# SSVEP-based brain–computer interface enabling graded dyspnoea self-report: proof-of-concept study in healthy volunteers

## TL;DR

A brain-computer interface using steady-state visual evoked potentials was tested to allow healthy volunteers to self-report breathing discomfort, showing promising results.

## Contribution

This is the first proof-of-concept study demonstrating SSVEP-based BCI for graded dyspnoea self-reporting in non-communicative contexts.

## Key findings

- The detection BCI achieved an AUC of 0.89 using 20–30 Hz stimuli for dyspnoea detection.
- The quantification BCI using low-frequency stimuli achieved an AUC of 0.84 for dyspnoea grading.
- Participants reported significant respiratory discomfort during specific breathing conditions compared to normal breathing.

## Abstract

Mechanically ventilated patients may experience respiratory suffering, which is difficult to assess when verbal communication is impaired. We evaluated the performance of a steady-state visual evoked potential (SSVEP)-based brain–computer interface (BCI) designed to enable self-reporting of dyspnoea in this context.

Forty-nine healthy volunteers were studied under five respiratory conditions: normal breathing (NB), inspiratory resistive loading (IRL), inspiratory threshold loading (ITL), CO₂ inhalation (CO₂), and a return to NB as wash-out (NBWO). Respiratory discomfort was evaluated using a visual analogue scale (VAS). Two BCIs models were tested: a detection BCI (D-BCI), designed to discriminate between ‘breathing is OK’ and ‘breathing is difficult’, and a quantification BCI in the form of a LED-based analogue scale (LAS), composed of five light-emitting diodes. Visual stimuli were delivered at different frequency sets: 12–15 Hz, 15–20 Hz, and 20–30 Hz for the D-BCI; low frequencies (13–17–19–23–29 Hz) and high frequencies (41–43–47–53–59 Hz) for the LAS. Performance was assessed using receiver operating characteristic (ROC) curves; the area under the ROC curve (AUC) was the primary outcome.

Participants reported significant respiratory discomfort during IRL, ITL, and CO₂ conditions in the D-BCI groups, and during ITL and CO₂ in the LAS groups, as reflected by higher dyspnoea VAS scores compared to NB. The best-performing frequency sets were 20–30 Hz for the D-BCI (AUC 0.89 [0.89–0.90]) and low frequencies for the LAS (AUC 0.84 [0.83–0.85]).

This study demonstrates that an SSVEP-based BCI can sucessfully detect and quantify experimentally induced dyspnoea in healthy individuals. Further research is needed to evaluate its clinical applicability for assessing dyspnoea in non-communicative patients.

The online version contains supplementary material available at 10.1186/s12984-025-01846-y.