Monitoring
Corresponding Author(s) : Husneni Mukhtar
Kinetik: Game Technology, Information System, Computer Network, Computing, Electronics, and Control,
Vol. 11, No. 1, February 2026
Abstract
Spurious SpO₂ readings—arising from motion artifacts, environmental interference, or device variability—remain a major limitation in wearable pulse oximetry, potentially triggering false alarms or missing hypoxemia during outpatient monitoring. Conventional devices often lack real-time mechanisms to detect and mitigate such errors, with previous reports indicating measurement biases of 11.2 - 24.5% across different models, underscoring the need for improved accuracy and user guidance. To address this gap, we present the design of an IoT-enabled wearable pulse oximeter with real-time user feedback, delivered through a mobile application. The system integrates a pulse oximetry and heart rate sensor (MAX30100) with a carbon monoxide gas sensor (MQ-7) and provides targeted notifications to guide corrective actions such as repositioning the probe, removing nail polish, or moving to fresh air. Validation involved controlled scenario testing (undetected SpO₂, CO >40 ppm, nail polish, and loose contact) and user trials with 15 healthy volunteers from varied academic backgrounds. The prototype demonstrated high accuracy, with low relative errors—0.92% (HR), 0.93% (SpO₂), and 0.015% (CO)—and strong usability, achieving 93.3% compliance with corrective prompts, an average response time of 4.0±0.7 seconds, and a satisfaction score of 4.3/5. Compared with commercial oximeters, the proposed system improved reliability by reducing measurement errors by at least 87% through real-time corrective feedback. Future work will focus on energy-efficient power management and large-scale community-based trials to further validate performance across diverse patient populations.
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References
Torres-Robles, A., Allison, K., Poon, S. K., Shaw, M., Hutchings, O., Britton, W. J., Wilson, A., & Baysari, M. (2023). Patient and Clinician Perceptions of the Pulse Oximeter in a Remote Monitoring Setting for COVID-19: Qualitative Study. Journal of medical Internet research, 25, e44540. https://doi.org/10.2196/44540.
Liu, Y., Arnaert, A., da Costa, D., Sumbly, P., Debe, Z., & Charbonneau, S. (2023). Experiences of Patients With Chronic Obstructive Pulmonary Disease Using the Apple Watch Series 6 Versus the Traditional Finger Pulse Oximeter for Home SpO2 Self-Monitoring: Qualitative Study Part 2. JMIR aging, 6, e41539. https://doi.org/10.2196/41539.
Shah, S., Majmudar, K., Stein, A., Gupta, N., Suppes, S., Karamanis, M., Capannari, J., Sethi, S., & Patte, C. (2020). Novel Use of Home Pulse Oximetry Monitoring in COVID-19 Patients Discharged From the Emergency Department Identifies Need for Hospitalization. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 27(8), 681–692. https://doi.org/10.1111/acem.14053.
Patterson, S., Sandercock, N., & Verhovsek, M. (2022). Understanding pulse oximetry in hematology patients: Hemoglobinopathies, racial differences, and beyond. American journal of hematology, 97(12), 1659–1663. https://doi.org/10.1002/ajh.26721.
Stell, D., Noble, J. J., Kay, R. H., Kwong, M. T., Jeffryes, M. J. R., Johnston, L., Glover, G., & Akinluyi, E. (2022). Exploring the impact of pulse oximeter selection within the COVID-19 home-use pulse oximetry pathways. BMJ open respiratory research, 9(1), e001159. https://doi.org/10.1136/bmjresp-2021-001159.
Khushhal, A. A., Mohamed, A. A., & Elsayed, M. E. (2024). Accuracy of Apple Watch to Measure Cardiovascular Indices in Patients with Chronic Diseases: A Cross Sectional Study. Journal of multidisciplinary healthcare, 17, 1053–1063. https://doi.org/10.2147/JMDH.S449071.
McCauley, K. E., Schroeder, A. A., DeBoth, T. K., Wiebe, A. M., Bosley, C. L., Ballweg, D. D., & Fang, J. L. (2021). Reducing Alarm Burden in a Level IV Neonatal Intensive Care Unit. Pediatric quality & safety, 6(2), e386. https://doi.org/10.1097/pq9.0000000000000386.
Crooks, C. J., West, J., Morling, J. R., Simmonds, M., Juurlink, I., Briggs, S., Cruickshank, S., Hammond-Pears, S., Shaw, D., Card, T. R., & Fogarty, A. W. (2022). Pulse oximeter measurement error of oxygen saturation in patients with SARS-CoV-2 infection stratified by smoking status. The European respiratory journal, 60(5), 2201190. https://doi.org/10.1183/13993003.01190-2022.
Dewi Lia Listyawati, Rachmaniyah, Marlik, Khambali, & Edza Aria Wikurendra. (2024). The Effect Of Carbon Monoxide Gas Exposure Levels On Oxygen Saturation In Parking Attendants . Window of Health : Jurnal Kesehatan, 7(3), 320-328. https://doi.org/10.33096/woh.v7i2.1281.
Aggarwal, A. N., Agarwal, R., Dhooria, S., Prasad, K. T., Sehgal, I. S., & Muthu, V. (2023). Impact of Fingernail Polish on Pulse Oximetry Measurements: A Systematic Review. Respiratory care, 68(9), 1271–1280. https://doi.org/10.4187/respcare.10399.
Fawzy, A., Ali, H., Dziedzic, P. H., Potu, N., Calvillo, E., Golden, S. H., Iwashyna, T. J., Suarez, J. I., Hager, D. N., & Garibaldi, B. T. (2023). Skin Pigmentation and Pulse Oximeter Accuracy in the Intensive Care Unit: a Pilot Prospective Study. medRxiv : the preprint server for health sciences, 2023.11.16.23298645. https://doi.org/10.1101/2023.11.16.23298645.
Smith, R. N., & Hofmeyr, R. (2019). Perioperative comparison of the agreement between a portable fingertip pulse oximeter v. a conventional bedside pulse oximeter in adult patients (COMFORT trial). South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 109(3), 154–158. https://doi.org/10.7196/SAMJ.2019.v109i3.13633.
Gudelunas, M. K., Lipnick, M., Hendrickson, C., Vanderburg, S., Okunlola, B., Auchus, I., Feiner, J. R., & Bickler, P. E. (2024). Low Perfusion and Missed Diagnosis of Hypoxemia by Pulse Oximetry in Darkly Pigmented Skin: A Prospective Study. Anesthesia and analgesia, 138(3), 552–561. https://doi.org/10.1213/ANE.0000000000006755.
Naseer, U., Siddiqi, F. A., Rehman, A., Shaheen, S., Gul, H., & Aziz, M. S. (2022). Impact of Nail Polish Colour on the Accuracy of Pulse Oximeter Reading in Healthy Individuals. Pakistan Armed Forces Medical Journal, 72(5), 1843-46. https://doi.org/10.51253/pafmj.v72i5.8861.
Yek, J. L. J., Abdullah, H. R., Goh, J. P. S., & Chan, Y. W. (2019). The effects of gel-based manicure on pulse oximetry. Singapore medical journal, 60(8), 432–435. https://doi.org/10.11622/smedj.2019031.
Cabanas, A. M., Fuentes-Guajardo, M., Latorre, K., León, D., & Martín-Escudero, P. (2022). Skin Pigmentation Influence on Pulse Oximetry Accuracy: A Systematic Review and Bibliometric Analysis. Sensors (Basel, Switzerland), 22(9), 3402. https://doi.org/10.3390/s22093402.
Yikar, S.K., Arslan, S. and Nazik, E. (2019). The Effect of Nail Polish on Pulseoximeter’s Measurements in Healthy Individuals. Int. J. Caring Sci., 12(2), 1144–1147. https://www.internationaljournalofcaringsciences.org/docs/62.
Gottlieb, E. R., Ziegler, J., Morley, K., Rush, B., & Celi, L. A. (2022). Assessment of Racial and Ethnic Differences in Oxygen Supplementation Among Patients in the Intensive Care Unit. JAMA internal medicine, 182(8), 849–858. https://doi.org/10.1001/jamainternmed.2022.2587.
Turanli, M., Ilhan, I. & Yavsan, E. Development of wearable device and synchronized Mobile application to monitor vital signs in real time. Multimed Tools Appl 84, 36435–36451 (2025). https://doi.org/10.1007/s11042-024-19600-2.
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