Comprehensive HRV estimation pipeline in Python using Neurokit2: Application to sleep physiology

Predicting Dysglycemia in Patients with Diabetes Using Electrocardiogram

Background: In this study, we explored the potential of predicting dysglycemia in patients who need to continuously manage blood glucose levels using a non-invasive method via electrocardiography (ECG). Methods: The data were collected from patients with diabetes, and heart rate variability (HRV) features were extracted via ECG processing. A residual block-based one-dimensional convolution neural network model was used to predict dysglycemia. Results: The dysglycemia prediction results at each time point, including at the time of blood glucose measurement, 15 min prior to measurement, and 30 min prior to measurement, exhibited no significant differences compared with the blood glucose measurement values. This result confirmed that the proposed artificial intelligence model for dysglycemia prediction performed well at each time point. Additionally, to determine the optimal number of features required for predicting dysglycemia, 77 HRV features were individually eliminated in the order of decreasing importance with respect to the prediction accuracy; the optimal number of features for the model to predict dysglycemia was determined to be 12. The dysglycemia prediction results obtained 30 min prior to measurement, which exhibited the highest prediction range in this study, were as follows: accuracy = 90.5, sensitivity = 87.52, specificity = 92.74, and precision = 89.86. Conclusions: Furthermore, we determined that no significant differences exist in the blood glucose prediction results reported in previous studies, wherein various vital signs and blood glucose values were used as model inputs, and the results obtained in this study, wherein only ECG data were used to predict dysglycemia.

Decoding influences of indoor temperature and light on neural activity: entropy analysis of electroencephalographic signals

Understanding the neural responses to indoor characteristics like temperature and light is crucial for comprehending how the physical environment influences the human brain. Our study introduces an innovative approach using entropy analysis, specifically, approximate entropy (ApEn), applied to electroencephalographic (EEG) signals to investigate neural responses to temperature and light variations in indoor environments. By strategically placing electrodes over specific brain regions linked to temperature and light processing, we show how ApEn can be influenced by indoor factors. We also integrate heart indices from a multi-sensor bracelet to create a machine learning classifier for temperature conditions. Results showed that in anterior frontal and temporoparietal areas, neutral temperature conditions yield higher ApEn values. The anterior frontal area showed a trend of gradually decreasing ApEn values from neutral to warm conditions, with cold being in an intermediate position. There was a significant interaction between light and site factors, only evident in the temporoparietal region. Here, the neutral light condition had higher ApEn values compared to blue and red light conditions. Positive correlations between anterior frontal ApEn and thermal comfort scores suggest a link between entropy and perceived thermal comfort. Our quadratic SVM classifier, incorporating entropy and heart features, demonstrates strong performance (until 90% in terms of AUC, accuracy, sensitivity, and specificity) in classifying temperature sensations. This study offers insights into neural responses to indoor factors and presents a novel approach for temperature classification using EEG entropy and heart features.

Deep Attention Networks With Multi-Temporal Information Fusion for Sleep Apnea Detection

Sleep Apnea (SA) is a prevalent sleep disorder with multifaceted etiologies that can have severe consequences for patients. Diagnosing SA traditionally relies on the in-laboratory polysomnogram (PSG), which records various human physiological activities overnight. SA diagnosis involves manual scoring by qualified physicians. Traditional machine learning methods for SA detection depend on hand-crafted features, making feature selection pivotal for downstream classification tasks. In recent years, deep learning has gained popularity in SA detection due to its capability for automatic feature extraction and superior classification accuracy. This study introduces a Deep Attention Network with Multi-Temporal Information Fusion (DAN-MTIF) for SA detection using single-lead electrocardiogram (ECG) signals. This framework utilizes three 1D convolutional neural network (CNN) blocks to extract features from R-R intervals and R-peak amplitudes using segments of varying lengths. Recognizing that features derived from different temporal scales vary in their contribution to classification, we integrate a multi-head attention module with a self-attention mechanism to learn the weights for each feature vector. Comprehensive experiments and comparisons between two paradigms of classical machine learning approaches and deep learning approaches are conducted. Our experiment results demonstrate that (1) compared with benchmark methods, the proposed DAN-MTIF exhibits excellent performance with 0.9106 accuracy, 0.9396 precision, 0.8470 sensitivity, 0.9588 specificity, and 0.8909 [Formula: see text] score at per-segment level; (2) DAN-MTIF can effectively extract features with a higher degree of discrimination from ECG segments of multiple timescales than those with a single time scale, ensuring a better SA detection performance; (3) the overall performance of deep learning methods is better than the classical machine learning algorithms, highlighting the superior performance of deep learning approaches for SA detection.

Long-COVID-19 autonomic dysfunction: An integrated view in the framework of inflammaging

The recently identified syndrome known as Long COVID (LC) is characterized by a constellation of debilitating conditions that impair both physical and cognitive functions, thus reducing the quality of life and increasing the risk of developing the most common age-related diseases. These conditions are linked to the presence of symptoms of autonomic dysfunction, in association with low cortisol levels, suggestive of reduced hypothalamic-pituitary-adrenal (HPA) axis activity, and with increased pro-inflammatory condition. Alterations of dopamine and serotonin neurotransmitter levels were also recently observed in LC. Interestingly, at least some of the proposed mechanisms of LC development overlap with mechanisms of Autonomic Nervous System (ANS) imbalance, previously detailed in the framework of the aging process. ANS imbalance is characterized by a proinflammatory sympathetic overdrive, and a concomitant decreased anti-inflammatory vagal parasympathetic activity, associated with reduced anti-inflammatory effects of the HPA axis and cholinergic anti-inflammatory pathway (CAP). These neuro-immune-endocrine system imbalanced activities fuel the vicious circle of chronic inflammation, i.e. inflammaging. Here, we refine our original hypothesis that ANS dysfunction fuels inflammaging and propose that biomarkers of ANS imbalance could also be considered biomarkers of inflammaging, recognized as the main risk factor for developing age-related diseases and the sequelae of viral infections, i.e. LC.

Real-time machine learning model to predict in-hospital cardiac arrest using heart rate variability in ICU

Predicting in-hospital cardiac arrest in patients admitted to an intensive care unit (ICU) allows prompt interventions to improve patient outcomes. We developed and validated a machine learning-based real-time model for in-hospital cardiac arrest predictions using electrocardiogram (ECG)-based heart rate variability (HRV) measures. The HRV measures, including time/frequency domains and nonlinear measures, were calculated from 5 min epochs of ECG signals from ICU patients. A light gradient boosting machine (LGBM) algorithm was used to develop the proposed model for predicting in-hospital cardiac arrest within 0.5-24 h. The LGBM model using 33 HRV measures achieved an area under the receiver operating characteristic curve of 0.881 (95% CI: 0.875-0.887) and an area under the precision-recall curve of 0.104 (95% CI: 0.093-0.116). The most important feature was the baseline width of the triangular interpolation of the RR interval histogram. As our model uses only ECG data, it can be easily applied in clinical practice.

Precise detection and localization of R-peaks from ECG signals

Heart rate variability (HRV) is derived from the R-R interval, which depends on the precise localization of R-peaks within an electrocardiogram (ECG) signal. However, current algorithm assessment methods prioritize the R-peak detection's sensitivity rather than the precision of pinpointing the exact R-peak positions. As a result, it is of great value to develop an R-peak detection algorithm with high-precision R-peak localization. This paper introduces a novel R-peak localization algorithm that involves modifications to the well-established Pan-Tompkins (PT) algorithm. The algorithm was implemented as follows. First, the raw ECG signal $ X\left(i\right) $ was band-pass filtered (5-35 Hz) to obtain a preprocessed signal $ Y\left(i\right) $. Second, $ Y\left(i\right) $ was squared to enhance the QRS complex, followed by a 5 Hz low-pass filter to obtain the QRS envelope, which was transformed into a window signal $ W\left(i\right) $ by dynamic threshold with a minimum width of 200 ms to mark the QRS complex. Third, $ Y\left(i\right) $ was used to generate QRS template $ T\left(n\right) $ automatically, and then the R-peak was identified by a template matching process to find the maximum absolute value of all cross-correlation values between $ T\left(n\right) $ and $ Y\left(i\right) $. The proposed algorithm achieved a sensitivity (SE) of 99.78%, a positive prediction value (PPV) of 99.78% and data error rate (DER) of 0.44% in R-peak localization for the MIT-BIH Arrhythmia database. The annotated-detected error (ADE), which represents the error between the annotated R-peak location and the detected R-peak location, was 8.35 ms for the MIT-BIH Arrhythmia database. These results outperformed the results obtained using the classical Pan-Tompkins algorithm which yielded an SE of 98.87%, a PPV of 99.14%, a DER of 1.98% and an ADE of 21.65 ms for the MIT-BIH Arrhythmia database. It can be concluded that the algorithm can precisely detect the location of R-peaks and may have the potential to enhance clinical applications of HRV analysis.

Heart Rate Variability Code: Does It Exist and Can We Hack It?

A code is generally defined as a system of signals or symbols for communication. Experimental evidence is synthesized for the presence and utility of such communication in heart rate variability (HRV) with particular attention to fetal HRV: HRV contains signatures of information flow between the organs and of response to physiological or pathophysiological stimuli as signatures of states (or syndromes). HRV exhibits features of time structure, phase space structure, specificity with respect to (organ) target and pathophysiological syndromes, and universality with respect to species independence. Together, these features form a spatiotemporal structure, a phase space, that can be conceived of as a manifold of a yet-to-be-fully understood dynamic complexity. The objective of this article is to synthesize physiological evidence supporting the existence of HRV code: hereby, the process-specific subsets of HRV measures indirectly map the phase space traversal reflecting the specific information contained in the code required for the body to regulate the physiological responses to those processes. The following physiological examples of HRV code are reviewed, which are reflected in specific changes to HRV properties across the signal-analytical domains and across physiological states and conditions: the fetal systemic inflammatory response, organ-specific inflammatory responses (brain and gut), chronic hypoxia and intrinsic (heart) HRV (iHRV), allostatic load (physiological stress due to surgery), and vagotomy (bilateral cervical denervation). Future studies are proposed to test these observations in more depth, and the author refers the interested reader to the referenced publications for a detailed study of the HRV measures involved. While being exemplified mostly in the studies of fetal HRV, the presented framework promises more specific fetal, postnatal, and adult HRV biomarkers of health and disease, which can be obtained non-invasively and continuously.