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Mauldin K, Pignotti GAP, Gieng J. Measures of nutrition status and health for weight-inclusive patient care: A narrative review. Nutr Clin Pract 2024; 39:751-771. [PMID: 38796769 DOI: 10.1002/ncp.11158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/07/2024] [Accepted: 04/25/2024] [Indexed: 05/28/2024] Open
Abstract
In healthcare, weight is often equated to and used as a marker for health. In examining nutrition and health status, there are many more effective markers independent of weight. In this article, we review practical and emerging clinical applications of technologies and tools used to collect non-weight-related data in nutrition assessment, monitoring, and evaluation in the outpatient setting. The aim is to provide clinicians with new ideas about various types of data to evaluate and track in nutrition care.
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Affiliation(s)
- Kasuen Mauldin
- Department of Nutrition, Food Science, and Packaging, San Jose State University, San Jose, California, USA
- Clinical Nutrition, Stanford Health Care, Stanford, California, USA
| | - Giselle A P Pignotti
- Department of Nutrition, Food Science, and Packaging, San Jose State University, San Jose, California, USA
| | - John Gieng
- Department of Nutrition, Food Science, and Packaging, San Jose State University, San Jose, California, USA
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2
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Moebus M, Holz C. Personalized interpretable prediction of perceived sleep quality: Models with meaningful cardiovascular and behavioral features. PLoS One 2024; 19:e0305258. [PMID: 38976698 PMCID: PMC11230538 DOI: 10.1371/journal.pone.0305258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/28/2024] [Indexed: 07/10/2024] Open
Abstract
Understanding a person's perceived quality of sleep is an important problem, but hard due to its poor definition and high intra- as well as inter-individual variation. In the short term, sleep quality has an established impact on cognitive function during the following day as well as on fatigue. In the long term, good quality sleep is essential for mental and physical health and contributes to quality of life. Despite the need to better understand sleep quality as an early indicator for sleep disorders, perceived sleep quality has been rarely modeled for multiple consecutive days using biosignals. In this paper, we present novel insights on the association of cardiac activity and perceived sleep quality using an interpretable modeling approach utilizing the publicly available intensive-longitudinal study M2Sleep. Our method takes as input signals from commodity wearable devices, including motion and blood volume pulses. Despite processing only simple and clearly interpretable features, we achieve an accuracy of up to 70% with an AUC of 0.76 and reduce the error by up to 36% compared to related work. We further argue that collected biosignals and sleep quality labels should be normalized per-participant to enable a medically insightful analysis. Coupled with explainable models, this allows for the interpretations of effects on perceived sleep quality. Analysis revealed that besides higher skin temperature and sufficient sleep duration, especially higher average heart rate while awake and lower minimal activity of the parasympathetic and sympathetic nervous system while asleep increased the chances of higher sleep quality.
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Affiliation(s)
- Max Moebus
- Department of Computer Science, ETH Zurich, Zürich, Switzerland
| | - Christian Holz
- Department of Computer Science, ETH Zurich, Zürich, Switzerland
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3
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Matzke I, Huhn S, Koch M, Maggioni MA, Munga S, Muma JO, Odhiambo CO, Kwaro D, Obor D, Bärnighausen T, Dambach P, Barteit S. Assessment of Heat Exposure and Health Outcomes in Rural Populations of Western Kenya by Using Wearable Devices: Observational Case Study. JMIR Mhealth Uhealth 2024; 12:e54669. [PMID: 38963698 DOI: 10.2196/54669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time. OBJECTIVE The aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures. METHODS We conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes. RESULTS Our cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P=.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8%) out of 204 days. Despite 10 (21%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6%, SD 21.3% and mean 86.1%, SD 18.9%, respectively), but low for heart rate (mean 7%, SD 14%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P=.003; Mann-Whitney U test: P=.001). Body shell temperature data achieved 36.2% (SD 24.5%) completeness. CONCLUSIONS Our study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study's application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change.
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Affiliation(s)
- Ina Matzke
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sophie Huhn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Mara Koch
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Martina Anna Maggioni
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environment, Berlin, Germany
- Department of Biomedical Sciences for Health, Universita degli Studi di Milano, Milan, Italy
| | - Stephen Munga
- Centre for Global Health Research KISUMU, Kenya Medical Research Institute, Kisumu, Kenya
| | - Julius Okoth Muma
- Centre for Global Health Research KISUMU, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Daniel Kwaro
- Centre for Global Health Research KISUMU, Kenya Medical Research Institute, Kisumu, Kenya
| | - David Obor
- Centre for Global Health Research KISUMU, Kenya Medical Research Institute, Kisumu, Kenya
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Havard University, Boston, MA, United States
- Africa Health Research Institute, KwaZulu-Natal, Somkhele, South Africa
| | - Peter Dambach
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sandra Barteit
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
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Song S, Seo Y, Hwang S, Kim HY, Kim J. Digital Phenotyping of Geriatric Depression Using a Community-Based Digital Mental Health Monitoring Platform for Socially Vulnerable Older Adults and Their Community Caregivers: 6-Week Living Lab Single-Arm Pilot Study. JMIR Mhealth Uhealth 2024; 12:e55842. [PMID: 38885033 PMCID: PMC11217709 DOI: 10.2196/55842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/03/2024] [Accepted: 05/23/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Despite the increasing need for digital services to support geriatric mental health, the development and implementation of digital mental health care systems for older adults have been hindered by a lack of studies involving socially vulnerable older adult users and their caregivers in natural living environments. OBJECTIVE This study aims to determine whether digital sensing data on heart rate variability, sleep quality, and physical activity can predict same-day or next-day depressive symptoms among socially vulnerable older adults in their everyday living environments. In addition, this study tested the feasibility of a digital mental health monitoring platform designed to inform older adult users and their community caregivers about day-to-day changes in the health status of older adults. METHODS A single-arm, nonrandomized living lab pilot study was conducted with socially vulnerable older adults (n=25), their community caregivers (n=16), and a managerial social worker over a 6-week period during and after the COVID-19 pandemic. Depressive symptoms were assessed daily using the 9-item Patient Health Questionnaire via scripted verbal conversations with a mobile chatbot. Digital biomarkers for depression, including heart rate variability, sleep, and physical activity, were measured using a wearable sensor (Fitbit Sense) that was worn continuously, except during charging times. Daily individualized feedback, using traffic signal signs, on the health status of older adult users regarding stress, sleep, physical activity, and health emergency status was displayed on a mobile app for the users and on a web application for their community caregivers. Multilevel modeling was used to examine whether the digital biomarkers predicted same-day or next-day depressive symptoms. Study staff conducted pre- and postsurveys in person at the homes of older adult users to monitor changes in depressive symptoms, sleep quality, and system usability. RESULTS Among the 31 older adult participants, 25 provided data for the living lab and 24 provided data for the pre-post test analysis. The multilevel modeling results showed that increases in daily sleep fragmentation (P=.003) and sleep efficiency (P=.001) compared with one's average were associated with an increased risk of daily depressive symptoms in older adults. The pre-post test results indicated improvements in depressive symptoms (P=.048) and sleep quality (P=.02), but not in the system usability (P=.18). CONCLUSIONS The findings suggest that wearable sensors assessing sleep quality may be utilized to predict daily fluctuations in depressive symptoms among socially vulnerable older adults. The results also imply that receiving individualized health feedback and sharing it with community caregivers may help improve the mental health of older adults. However, additional in-person training may be necessary to enhance usability. TRIAL REGISTRATION ClinicalTrials.gov NCT06270121; https://clinicaltrials.gov/study/NCT06270121.
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Affiliation(s)
- Sunmi Song
- Department of Health and Environmental Science, Undergraduate School, Korea University, Seoul, Republic of Korea
- Department of Physical Therapy, College of Health Science, Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea
| | - YoungBin Seo
- Department of Healthcare Sciences, Graduate School, Korea University, Seoul, Republic of Korea
- BK21FOUR: L-HOPE Program for Community-Based Total Learning Health Systems, College of Health Science, Korea University, Seoul, Republic of Korea
| | - SeoYeon Hwang
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea
- BK21FOUR: L-HOPE Program for Community-Based Total Learning Health Systems, College of Health Science, Korea University, Seoul, Republic of Korea
| | - Hae-Young Kim
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea
- Department of Healthcare Sciences, Graduate School, Korea University, Seoul, Republic of Korea
- BK21FOUR: L-HOPE Program for Community-Based Total Learning Health Systems, College of Health Science, Korea University, Seoul, Republic of Korea
- Department of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
| | - Junesun Kim
- Department of Health and Environmental Science, Undergraduate School, Korea University, Seoul, Republic of Korea
- Department of Physical Therapy, College of Health Science, Korea University, Seoul, Republic of Korea
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea
- BK21FOUR: L-HOPE Program for Community-Based Total Learning Health Systems, College of Health Science, Korea University, Seoul, Republic of Korea
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Weng WH, Baur S, Daswani M, Chen C, Harrell L, Kakarmath S, Jabara M, Behsaz B, McLean CY, Matias Y, Corrado GS, Shetty S, Prabhakara S, Liu Y, Danaei G, Ardila D. Predicting cardiovascular disease risk using photoplethysmography and deep learning. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003204. [PMID: 38833495 PMCID: PMC11149850 DOI: 10.1371/journal.pgph.0003204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 04/12/2024] [Indexed: 06/06/2024]
Abstract
Cardiovascular diseases (CVDs) are responsible for a large proportion of premature deaths in low- and middle-income countries. Early CVD detection and intervention is critical in these populations, yet many existing CVD risk scores require a physical examination or lab measurements, which can be challenging in such health systems due to limited accessibility. We investigated the potential to use photoplethysmography (PPG), a sensing technology available on most smartphones that can potentially enable large-scale screening at low cost, for CVD risk prediction. We developed a deep learning PPG-based CVD risk score (DLS) to predict the probability of having major adverse cardiovascular events (MACE: non-fatal myocardial infarction, stroke, and cardiovascular death) within ten years, given only age, sex, smoking status and PPG as predictors. We compare the DLS with the office-based refit-WHO score, which adopts the shared predictors from WHO and Globorisk scores (age, sex, smoking status, height, weight and systolic blood pressure) but refitted on the UK Biobank (UKB) cohort. All models were trained on a development dataset (141,509 participants) and evaluated on a geographically separate test (54,856 participants) dataset, both from UKB. DLS's C-statistic (71.1%, 95% CI 69.9-72.4) is non-inferior to office-based refit-WHO score (70.9%, 95% CI 69.7-72.2; non-inferiority margin of 2.5%, p<0.01) in the test dataset. The calibration of the DLS is satisfactory, with a 1.8% mean absolute calibration error. Adding DLS features to the office-based score increases the C-statistic by 1.0% (95% CI 0.6-1.4). DLS predicts ten-year MACE risk comparable with the office-based refit-WHO score. Interpretability analyses suggest that the DLS-extracted features are related to PPG waveform morphology and are independent of heart rate. Our study provides a proof-of-concept and suggests the potential of a PPG-based approach strategies for community-based primary prevention in resource-limited regions.
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Affiliation(s)
- Wei-Hung Weng
- Google LLC, Mountain View, California, United States of America
| | - Sebastien Baur
- Google LLC, Mountain View, California, United States of America
| | - Mayank Daswani
- Google LLC, Mountain View, California, United States of America
| | - Christina Chen
- Google LLC, Mountain View, California, United States of America
| | - Lauren Harrell
- Google LLC, Mountain View, California, United States of America
| | - Sujay Kakarmath
- Google LLC, Mountain View, California, United States of America
| | - Mariam Jabara
- Google LLC, Mountain View, California, United States of America
| | - Babak Behsaz
- Google LLC, Mountain View, California, United States of America
| | - Cory Y. McLean
- Google LLC, Mountain View, California, United States of America
| | - Yossi Matias
- Google LLC, Mountain View, California, United States of America
| | - Greg S. Corrado
- Google LLC, Mountain View, California, United States of America
| | - Shravya Shetty
- Google LLC, Mountain View, California, United States of America
| | | | - Yun Liu
- Google LLC, Mountain View, California, United States of America
| | - Goodarz Danaei
- Department of Global Health and Population, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Diego Ardila
- Google LLC, Mountain View, California, United States of America
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Keshmiri S, Tomonaga S, Mizutani H, Doya K. Respiratory modulation of the heart rate: A potential biomarker of cardiorespiratory function in human. Comput Biol Med 2024; 173:108335. [PMID: 38564855 DOI: 10.1016/j.compbiomed.2024.108335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
In recent decade, wearable digital devices have shown potentials for the discovery of novel biomarkers of humans' physiology and behavior. Heart rate (HR) and respiration rate (RR) are most crucial bio-signals in humans' digital phenotyping research. HR is a continuous and non-invasive proxy to autonomic nervous system and ample evidence pinpoints the critical role of respiratory modulation of cardiac function. In the present study, we recorded longitudinal (7 days, 4.63 ± 1.52) HR and RR of 89 freely behaving human subjects (Female: 39, age 57.28 ± 5.67, Male: 50, age 58.48 ± 6.32) and analyzed their dynamics using linear models and information theoretic measures. While HR's linear and nonlinear characteristics were expressed within the plane of the HR-RR directed flow of information (HR→RR - RR→HR), their dynamics were determined by its RR→HR axis. More importantly, RR→HR quantified the effect of alcohol consumption on individuals' cardiorespiratory function independent of their consumed amount of alcohol, thereby signifying the presence of this habit in their daily life activities. The present findings provided evidence for the critical role of the respiratory modulation of HR, which was previously only studied in non-human animals. These results can contribute to humans' phenotyping research by presenting RR→HR as a digital diagnosis/prognosis marker of humans' cardiorespiratory pathology.
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Affiliation(s)
- Soheil Keshmiri
- Optical Neuroimaging Unit, Okinawa Institute of Science and Technology, Okinawa, Japan.
| | - Sutashu Tomonaga
- Neural Computation Unit (NCU), Okinawa Institute of Science and Technology, Okinawa, Japan.
| | - Haruo Mizutani
- Suntory Global Innovation Center Limited (SGIC), Suntory, Kyoto, Japan.
| | - Kenji Doya
- Neural Computation Unit (NCU), Okinawa Institute of Science and Technology, Okinawa, Japan.
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Yasar MN, Sica M, O'Flynn B, Tedesco S, Menolotto M. A dataset for fatigue estimation during shoulder internal and external rotation movements using wearables. Sci Data 2024; 11:433. [PMID: 38678019 PMCID: PMC11055894 DOI: 10.1038/s41597-024-03254-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
Wearable sensors have recently been extensively used in sports science, physical rehabilitation, and industry providing feedback on physical fatigue. Information obtained from wearable sensors can be analyzed by predictive analytics methods, such as machine learning algorithms, to determine fatigue during shoulder joint movements, which have complex biomechanics. The presented dataset aims to provide data collected via wearable sensors during a fatigue protocol involving dynamic shoulder internal rotation (IR) and external rotation (ER) movements. Thirty-four healthy subjects performed shoulder IR and ER movements with different percentages of maximal voluntary isometric contraction (MVIC) force until they reached the maximal exertion. The dataset includes demographic information, anthropometric measurements, MVIC force measurements, and digital data captured via surface electromyography, inertial measurement unit, and photoplethysmography, as well as self-reported assessments using the Borg rating scale of perceived exertion and the Karolinska sleepiness scale. This comprehensive dataset provides valuable insights into physical fatigue assessment, allowing the development of fatigue detection/prediction algorithms and the study of human biomechanical characteristics during shoulder movements within a fatigue protocol.
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Affiliation(s)
- Merve Nur Yasar
- Tyndall National Institute, University College Cork, Cork, T12 R5CP, Ireland.
| | - Marco Sica
- Tyndall National Institute, University College Cork, Cork, T12 R5CP, Ireland.
| | - Brendan O'Flynn
- Tyndall National Institute, University College Cork, Cork, T12 R5CP, Ireland
| | - Salvatore Tedesco
- Tyndall National Institute, University College Cork, Cork, T12 R5CP, Ireland
| | - Matteo Menolotto
- Tyndall National Institute, University College Cork, Cork, T12 R5CP, Ireland
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Bester M, Nichting TJ, Joshi R, Aissati L, Oei GS, Mischi M, van Laar JOEH, Vullings R. Changes in Maternal Heart Rate Variability and Photoplethysmography Morphology after Corticosteroid Administration: A Prospective, Observational Study. J Clin Med 2024; 13:2442. [PMID: 38673715 PMCID: PMC11051424 DOI: 10.3390/jcm13082442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Owing to the association between dysfunctional maternal autonomic regulation and pregnancy complications, assessing non-invasive features reflecting autonomic activity-e.g., heart rate variability (HRV) and the morphology of the photoplethysmography (PPG) pulse wave-may aid in tracking maternal health. However, women with early pregnancy complications typically receive medication, such as corticosteroids, and the effect of corticosteroids on maternal HRV and PPG pulse wave morphology is not well-researched. Methods: We performed a prospective, observational study assessing the effect of betamethasone (a commonly used corticosteroid) on non-invasively assessed features of autonomic regulation. Sixty-one women with an indication for betamethasone were enrolled and wore a wrist-worn PPG device for at least four days, from which five-minute measurements were selected for analysis. A baseline measurement was selected either before betamethasone administration or sufficiently thereafter (i.e., three days after the last injection). Furthermore, measurements were selected 24, 48, and 72 h after betamethasone administration. HRV features in the time domain and frequency domain and describing heart rate (HR) complexity were calculated, along with PPG morphology features. These features were compared between the different days. Results: Maternal HR was significantly higher and HRV features linked to parasympathetic activity were significantly lower 24 h after betamethasone administration. Features linked to sympathetic activity remained stable. Furthermore, based on the PPG morphology features, betamethasone appears to have a vasoconstrictive effect. Conclusions: Our results suggest that administering betamethasone affects maternal autonomic regulation and cardiovasculature. Researchers assessing maternal HRV in complicated pregnancies should schedule measurements before or sufficiently after corticosteroid administration.
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Affiliation(s)
- Maretha Bester
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
- Patient Care and Monitoring, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Thomas J. Nichting
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
- Department of Obstetrics and Gynecology, Máxima Medical Centrum, 5504 DB Veldhoven, The Netherlands
| | - Rohan Joshi
- Patient Care and Monitoring, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Lamyae Aissati
- Faculty of Health, Medicine and Life Science, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Guid S. Oei
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
- Department of Obstetrics and Gynecology, Máxima Medical Centrum, 5504 DB Veldhoven, The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Judith O. E. H. van Laar
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
- Department of Obstetrics and Gynecology, Máxima Medical Centrum, 5504 DB Veldhoven, The Netherlands
| | - Rik Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
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Choi DH, Lee H, Joo H, Kong HJ, Lee SB, Kim S, Shin SD, Kim KH. Development of Prediction Model for Intensive Care Unit Admission Based on Heart Rate Variability: A Case-Control Matched Analysis. Diagnostics (Basel) 2024; 14:816. [PMID: 38667462 PMCID: PMC11049103 DOI: 10.3390/diagnostics14080816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
This study aimed to develop a predictive model for intensive care unit (ICU) admission by using heart rate variability (HRV) data. This retrospective case-control study used two datasets (emergency department [ED] patients admitted to the ICU, and patients in the operating room without ICU admission) from a single academic tertiary hospital. HRV metrics were measured every 5 min using R-peak-to-R-peak (R-R) intervals. We developed a generalized linear mixed model to predict ICU admission and assessed the area under the receiver operating characteristic curve (AUC). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated from the coefficients. We analyzed 610 (ICU: 122; non-ICU: 488) patients, and the factors influencing the odds of ICU admission included a history of diabetes mellitus (OR [95% CI]: 3.33 [1.71-6.48]); a higher heart rate (OR [95% CI]: 3.40 [2.97-3.90] per 10-unit increase); a higher root mean square of successive R-R interval differences (RMSSD; OR [95% CI]: 1.36 [1.22-1.51] per 10-unit increase); and a lower standard deviation of R-R intervals (SDRR; OR [95% CI], 0.68 [0.60-0.78] per 10-unit increase). The final model achieved an AUC of 0.947 (95% CI: 0.906-0.987). The developed model effectively predicted ICU admission among a mixed population from the ED and operating room.
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Affiliation(s)
- Dong Hyun Choi
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul 03080, Republic of Korea; (D.H.C.); (S.K.)
| | - Hyunju Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Republic of Korea; (H.L.); (S.D.S.)
| | - Hyunjin Joo
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul 03080, Republic of Korea; (H.J.); (H.-J.K.)
| | - Hyoun-Joong Kong
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul 03080, Republic of Korea; (H.J.); (H.-J.K.)
- Department of Transdisciplinary Medicine, Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Seung Bok Lee
- Medical Big Data Research Center, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul 03080, Republic of Korea; (D.H.C.); (S.K.)
- Institute of Bioengineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Republic of Korea; (H.L.); (S.D.S.)
- Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Ki Hong Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Republic of Korea; (H.L.); (S.D.S.)
- Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
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Goda MÁ, Charlton PH, Behar JA. pyPPG: a Python toolbox for comprehensive photoplethysmography signal analysis. Physiol Meas 2024; 45:045001. [PMID: 38478997 PMCID: PMC11003363 DOI: 10.1088/1361-6579/ad33a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/21/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024]
Abstract
Objective.Photoplethysmography is a non-invasive optical technique that measures changes in blood volume within tissues. It is commonly and being increasingly used for a variety of research and clinical applications to assess vascular dynamics and physiological parameters. Yet, contrary to heart rate variability measures, a field which has seen the development of stable standards and advanced toolboxes and software, no such standards and limited open tools exist for continuous photoplethysmogram (PPG) analysis. Consequently, the primary objective of this research was to identify, standardize, implement and validate key digital PPG biomarkers.Approach.This work describes the creation of a standard Python toolbox, denotedpyPPG, for long-term continuous PPG time-series analysis and demonstrates the detection and computation of a high number of fiducial points and digital biomarkers using a standard fingerbased transmission pulse oximeter.Main results.The improved PPG peak detector had an F1-score of 88.19% for the state-of-the-art benchmark when evaluated on 2054 adult polysomnography recordings totaling over 91 million reference beats. The algorithm outperformed the open-source original Matlab implementation by ∼5% when benchmarked on a subset of 100 randomly selected MESA recordings. More than 3000 fiducial points were manually annotated by two annotators in order to validate the fiducial points detector. The detector consistently demonstrated high performance, with a mean absolute error of less than 10 ms for all fiducial points.Significance.Based on these fiducial points,pyPPGengineered a set of 74 PPG biomarkers. Studying PPG time-series variability usingpyPPGcan enhance our understanding of the manifestations and etiology of diseases. This toolbox can also be used for biomarker engineering in training data-driven models.pyPPGis available onhttps://physiozoo.com/.
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Affiliation(s)
- Márton Á Goda
- Faculty of Biomedical Engineering, Technion Institute of Technology, Technion-IIT, Haifa, 32000, Israel
- Pázmány Péter Catholic University Faculty of Information Technology and Bionics, Budapest, Práter u. 50/A, 1083, Hungary
| | - Peter H Charlton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, United Kingdom
| | - Joachim A Behar
- Faculty of Biomedical Engineering, Technion Institute of Technology, Technion-IIT, Haifa, 32000, Israel
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11
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Salmio A, Rissanen APE, Kurkela JLO, Rottensteiner M, Seipäjärvi S, Juurakko J, Kujala UM, Laukkanen JA, Wikgren J. Cardiorespiratory fitness is linked with heart rate variability during stress in "at-risk" adults. J Sports Med Phys Fitness 2024; 64:334-347. [PMID: 38213267 DOI: 10.23736/s0022-4707.23.15373-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Physiological mechanisms explaining why cardiorespiratory fitness (CRF) predicts cardiovascular morbidity and mortality are incompletely understood. We examined if CRF modifies vagally mediated heart rate variability (HRV) during acute physical or psychosocial stress or night-time sleep in adults with cardiovascular risk factors. METHODS Seventy-eight adults (age 56 years [IQR 50-60], 74% female, body mass index 28 kg/m2 [IQR 25-31]) with frequent cardiovascular risk factors participated in this cross-sectional study. They went through physical (treadmill cardiopulmonary exercise test [CPET]) and psychosocial (Trier Social Stress Test for Groups [TSST-G]) stress tests and night-time sleep monitoring (polysomnography). Heart rate (HR) and vagally mediated HRV (root mean square of successive differences between normal R-R intervals [RMSSD]) were recorded during the experiments and analyzed by taking account of potential confounders. RESULTS CRF (peak O2 uptake) averaged 99% (range 78-126) in relation to reference data. From pre-rest to moderate intensities during CPET and throughout TSST-G, HR did not differ between participants with CRF below median (CRFlower) and CRF equal to or above median (CRFhigher), whereas CRFhigher had higher HRV than CRFlower, and CRF correlated positively with HRV in all participants. Meanwhile, CRF had no independent associations with HR or HRV levels during slow-wave sleep, the presence of metabolic syndrome was not associated with recorded HR or HRV levels, and single factors predicted HRV responsiveness independently only to limited extents. CONCLUSIONS CRF is positively associated with prevailing vagally mediated HRV at everyday levels of physical and psychosocial stress in adults with cardiovascular risk factors.
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Affiliation(s)
- Anniina Salmio
- Center for Interdisciplinary Brain Research, Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Antti-Pekka E Rissanen
- Central Finland Health Care District, Jyväskylä, Finland -
- Sports and Exercise Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- HULA - Helsinki Sports and Exercise Medicine Clinic, Foundation for Sports and Exercise Medicine, Helsinki, Finland
| | - Jari L O Kurkela
- Center for Interdisciplinary Brain Research, Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Mirva Rottensteiner
- Central Finland Health Care District, Jyväskylä, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Santtu Seipäjärvi
- Center for Interdisciplinary Brain Research, Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Joona Juurakko
- Center for Interdisciplinary Brain Research, Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jari A Laukkanen
- Central Finland Health Care District, Jyväskylä, Finland
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jan Wikgren
- Center for Interdisciplinary Brain Research, Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
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Nashiro K, Yoo HJ, Cho C, Kim AJ, Nasseri P, Min J, Dahl MJ, Mercer N, Choupan J, Choi P, Lee HRJ, Choi D, Alemu K, Herrera AY, Ng NF, Thayer JF, Mather M. Heart rate and breathing effects on attention and memory (HeartBEAM): study protocol for a randomized controlled trial in older adults. Trials 2024; 25:190. [PMID: 38491546 PMCID: PMC10941428 DOI: 10.1186/s13063-024-07943-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/18/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND In healthy people, the "fight-or-flight" sympathetic system is counterbalanced by the "rest-and-digest" parasympathetic system. As we grow older, the parasympathetic system declines as the sympathetic system becomes hyperactive. In our prior heart rate variability biofeedback and emotion regulation (HRV-ER) clinical trial, we found that increasing parasympathetic activity through daily practice of slow-paced breathing significantly decreased plasma amyloid-β (Aβ) in healthy younger and older adults. In healthy adults, higher plasma Aβ is associated with greater risk of Alzheimer's disease (AD). Our primary goal of this trial is to reproduce and extend our initial findings regarding effects of slow-paced breathing on Aβ. Our secondary objectives are to examine the effects of daily slow-paced breathing on brain structure and the rate of learning. METHODS Adults aged 50-70 have been randomized to practice one of two breathing protocols twice daily for 9 weeks: (1) "slow-paced breathing condition" involving daily cognitive training followed by slow-paced breathing designed to maximize heart rate oscillations or (2) "random-paced breathing condition" involving daily cognitive training followed by random-paced breathing to avoid increasing heart rate oscillations. The primary outcomes are plasma Aβ40 and Aβ42 levels and plasma Aβ42/40 ratio. The secondary outcomes are brain perivascular space volume, hippocampal volume, and learning rates measured by cognitive training performance. Other pre-registered outcomes include plasma pTau-181/tTau ratio and urine Aβ42. Recruitment began in January 2023. Interventions are ongoing and will be completed by the end of 2023. DISCUSSION Our HRV-ER trial was groundbreaking in demonstrating that a behavioral intervention can reduce plasma Aβ levels relative to a randomized control group. We aim to reproduce these findings while testing effects on brain clearance pathways and cognition. TRIAL REGISTRATION ClinicalTrials.gov NCT05602220. Registered on January 12, 2023.
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Affiliation(s)
- Kaoru Nashiro
- University of Southern California, Los Angeles, USA.
| | - Hyun Joo Yoo
- University of Southern California, Los Angeles, USA
| | | | | | | | - Jungwon Min
- University of Southern California, Los Angeles, USA
| | - Martin J Dahl
- University of Southern California, Los Angeles, USA
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Noah Mercer
- University of Southern California, Los Angeles, USA
| | - Jeiran Choupan
- University of Southern California, Los Angeles, USA
- NeuroScope Inc., New York, USA
| | - Paul Choi
- University of Southern California, Los Angeles, USA
| | | | - David Choi
- University of Southern California, Los Angeles, USA
| | | | | | | | | | - Mara Mather
- University of Southern California, Los Angeles, USA
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13
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Lin Z, Zheng J, Wang Y, Su Z, Zhu R, Liu R, Wei Y, Zhang X, Wang F. Prediction of the efficacy of group cognitive behavioral therapy using heart rate variability based smart wearable devices: a randomized controlled study. BMC Psychiatry 2024; 24:187. [PMID: 38448895 PMCID: PMC10916138 DOI: 10.1186/s12888-024-05638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Depression and anxiety are common and disabling mental health problems in children and young adults. Group cognitive behavioral therapy (GCBT) is considered that an efficient and effective treatment for these significant public health concerns, but not all participants respond equally well. The aim of this study was to examine the predictive ability of heart rate variability (HRV), based on sensor data from consumer-grade wearable devices to detect GCBT effectiveness in early intervention. METHODS In a study of 33 college students with depression and anxiety, participants were randomly assigned to either GCBT group or a wait-list control (WLC) group. They wore smart wearable devices to measure their physiological activities and signals in daily life. The HRV parameters were calculated and compared between the groups. The study also assessed correlations between participants' symptoms, HRV, and GCBT outcomes. RESULTS The study showed that participants in GCBT had significant improvement in depression and anxiety symptoms after four weeks. Higher HRV was associated with greater improvement in depressive and anxious symptoms following GCBT. Additionally, HRV played a noteworthy role in determining how effective GCBT was in improve anxiety(P = 0.002) and depression(P = 0.020), and its predictive power remained significant even when considering other factors. CONCLUSION HRV may be a useful predictor of GCBT treatment efficacy. Identifying predictors of treatment response can help personalize treatment and improve outcomes for individuals with depression and anxiety. TRIAL REGISTRATION The trial has been retrospectively registered on [22/06/2023] with the registration number [NCT05913349] in the ClinicalTrials.gov. Variations in heart rate variability (HRV) have been associated with depression and anxiety, but the relationship of baseline HRV to treatment outcome in depression and anxiety is unclear. This study predicted GCBT effectiveness using HRV measured by wearable devices. 33 students with depression and anxiety participated in a trial comparing GCBT and wait-list control. HRV parameters from wearables correlated with symptoms (PHQ, PSS) and GCBT effectiveness. Baseline HRV levels are strongly associated with GCBT treatment outcomes. HRV may serve as a useful predictor of efficacy of GCBT treatment,facilitating personalized treatment approaches for individuals with depression and anxiety.
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Affiliation(s)
- Zexin Lin
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China
| | - Junjie Zheng
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China
| | - Yang Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China
| | - Zhao Su
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rongxin Zhu
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China
| | - Rongxun Liu
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China
- Henan Key Laboratory of Immunology and Targeted Drugs, School of Laboratory Medicine, Xinxiang Medical University, Xinxiang, P.R. China
| | - Yange Wei
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan, China
| | - Xizhe Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China.
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China.
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Cho HM, Han S, Seong JK, Youn I. Deep learning-based dynamic ventilatory threshold estimation from electrocardiograms. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107973. [PMID: 38118329 DOI: 10.1016/j.cmpb.2023.107973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND AND OBJECTIVE The ventilatory threshold (VT) marks the transition from aerobic to anaerobic metabolism and is used to assess cardiorespiratory endurance. A conventional way to assess VT is cardiopulmonary exercise testing, which requires a gas analyzer. Another method for measuring VT involves calculating the heart rate variability (HRV) from an electrocardiogram (ECG) by computing the variability of heartbeats. However, the HRV method has some limitations. ECGs should be recorded for at least 5 minutes to calculate the HRV, and the result may depend on the utilized ECG preprocessing algorithms. METHODS To overcome these problems, we developed a deep learning-based model consisting of long short-term memory (LSTM) and convolutional neural network (CNN) for a lead II ECG. Variables reflecting subjects' physical characteristics, as well as ECG signals, were input into the model to estimate VT. We applied joint optimization to the CNN layers to generate an informative latent space, which was fed to the LSTM layers. The model was trained and evaluated on two datasets, one from the Bruce protocol and the other from a protocol including multiple tasks (MT). RESULTS Acceptable performances (mean and 95% CI) were obtained on the datasets from the Bruce protocol (-0.28[-1.91,1.34] ml/min/kg) and the MT protocol (0.07[-3.14,3.28] ml/min/kg) regarding the differences between the predictions and labels. The coefficient of determination, Pearson correlation coefficient, and root mean square error were 0.84, 0.93, and 0.868 for the Bruce protocol and 0.73, 0.97, and 3.373 for the MT protocol, respectively. CONCLUSIONS The results indicated that it is possible for the proposed model to simultaneously assess VT with the inputs of successive ECGs. In addition, from ablation studies concerning the physical variables and the joint optimization process, it was demonstrated that their use could boost the VT assessment performance of the model. The proposed model enables dynamic VT estimation with ECGs, which could help with managing cardiorespiratory fitness in daily life and cardiovascular rehabilitation in patients.
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Affiliation(s)
- Hyun-Myung Cho
- Biomedical Research Institute, Korea Institute of Science and Technology, 5, Hwarang-ro 14-gil, Seongbuk-gu, 02792, Seoul, Republic of Korea; Department of Artificial Intelligence, Korea University, 145 Anam-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea.
| | - Sungmin Han
- Bionics Research Center, Korea Institute of Science and Technology, 5, Hwarang-ro 14-gil, Seongbuk-gu, 02792, Seoul, Republic of Korea.
| | - Joon-Kyung Seong
- Department of Artificial Intelligence, Korea University, 145 Anam-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea.
| | - Inchan Youn
- Biomedical Research Institute, Korea Institute of Science and Technology, 5, Hwarang-ro 14-gil, Seongbuk-gu, 02792, Seoul, Republic of Korea.
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15
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Moses JC, Adibi S, Angelova M, Islam SMS. Time-domain heart rate variability features for automatic congestive heart failure prediction. ESC Heart Fail 2024; 11:378-389. [PMID: 38009405 PMCID: PMC10804149 DOI: 10.1002/ehf2.14593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/10/2023] [Accepted: 11/07/2023] [Indexed: 11/28/2023] Open
Abstract
AIMS Heart failure is a serious condition that often goes undiagnosed in primary care due to the lack of reliable diagnostic tools and the similarity of its symptoms with other diseases. Non-invasive monitoring of heart rate variability (HRV), which reflects the activity of the autonomic nervous system, could offer a novel and accurate way to detect and manage heart failure patients. This study aimed to assess the feasibility of using machine learning techniques on HRV data as a non-invasive biomarker to classify healthy adults and those with heart failure. METHODS AND RESULTS We used digitized electrocardiogram recordings from 54 adults with normal sinus rhythm and 44 adults categorized into New York Heart Association classes 1, 2, and 3, suffering from congestive heart failure. All recordings were sourced from the PhysioNet database. Following data pre-processing, we performed time-domain HRV analysis on all individual recordings, including root mean square of the successive difference in adjacent RR interval (RRi) (RMSSD), the standard deviation of RRi (SDNN, the NN stands for natural or sinus intervals), the standard deviation of the successive differences between successive RRi (SDSD), the number or percentage of RRi longer than 50 ms (NN50 and pNN50), and the average value of RRi [mean RR interval (mRRi)]. In our experimental classification performance evaluation, on the computed HRV parameters, we optimized hyperparameters and performed five-fold cross-validation using four machine learning classification algorithms: support vector machine, k-nearest neighbour (KNN), naïve Bayes, and decision tree (DT). We evaluated the prediction accuracy of these models using performance criteria, namely, precision, recall, specificity, F1 score, and overall accuracy. For added insight, we also presented receiver operating characteristic (ROC) plots and area under the ROC curve (AUC) values. The overall best performance accuracy of 77% was achieved when KNN and DT were trained on computed HRV parameters with a 5 min time window. KNN obtained an AUC of 0.77, while DT attained 0.78. Additionally, in the classification of severe congestive heart failure, KNN and DT had the best accuracy of 91%, with KNN achieving an AUC of 0.88 and DT obtaining 0.92. CONCLUSIONS The results show that HRV can accurately predict severe congestive heart failure. The findings of this study could inform the use of machine learning approaches on non-invasive HRV, to screen congestive heart failure individuals in primary care.
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Affiliation(s)
| | - Sasan Adibi
- School of Information TechnologyDeakin UniversityBurwoodVIC3125Australia
| | - Maia Angelova
- School of Information TechnologyDeakin UniversityBurwoodVIC3125Australia
- Aston Digital Futures Institute, College of Physical Sciences and EngineeringAston UniversityBirminghamUK
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16
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Babu M, Lautman Z, Lin X, Sobota MHB, Snyder MP. Wearable Devices: Implications for Precision Medicine and the Future of Health Care. Annu Rev Med 2024; 75:401-415. [PMID: 37983384 DOI: 10.1146/annurev-med-052422-020437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Wearable devices are integrated analytical units equipped with sensitive physical, chemical, and biological sensors capable of noninvasive and continuous monitoring of vital physiological parameters. Recent advances in disciplines including electronics, computation, and material science have resulted in affordable and highly sensitive wearable devices that are routinely used for tracking and managing health and well-being. Combined with longitudinal monitoring of physiological parameters, wearables are poised to transform the early detection, diagnosis, and treatment/management of a range of clinical conditions. Smartwatches are the most commonly used wearable devices and have already demonstrated valuable biomedical potential in detecting clinical conditions such as arrhythmias, Lyme disease, inflammation, and, more recently, COVID-19 infection. Despite significant clinical promise shown in research settings, there remain major hurdles in translating the medical uses of wearables to the clinic. There is a clear need for more effective collaboration among stakeholders, including users, data scientists, clinicians, payers, and governments, to improve device security, user privacy, data standardization, regulatory approval, and clinical validity. This review examines the potential of wearables to offer affordable and reliable measures of physiological status that are on par with FDA-approved specialized medical devices. We briefly examine studies where wearables proved critical for the early detection of acute and chronic clinical conditions with a particular focus on cardiovascular disease, viral infections, and mental health. Finally, we discuss current obstacles to the clinical implementation of wearables and provide perspectives on their potential to deliver increasingly personalized proactive health care across a wide variety of conditions.
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Affiliation(s)
- Mohan Babu
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
| | - Ziv Lautman
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
- Department of Bioengineering, Stanford University School of Medicine, Stanford, California, USA
| | - Xiangping Lin
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
| | - Milan H B Sobota
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
| | - Michael P Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
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17
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Lu L, Zhu T, Morelli D, Creagh A, Liu Z, Yang J, Liu F, Zhang YT, Clifton DA. Uncertainties in the Analysis of Heart Rate Variability: A Systematic Review. IEEE Rev Biomed Eng 2024; 17:180-196. [PMID: 37186539 DOI: 10.1109/rbme.2023.3271595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Heart rate variability (HRV) is an important metric with a variety of applications in clinical situations such as cardiovascular diseases, diabetes mellitus, and mental health. HRV data can be potentially obtained from electrocardiography and photoplethysmography signals, then computational techniques such as signal filtering and data segmentation are used to process the sampled data for calculating HRV measures. However, uncertainties arising from data acquisition, computational models, and physiological factors can lead to degraded signal quality and affect HRV analysis. Therefore, it is crucial to address these uncertainties and develop advanced models for HRV analysis. Although several reviews of HRV analysis exist, they primarily focus on clinical applications, trends in HRV methods, or specific aspects of uncertainties such as measurement noise. This paper provides a comprehensive review of uncertainties in HRV analysis, quantifies their impacts, and outlines potential solutions. To the best of our knowledge, this is the first study that presents a holistic review of uncertainties in HRV methods and quantifies their impacts on HRV measures from an engineer's perspective. This review is essential for developing robust and reliable models, and could serve as a valuable future reference in the field, particularly for dealing with uncertainties in HRV analysis.
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18
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Tang C, Liu Z, Hu Q, Jiang Z, Zheng M, Xiong C, Wang S, Yao S, Zhao Y, Wan X, Liu G, Sun Q, Wang ZL, Li L. Unconstrained Piezoelectric Vascular Electronics for Wireless Monitoring of Hemodynamics and Cardiovascular Health. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2304752. [PMID: 37691019 DOI: 10.1002/smll.202304752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/15/2023] [Indexed: 09/12/2023]
Abstract
The patient-centered healthcare requires timely disease diagnosis and prognostic assessment, calling for individualized physiological monitoring. To assess the postoperative hemodynamic status of patients, implantable blood flow monitoring devices are highly expected to deliver real time, long-term, sensitive, and reliable hemodynamic signals, which can accurately reflect multiple physiological conditions. Herein, an implantable and unconstrained vascular electronic system based on a piezoelectric sensor immobilized is presented by a "growable" sheath around continuously growing arterial vessels for real-timely and wirelessly monitoring of hemodynamics. The piezoelectric sensor made of circumferentially aligned polyvinylidene fluoride nanofibers around pulsating artery can sensitively perceive mechanical signals, and the growable sheath bioinspired by the structure and function of leaf sheath has elasticity and conformal shape adaptive to the dynamically growing arterial vessels to avoid growth constriction. With this integrated and smart design, long-term, wireless, and sensitive monitoring of hemodynamics are achieved and demonstrated in rats and rabbits. It provides a simple and versatile strategy for designing implantable sensors in a less invasive way.
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Affiliation(s)
- Chuyu Tang
- Center on Nanoenergy Research, School of Physical Science & Technology, Guangxi University, Nanning, 530004, China
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, P. R. China
| | - Zhirong Liu
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, P. R. China
- School of Nanoscience and Engineering, University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Quanhong Hu
- Center on Nanoenergy Research, School of Physical Science & Technology, Guangxi University, Nanning, 530004, China
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, P. R. China
| | - Zhuoheng Jiang
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, P. R. China
- School of Nanoscience and Engineering, University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Mingjia Zheng
- Center on Nanoenergy Research, School of Physical Science & Technology, Guangxi University, Nanning, 530004, China
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, P. R. China
| | - Cheng Xiong
- Center on Nanoenergy Research, School of Physical Science & Technology, Guangxi University, Nanning, 530004, China
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, P. R. China
| | - Shaobo Wang
- Center on Nanoenergy Research, School of Physical Science & Technology, Guangxi University, Nanning, 530004, China
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, P. R. China
| | - Shuncheng Yao
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, P. R. China
- School of Nanoscience and Engineering, University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Yunchao Zhao
- Center on Nanoenergy Research, School of Physical Science & Technology, Guangxi University, Nanning, 530004, China
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, P. R. China
| | - Xingyi Wan
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, P. R. China
- School of Nanoscience and Engineering, University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Guanlin Liu
- Center on Nanoenergy Research, School of Physical Science & Technology, Guangxi University, Nanning, 530004, China
| | - Qijun Sun
- Center on Nanoenergy Research, School of Physical Science & Technology, Guangxi University, Nanning, 530004, China
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, P. R. China
| | - Zhong Lin Wang
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, P. R. China
- School of Nanoscience and Engineering, University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
- Georgia Institute of Technology, Atlanta, GA 30332-0245, USA
| | - Linlin Li
- Center on Nanoenergy Research, School of Physical Science & Technology, Guangxi University, Nanning, 530004, China
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing, 101400, P. R. China
- School of Nanoscience and Engineering, University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
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Chen LJ, Burr R, Cain K, Kamp K, Heitkemper M. Age Differences in Upper Gastrointestinal Symptoms and Vagal Modulation in Women With Irritable Bowel Syndrome. Biol Res Nurs 2024; 26:46-55. [PMID: 37353474 PMCID: PMC10850873 DOI: 10.1177/10998004231186188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
BACKGROUND/AIMS Patients with irritable bowel syndrome (IBS) often report upper gastrointestinal (GI) (e.g., nausea and heartburn), somatic, and emotional symptoms. This study seeks to examine the relationships among younger and older women with IBS and indicators of autonomic nervous system (ANS) function and daily nausea and heartburn symptoms. METHODS Women were recruited through clinics and the community. Nocturnal heart rate variability (HRV) was obtained using ambulatory electrocardiogram Holter monitors. Individual symptom severity and frequency were collected using 28-day diaries. All variables were stratified by younger (<46 years) and older (≥46 years) age groups. RESULTS Eighty-nine women with IBS were included in this descriptive correlation study (n = 57 younger; n = 32 older). Older women had reduced indices of vagal activity when compared to younger women. In older women, there was an inverse correlation between nausea and vagal measures (Ln RMSSD, r = -.41, p = .026; Ln pNN50, r = -.39, p = .034). Heartburn in older women was associated with sleepiness (r = .59, p < .001) and anger (r = .48, p = .006). Nausea was significantly correlated with anger in the younger group (r = .41, p = .001). There were no significant relationships between HRV indicators and nausea and heartburn in younger women. CONCLUSIONS Age-related differences in ANS function that are associated with nausea may portend unique opportunities to better understand the vagal dysregulation in women with IBS.
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Affiliation(s)
- Li Juen Chen
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
- UW Medicine Valley Medical Center, Renton, WA, USA
| | - Robert Burr
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Kevin Cain
- Center for Biomedical Statistics, University of Washington, Seattle, WA, USA
| | - Kendra Kamp
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
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20
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Bachir W. Diffuse transmittance visible spectroscopy using smartphone flashlight for photoplethysmography and vital signs measurements. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2023; 303:123181. [PMID: 37506454 DOI: 10.1016/j.saa.2023.123181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
Photoplethysmography (PPG), with its wide range of applications, has become one of the most promising modalities for healthcare monitoring technology. In this work, we present a new PPG measurement technique based on diffuse transmittance spectroscopy (DTS) with the help of a smartphone built-in flashlight as an alternative broadband light source. The blood Volume Pulse (BVP) signal was extracted from recorded transmittance spectra at 620 nm. The results were compared with the ground truth and conventional contact finger PPG sensors. A very high correlation was found between the diffuse transmittance signal and the reference PPG signals (r = 0.997, p < 0.0001). The accuracy and root mean square error (RMSE) were 99.23% and 0.8 bpm, respectively. In addition, a Bland-Altman analysis showed a good agreement between both techniques, with a very small bias between mean paired differences of heart rate observations. A simple forward model for diffuse transmittance spectra for different levels of blood oxygen saturation is developed and supported by experimental measurements. It was also found that blood oxygen saturation (SpO2) can be estimated with the aid of DTS based smartphone flash by tracking the wavelength corresponding to the oxygenation level in the visible range between orange and red regions of the visible spectrum particularly in the range between 610 and 635 nm for 26 healthy subjects. 624 nm on average seems to be the wavelength that corresponds with the normal blood oxygenation level. These findings show the potential of DTS PPG to reliably extract cardiac frequency and estimate SpO2 with adequate accuracy. The results also demonstrate the capability of smartphone flash as a miniature visible light source for recording multispectral PPG signals and quantifying vital signs in the transmission mode at the fingertip with acceptable signal quality over a wide range of wavelengths from 550 nm to 650 nm.
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Affiliation(s)
- Wesam Bachir
- Institute of Metrology and Biomedical Engineering, Faculty of Mechatronics, Warsaw University of Technology, Św. A. Boboli 8 St., Warsaw 02-525, Poland; Biomedical Photonics Laboratory, Higher Institute for Laser Research and Applications, Damascus University, Damascus, Syria
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21
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Johnson NE, Venturo-Conerly KE, Rusch T. Using wearable activity trackers for research in the global south: Lessons learned from adolescent psychotherapy research in Kenya. Glob Ment Health (Camb) 2023; 10:e86. [PMID: 38161741 PMCID: PMC10755372 DOI: 10.1017/gmh.2023.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/13/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Wearable activity trackers have emerged as valuable tools for health research, providing high-resolution data on measures such as physical activity. While most research on these devices has been conducted in high-income countries, there is growing interest in their use in the global south. This perspective discusses the challenges faced and strategies employed when using wearable activity trackers to test the effects of a school-based intervention for depression and anxiety among Kenyan youth. Lessons learned include the importance of validating data output, establishing an internal procedure for international procurement, providing on-site support for participants, designating a full-time team member for wearable activity tracker operation, and issuing a paper-based information sheet to participants. The insights shared in this perspective serve as guidance for researchers undertaking studies with wearables in similar settings, contributing to the evidence base for mental health interventions targeting youth in the global south. Despite the challenges to set up, deploy and extract data from wearable activity trackers, we believe that wearables are a relatively economical approach to provide insight into the daily lives of research participants, and recommend their use to other researchers.
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Affiliation(s)
- Natalie E. Johnson
- Department of Research and Evidence, Shamiri Institute, Nairobi, Kenya
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Katherine E. Venturo-Conerly
- Department of Research and Evidence, Shamiri Institute, Nairobi, Kenya
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Thomas Rusch
- Competence Center for Empirical Research Methods, WU Vienna University of Economics and Business, Vienna, Austria
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22
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Woelfle T, Pless S, Reyes Ó, Wiencierz A, Kappos L, Granziera C, Lorscheider J. Smartwatch-derived sleep and heart rate measures complement step counts in explaining established metrics of MS severity. Mult Scler Relat Disord 2023; 80:105104. [PMID: 37913676 DOI: 10.1016/j.msard.2023.105104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/01/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Passive remote monitoring of patients with MS (PwMS) with sensor-based wearable technologies promises near-continuous evaluation with high ecological validity. Step counts correlate strongly with traditional measures of MS severity. We hypothesized that remote monitoring of sleep and heart rate will yield complementary information. METHODS We recruited 31 PwMS and 31 age- and sex-matched healthy volunteers (HV) as part of the dreaMS feasibility study (NCT04413032). Fitbit Versa 2 smartwatches were worn for 6 weeks and provided a total of 25 features for activity, heart rate, and sleep. Features were selected based on their pairwise intercorrelation (Pearson |r| < 0.6), test-retest reliability (intraclass correlation coefficient ≥ 0.6 or median coefficient of variation < 0.2) and group comparisons between HV and PwMS with moderate disability (expanded disability status scale (EDSS) ≥ 3.5) (rank-biserial |r| ≥ 0.5). These selected features were correlated with clinical reference tests (EDSS, timed 25-foot walk (T25FW), MS-walking scale (MSWS-12)) in PwMS, and multivariate models adjusted for age, sex, and disease duration were compared. RESULTS We analyzed 28 PwMS (68% female, mean age 44 years, median EDSS 3.0) and 26 HV in our primary analysis. The objectively selected features discriminated well between HV and PwMS with moderate disability with rank-biserial r = 0.83 for Total number of steps, 0.51 for Deep sleep proportion, -0.51 for Median heart rate, 0.85 for Proportion very active, and 0.65 for Total number of floors. In PwMS they correlated strongly with the three clinical reference tests EDSS (strongest Spearman ρ = -0.75 for Proportion very active), T25FW (-0.75 for Total number of floors), and MSWS-12 (-0.72 for Total number of floors). Deep sleep proportion and Median heart rate complemented Total number of steps in explaining the variance of reference tests. CONCLUSIONS Activity, deep sleep and heart rate measures can be derived reliably from smartwatches and contain independent clinically meaningful information about MS severity, highlighting their potential for continuous passive monitoring in both clinical trials and clinical care of PwMS.
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Affiliation(s)
- Tim Woelfle
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Switzerland; Department of Neurology and MS Center, University Hospital Basel, Switzerland; Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital, University of Basel, Switzerland.
| | - Silvan Pless
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Switzerland; Department of Neurology and MS Center, University Hospital Basel, Switzerland
| | | | - Andrea Wiencierz
- Department of Clinical Research, University Hospital, University of Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Switzerland
| | - Cristina Granziera
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Switzerland; Department of Neurology and MS Center, University Hospital Basel, Switzerland; Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital, University of Basel, Switzerland
| | - Johannes Lorscheider
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Switzerland; Department of Neurology and MS Center, University Hospital Basel, Switzerland
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23
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Vondrasek JD, Riemann BL, Grosicki GJ, Flatt AA. Validity and Efficacy of the Elite HRV Smartphone Application during Slow-Paced Breathing. SENSORS (BASEL, SWITZERLAND) 2023; 23:9496. [PMID: 38067869 PMCID: PMC10708620 DOI: 10.3390/s23239496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/25/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023]
Abstract
Slow-paced breathing is a clinical intervention used to increase heart rate variability (HRV). The practice is made more accessible via cost-free smartphone applications like Elite HRV. We investigated whether Elite HRV can accurately measure and augment HRV via its slow-paced breathing feature. Twenty young adults completed one counterbalanced cross-over protocol involving 10 min each of supine spontaneous (SPONT) and paced (PACED; 6 breaths·min-1) breathing while RR intervals were simultaneously recorded via a Polar H10 paired with Elite HRV and reference electrocardiography (ECG). Individual differences in HRV between devices were predominately skewed, reflecting a tendency for Elite HRV to underestimate ECG-derived values. Skewness was typically driven by a limited number of outliers as median bias values were ≤1.3 ms and relative agreement was ≥very large for time-domain parameters. Despite no significant bias and ≥large relative agreement for frequency-domain parameters, limits of agreement (LOAs) were excessively wide and tended to be wider during PACED for all HRV parameters. PACED significantly increased low-frequency power (LF) for Elite HRV and ECG, and between-condition differences showed very large relative agreement. Elite HRV-guided slow-paced breathing effectively increased LF values, but it demonstrated greater precision during SPONT and in computing time-domain HRV.
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Affiliation(s)
- Joseph D. Vondrasek
- Biodynamics and Human Performance Center, Department of Health Sciences and Kinesiology, Georgia Southern University (Armstrong), 11935 Abercorn St., Savannah, GA 31419, USA; (B.L.R.); (G.J.G.); (A.A.F.)
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24
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Charlton PH, Allen J, Bailón R, Baker S, Behar JA, Chen F, Clifford GD, Clifton DA, Davies HJ, Ding C, Ding X, Dunn J, Elgendi M, Ferdoushi M, Franklin D, Gil E, Hassan MF, Hernesniemi J, Hu X, Ji N, Khan Y, Kontaxis S, Korhonen I, Kyriacou PA, Laguna P, Lázaro J, Lee C, Levy J, Li Y, Liu C, Liu J, Lu L, Mandic DP, Marozas V, Mejía-Mejía E, Mukkamala R, Nitzan M, Pereira T, Poon CCY, Ramella-Roman JC, Saarinen H, Shandhi MMH, Shin H, Stansby G, Tamura T, Vehkaoja A, Wang WK, Zhang YT, Zhao N, Zheng D, Zhu T. The 2023 wearable photoplethysmography roadmap. Physiol Meas 2023; 44:111001. [PMID: 37494945 PMCID: PMC10686289 DOI: 10.1088/1361-6579/acead2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/04/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023]
Abstract
Photoplethysmography is a key sensing technology which is used in wearable devices such as smartwatches and fitness trackers. Currently, photoplethysmography sensors are used to monitor physiological parameters including heart rate and heart rhythm, and to track activities like sleep and exercise. Yet, wearable photoplethysmography has potential to provide much more information on health and wellbeing, which could inform clinical decision making. This Roadmap outlines directions for research and development to realise the full potential of wearable photoplethysmography. Experts discuss key topics within the areas of sensor design, signal processing, clinical applications, and research directions. Their perspectives provide valuable guidance to researchers developing wearable photoplethysmography technology.
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Affiliation(s)
- Peter H Charlton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, United Kingdom
- Research Centre for Biomedical Engineering, City, University of London, London, EC1V 0HB, United Kingdom
| | - John Allen
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5RW, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Raquel Bailón
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Stephanie Baker
- College of Science and Engineering, James Cook University, Cairns, 4878 Queensland, Australia
| | - Joachim A Behar
- Faculty of Biomedical Engineering, Technion Israel Institute of Technology, Haifa, 3200003, Israel
| | - Fei Chen
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen, 518055 Guandong, People’s Republic of China
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, United States of America
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
| | - David A Clifton
- Department of Engineering Science, University of Oxford, Oxford, OX3 7DQ, United Kingdom
| | - Harry J Davies
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Cheng Ding
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, United States of America
- Department of Biomedical Engineering, Emory University, Atlanta, GA 30322, United States of America
| | - Xiaorong Ding
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China
| | - Jessilyn Dunn
- Department of Biomedical Engineering, Duke University, Durham, NC 27708-0187, United States of America
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC 27708-0187, United States of America
- Duke Clinical Research Institute, Durham, NC 27705-3976, United States of America
| | - Mohamed Elgendi
- Biomedical and Mobile Health Technology Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, 8008, Switzerland
| | - Munia Ferdoushi
- Department of Electrical and Computer Engineering, University of Southern California, 90089, Los Angeles, California, United States of America
- The Institute for Technology and Medical Systems (ITEMS), Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Daniel Franklin
- Institute of Biomedical Engineering, Translational Biology & Engineering Program, Ted Rogers Centre for Heart Research, University of Toronto, Toronto, M5G 1M1, Canada
| | - Eduardo Gil
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Md Farhad Hassan
- Department of Electrical and Computer Engineering, University of Southern California, 90089, Los Angeles, California, United States of America
- The Institute for Technology and Medical Systems (ITEMS), Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Jussi Hernesniemi
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, 33720, Finland
- Tampere Heart Hospital, Wellbeing Services County of Pirkanmaa, Tampere, 33520, Finland
| | - Xiao Hu
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, 30322, Georgia, United States of America
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, 30322, Georgia, United States of America
- Department of Computer Sciences, College of Arts and Sciences, Emory University, Atlanta, GA 30322, United States of America
| | - Nan Ji
- Hong Kong Center for Cerebrocardiovascular Health Engineering (COCHE), Hong Kong Science and Technology Park, Hong Kong, 999077, People’s Republic of China
| | - Yasser Khan
- Department of Electrical and Computer Engineering, University of Southern California, 90089, Los Angeles, California, United States of America
- The Institute for Technology and Medical Systems (ITEMS), Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Spyridon Kontaxis
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Ilkka Korhonen
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, 33720, Finland
| | - Panicos A Kyriacou
- Research Centre for Biomedical Engineering, City, University of London, London, EC1V 0HB, United Kingdom
| | - Pablo Laguna
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Jesús Lázaro
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, E-50018 Zaragoza, Spain
- CIBER-BBN, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, E-28029 Madrid, Spain
| | - Chungkeun Lee
- Digital Health Devices Division, Medical Device Evaluation Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju, 28159, Republic of Korea
| | - Jeremy Levy
- Faculty of Biomedical Engineering, Technion Israel Institute of Technology, Haifa, 3200003, Israel
- Faculty of Electrical and Computer Engineering, Technion Institute of Technology, Haifa, 3200003, Israel
| | - Yumin Li
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, People’s Republic of China
| | - Chengyu Liu
- State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, People’s Republic of China
| | - Jing Liu
- Analog Devices Inc, San Jose, CA 95124, United States of America
| | - Lei Lu
- Department of Engineering Science, University of Oxford, Oxford, OX3 7DQ, United Kingdom
| | - Danilo P Mandic
- Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Vaidotas Marozas
- Department of Electronics Engineering, Kaunas University of Technology, 44249 Kaunas, Lithuania
- Biomedical Engineering Institute, Kaunas University of Technology, 44249 Kaunas, Lithuania
| | - Elisa Mejía-Mejía
- Research Centre for Biomedical Engineering, City, University of London, London, EC1V 0HB, United Kingdom
| | - Ramakrishna Mukkamala
- Department of Bioengineering and Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Meir Nitzan
- Department of Physics/Electro-Optic Engineering, Lev Academic Center, 91160 Jerusalem, Israel
| | - Tania Pereira
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, Porto, 4200-465, Portugal
- Faculty of Engineering, University of Porto, Porto, 4200-465, Portugal
| | | | - Jessica C Ramella-Roman
- Department of Biomedical Engineering and Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33174, United States of America
| | - Harri Saarinen
- Tampere Heart Hospital, Wellbeing Services County of Pirkanmaa, Tampere, 33520, Finland
| | - Md Mobashir Hasan Shandhi
- Department of Biomedical Engineering, Duke University, Durham, NC 27708-0187, United States of America
| | - Hangsik Shin
- Department of Digital Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Gerard Stansby
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
- Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, United Kingdom
| | - Toshiyo Tamura
- Future Robotics Organization, Waseda University, Tokyo, 1698050, Japan
| | - Antti Vehkaoja
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, 33720, Finland
- PulseOn Ltd, Espoo, 02150, Finland
| | - Will Ke Wang
- Department of Biomedical Engineering, Duke University, Durham, NC 27708-0187, United States of America
| | - Yuan-Ting Zhang
- Hong Kong Center for Cerebrocardiovascular Health Engineering (COCHE), Hong Kong Science and Technology Park, Hong Kong, 999077, People’s Republic of China
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, 999077, People’s Republic of China
| | - Ni Zhao
- Department of Electronic Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Dingchang Zheng
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5RW, United Kingdom
| | - Tingting Zhu
- Department of Engineering Science, University of Oxford, Oxford, OX3 7DQ, United Kingdom
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25
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Lee H, Yang HL, Ryu HG, Jung CW, Cho YJ, Yoon SB, Yoon HK, Lee HC. Real-time machine learning model to predict in-hospital cardiac arrest using heart rate variability in ICU. NPJ Digit Med 2023; 6:215. [PMID: 37993540 PMCID: PMC10665411 DOI: 10.1038/s41746-023-00960-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023] Open
Abstract
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.
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Affiliation(s)
- Hyeonhoon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Data Science Research, Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Lim Yang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medical Device Development Support, Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul-Woo Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soo Bin Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung-Chul Lee
- Department of Data Science Research, Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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26
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Orini M, van Duijvenboden S, Young WJ, Ramírez J, Jones AR, Hughes AD, Tinker A, Munroe PB, Lambiase PD. Long-term association of ultra-short heart rate variability with cardiovascular events. Sci Rep 2023; 13:18966. [PMID: 37923787 PMCID: PMC10624663 DOI: 10.1038/s41598-023-45988-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
Heart rate variability (HRV) is a cardiac autonomic marker with predictive value in cardiac patients. Ultra-short HRV (usHRV) can be measured at scale using standard and wearable ECGs, but its association with cardiovascular events in the general population is undetermined. We aimed to validate usHRV measured using ≤ 15-s ECGs (using RMSSD, SDSD and PHF indices) and investigate its association with atrial fibrillation, major adverse cardiac events, stroke and mortality in individuals without cardiovascular disease. In the National Survey for Health and Development (n = 1337 participants), agreement between 15-s and 6-min HRV, assessed with correlation analysis and Bland-Altman plots, was very good for RMSSD and SDSD and good for PHF. In the UK Biobank (n = 51,628 participants, 64% male, median age 58), after a median follow-up of 11.5 (11.4-11.7) years, incidence of outcomes ranged between 1.7% and 4.3%. Non-linear Cox regression analysis showed that reduced usHRV from 15-, 10- and 5-s ECGs was associated with all outcomes. Individuals with low usHRV (< 20th percentile) had hazard ratios for outcomes between 1.16 and 1.29, p < 0.05, with respect to the reference group. In conclusion, usHRV from ≤ 15-s ECGs correlates with standard short-term HRV and predicts increased risk of cardiovascular events in a large population-representative cohort.
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Affiliation(s)
- Michele Orini
- Institute of Cardiovascular Science, University College London, 1-19 Torrington Pl, London, WC1E 7HB, UK.
- MRC Unit for Lifelong Health and Ageing at University College London, London, UK.
| | - Stefan van Duijvenboden
- Institute of Cardiovascular Science, University College London, 1-19 Torrington Pl, London, WC1E 7HB, UK
- Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - William J Young
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
- Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Julia Ramírez
- Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red, Bioingeniería, Biomateriales y Nanotecnología, Zaragoza, Spain
| | - Aled R Jones
- Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, 1-19 Torrington Pl, London, WC1E 7HB, UK
- MRC Unit for Lifelong Health and Ageing at University College London, London, UK
| | - Andrew Tinker
- Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- NIHR Barts Biomedical Research Centre, Faculty of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Patricia B Munroe
- Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- NIHR Barts Biomedical Research Centre, Faculty of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, 1-19 Torrington Pl, London, WC1E 7HB, UK
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
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Zhan J, Gan Z, Chou L, Hu L, Zhou Y, Yang H, Chou Y. A fast permutation entropy for pulse rate variability online analysis with one-sample recursion. Med Eng Phys 2023; 120:104050. [PMID: 37838407 DOI: 10.1016/j.medengphy.2023.104050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/17/2023] [Accepted: 09/11/2023] [Indexed: 10/16/2023]
Abstract
Pulse rate variability (PRV) signals are extracted from pulsation signal can be effectively used for cardiovascular disease monitoring in wearable devices. Permutation entropy (PE) algorithm is an effective index for the analysis of PRV signals. However, PE is computationally intensive and impractical for online PRV processing on wearable devices. Therefore, to overcome this challenge, a fast permutation entropy (FPE) algorithm is proposed based on the microprocessor data updating process in this paper, which can analyze PRV signals with single-sample recursive. The simulation data and PRV signals extracted from pulse signals in "Fantasia database" were utilized to verify the performance and accuracy of the improved methods. The results show that the speed of FPE is 211 times faster than PE and maintain the accuracy of algorithm (Root Mean Squared Error = 0) for simulation data with a length of 10,000 samples and embedded dimension m = 5, time delay τ = 5, buffer length Lw = 512. For the RRV signals with 3000∼5000 samples, the result show that the consumption of FPE is less than 0.2 s, which is 175 times faster than PE. This indicates that FPE has better application performance than PE. Furthermore, a low-cost wearable signal detection system is developed to verify the proposed method, the result show that the proposed method can calculate the FPE of PRV signal online with single-sample recursive calculation. Subsequently, entropy-based features are used to explore the performance of decision trees in identifying life-threatening arrhythmias, and the method resulted in a classification accuracy of 85.43%. It can therefore be inferred that the proposed method has great potential in cardiovascular disease.
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Affiliation(s)
- Jianan Zhan
- School of Electrical and Automatic Engineering, Changshu Institute of Technology, Suzhou, 215500, China
| | - Zhengli Gan
- School of Electrical and Automatic Engineering, Changshu Institute of Technology, Suzhou, 215500, China
| | - Lijuan Chou
- School of Electrical and Automatic Engineering, Changshu Institute of Technology, Suzhou, 215500, China; School of Computer and Information Technology, Northeast Petroleum University, Daqing, 163318, China
| | - Linqi Hu
- School of Electrical and Automatic Engineering, Changshu Institute of Technology, Suzhou, 215500, China; School of Chemical Engineering, Huaiyin Institute of Technology, Huaian, 223003, China
| | - Yan Zhou
- School of Electrical and Automatic Engineering, Changshu Institute of Technology, Suzhou, 215500, China; College of Electrical and Information Engineering, Lanzhou University of Technology, Lanzhou, 730050, China
| | - Haiping Yang
- School of Electrical and Automatic Engineering, Changshu Institute of Technology, Suzhou, 215500, China
| | - Yongxin Chou
- School of Electrical and Automatic Engineering, Changshu Institute of Technology, Suzhou, 215500, China.
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Parlato S, Centracchio J, Esposito D, Bifulco P, Andreozzi E. ECG-Free Heartbeat Detection in Seismocardiography and Gyrocardiography Signals Provides Acceptable Heart Rate Variability Indices in Healthy and Pathological Subjects. SENSORS (BASEL, SWITZERLAND) 2023; 23:8114. [PMID: 37836942 PMCID: PMC10575135 DOI: 10.3390/s23198114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
Cardio-mechanical monitoring techniques, such as Seismocardiography (SCG) and Gyrocardiography (GCG), have received an ever-growing interest in recent years as potential alternatives to Electrocardiography (ECG) for heart rate monitoring. Wearable SCG and GCG devices based on lightweight accelerometers and gyroscopes are particularly appealing for continuous, long-term monitoring of heart rate and its variability (HRV). Heartbeat detection in cardio-mechanical signals is usually performed with the support of a concurrent ECG lead, which, however, limits their applicability in standalone cardio-mechanical monitoring applications. The complex and variable morphology of SCG and GCG signals makes the ECG-free heartbeat detection task quite challenging; therefore, only a few methods have been proposed. Very recently, a template matching method based on normalized cross-correlation (NCC) has been demonstrated to provide very accurate detection of heartbeats and estimation of inter-beat intervals in SCG and GCG signals of pathological subjects. In this study, the accuracy of HRV indices obtained with this template matching method is evaluated by comparison with ECG. Tests were performed on two public datasets of SCG and GCG signals from healthy and pathological subjects. Linear regression, correlation, and Bland-Altman analyses were carried out to evaluate the agreement of 24 HRV indices obtained from SCG and GCG signals with those obtained from ECG signals, simultaneously acquired from the same subjects. The results of this study show that the NCC-based template matching method allowed estimating HRV indices from SCG and GCG signals of healthy subjects with acceptable accuracy. On healthy subjects, the relative errors on time-domain indices ranged from 0.25% to 15%, on frequency-domain indices ranged from 10% to 20%, and on non-linear indices were within 8%. The estimates obtained on signals from pathological subjects were affected by larger errors. Overall, GCG provided slightly better performances as compared to SCG, both on healthy and pathological subjects. These findings provide, for the first time, clear evidence that monitoring HRV via SCG and GCG sensors without concurrent ECG is feasible with the NCC-based template matching method for heartbeat detection.
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Affiliation(s)
| | - Jessica Centracchio
- Department of Electrical Engineering and Information Technologies, University of Naples Federico II, Via Claudio 21, 80125 Naples, Italy; (S.P.); (D.E.); (P.B.)
| | | | | | - Emilio Andreozzi
- Department of Electrical Engineering and Information Technologies, University of Naples Federico II, Via Claudio 21, 80125 Naples, Italy; (S.P.); (D.E.); (P.B.)
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29
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Friligkou E, Koller D, Pathak GA, Miller EJ, Lampert R, Stein MB, Polimanti R. Integrating Genome-wide information and Wearable Device Data to Explore the Link of Anxiety and Antidepressants with Heart Rate Variability. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.02.23293170. [PMID: 37577704 PMCID: PMC10418572 DOI: 10.1101/2023.08.02.23293170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background Anxiety disorders are associated with decreased heart rate variability (HRV), but the underlying mechanisms remain elusive. Methods We selected individuals with whole-genome sequencing, Fitbit, and electronic health record data (N=920; 61,333 data points) from the All of Us Research Program. Anxiety PRS were derived with PRS-CS after meta-analyzing anxiety genome-wide association studies from three major cohorts-UK Biobank, FinnGen, and the Million Veterans Program (N Total =364,550). The standard deviation of average RR intervals (SDANN) was calculated using five-minute average RR intervals over full 24-hour heart rate measurements. Antidepressant exposure was defined as an active antidepressant prescription at the time of the HRV measurement in the EHR. The associations of daily SDANN measurements with the anxiety PRS, antidepressant classes, and antidepressant substances were tested. Participants with lifetime diagnoses of cardiovascular disorders, diabetes mellitus, and major depression were excluded in sensitivity analyses. One-sample Mendelian randomization (MR) was employed to assess potential causal effect of anxiety on SDANN. Results Anxiety PRS was independently associated with reduced SDANN (beta=-0.08; p=0.003). Of the eight antidepressant medications and four classes tested, venlafaxine (beta=-0.12, p=0.002) and bupropion (beta=-0.071, p=0.01), tricyclic antidepressants (beta=-0.177, p=0.0008), selective serotonin reuptake inhibitors (beta=-0.069; p=0.0008) and serotonin and norepinephrine reuptake inhibitors (beta=-0.16; p=2×10 -6 ) were associated with decreased SDANN. One-sample MR indicated an inverse effect of anxiety on SDANN (beta=-2.22, p=0.03). Conclusions Anxiety and antidepressants are independently associated with decreased HRV, and anxiety appears to exert a causal effect on HRV. Our observational findings provide novel insights into the impact of anxiety on HRV.
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Petek BJ, Al-Alusi MA, Moulson N, Grant AJ, Besson C, Guseh JS, Wasfy MM, Gremeaux V, Churchill TW, Baggish AL. Consumer Wearable Health and Fitness Technology in Cardiovascular Medicine: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:245-264. [PMID: 37438010 PMCID: PMC10662962 DOI: 10.1016/j.jacc.2023.04.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 07/14/2023]
Abstract
The use of consumer wearable devices (CWDs) to track health and fitness has rapidly expanded over recent years because of advances in technology. The general population now has the capability to continuously track vital signs, exercise output, and advanced health metrics. Although understanding of basic health metrics may be intuitive (eg, peak heart rate), more complex metrics are derived from proprietary algorithms, differ among device manufacturers, and may not historically be common in clinical practice (eg, peak V˙O2, exercise recovery scores). With the massive expansion of data collected at an individual patient level, careful interpretation is imperative. In this review, we critically analyze common health metrics provided by CWDs, describe common pitfalls in CWD interpretation, provide recommendations for the interpretation of abnormal results, present the utility of CWDs in exercise prescription, examine health disparities and inequities in CWD use and development, and present future directions for research and development.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA; Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Mostafa A Al-Alusi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathaniel Moulson
- Division of Cardiology and Sports Cardiology BC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aubrey J Grant
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cyril Besson
- Swiss Olympic Medical Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
| | - J Sawalla Guseh
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vincent Gremeaux
- Swiss Olympic Medical Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA; Swiss Olympic Medical Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland.
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31
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Dudarev V, Barral O, Zhang C, Davis G, Enns JT. On the Reliability of Wearable Technology: A Tutorial on Measuring Heart Rate and Heart Rate Variability in the Wild. SENSORS (BASEL, SWITZERLAND) 2023; 23:5863. [PMID: 37447713 DOI: 10.3390/s23135863] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
Wearable sensors are quickly making their way into psychophysiological research, as they allow collecting data outside of a laboratory and for an extended period of time. The present tutorial considers fidelity of physiological measurement with wearable sensors, focusing on reliability. We elaborate on why ensuring reliability for wearables is important and offer statistical tools for assessing wearable reliability for between participants and within-participant designs. The framework offered here is illustrated using several brands of commercially available heart rate sensors. Measurement reliability varied across sensors and, more importantly, across the situations tested, and was highest during sleep. Our hope is that by systematically quantifying measurement reliability, researchers will be able to make informed choices about specific wearable devices and measurement procedures that meet their research goals.
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Affiliation(s)
- Veronica Dudarev
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- HealthQb Technologies Inc., Vancouver, BC V6K 1B5, Canada
| | - Oswald Barral
- HealthQb Technologies Inc., Vancouver, BC V6K 1B5, Canada
| | - Chuxuan Zhang
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Department of Mathematics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Guy Davis
- HealthQb Technologies Inc., Vancouver, BC V6K 1B5, Canada
| | - James T Enns
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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32
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Presby DM, Jasinski SR, Capodilupo ER. Wearable derived cardiovascular responses to stressors in free-living conditions. PLoS One 2023; 18:e0285332. [PMID: 37267318 DOI: 10.1371/journal.pone.0285332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/20/2023] [Indexed: 06/04/2023] Open
Abstract
Stress contributes to the progression of many diseases. Despite stress' contribution towards disease, few methods for continuously measuring stress exist. We investigated if continuously measured cardiovascular signals from a wearable device can be used as markers of stress. Using wearable technology (WHOOP Inc, Boston, MA) that continuously measures and calculates heart rate (HR) and heart rate variability (root-mean-square of successive differences; HRV), we assessed duration and magnitude of deviations in HR and HRV around the time of a run (from 23665 runs) or high-stress work (from 8928 high-stress work events) in free-living conditions. HR and HRV were assessed only when participants were motionless (HRmotionless). Runs were grouped into light, moderate, and vigorous runs to determine dose response relationships. When examining HRmotionless and HRV throughout the day, we found that these metrics display circadian rhythms; therefore, we normalized HRmotionless and HRV measures for each participant relative to the time of day. Relative to the period within 30 minutes leading up to a run, HRmotionless is elevated for up to 180-210 minutes following a moderate or vigorous run (P<0.05) and is unchanged or reduced following a light run. HRV is reduced for at least 300 minutes following a moderate or vigorous run (P<0.05) and is unchanged during a light run. Relative to the period within 30 minutes leading up to high-stress work, HRmotionless is elevated during and for up to 30 minutes following high-stress work. HRV tends to be lower during high-stress work (P = 0.06) and is significantly lower 90-300 minutes after the end of the activity (P<0.05). These results demonstrate that wearables can quantify stressful events, which may be used to provide feedback to help individuals manage stress.
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Affiliation(s)
- David M Presby
- Department of Data Science and Research, Whoop, Inc., Boston, Massachusetts, United States of America
| | - Summer R Jasinski
- Department of Data Science and Research, Whoop, Inc., Boston, Massachusetts, United States of America
| | - Emily R Capodilupo
- Department of Data Science and Research, Whoop, Inc., Boston, Massachusetts, United States of America
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Saglietto A, Scarsoglio S, Canova D, De Ferrari GM, Ridolfi L, Anselmino M. Beat-to-beat finger photoplethysmography in atrial fibrillation patients undergoing electrical cardioversion. Sci Rep 2023; 13:6751. [PMID: 37185372 PMCID: PMC10130175 DOI: 10.1038/s41598-023-33952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
Atrial fibrillation (AF)-induced peripheral microcirculatory alterations have poorly been investigated. The present study aims to expand current knowledge through a beat-to-beat analysis of non-invasive finger photoplethysmography (PPG) in AF patients restoring sinus rhythm by electrical cardioversion (ECV). Continuous non-invasive arterial blood pressure and left middle finger PPG pulse oximetry waveform (POW) signals were continuously recorded before and after elective ECV of consecutive AF or atrial flutter (AFL) patients. The main metrics (mean, standard deviation, coefficient of variation), as well as a beat-to-beat analysis of the pulse pressure (PP) and POW beat-averaged value (aPOW), were computed to compare pre- and post-ECV phases. 53 patients (mean age 69 ± 8 years, 79% males) were enrolled; cardioversion was successful in restoring SR in 51 (96%) and signal post-processing was feasible in 46 (87%) patients. In front of a non-significant difference in mean PP (pre-ECV: 51.96 ± 13.25, post-ECV: 49.58 ± 10.41 mmHg; p = 0.45), mean aPOW significantly increased after SR restoration (pre-ECV: 0.39 ± 0.09, post-ECV: 0.44 ± 0.06 a.u.; p < 0.001). Moreover, at beat-to-beat analysis linear regression yielded significantly different slope (m) for the PP (RR) relationship compared to aPOW(RR) [PP(RR): 0.43 ± 0.18; aPOW(RR): 1.06 ± 0.17; p < 0.001]. Long (> 95th percentile) and short (< 5th percentile) RR intervals were significantly more irregular in the pre-ECV phases for both PP and aPOW; however, aPOW signal suffered more fluctuations compared to PP (p < 0.001 in both phases). Present findings suggest that AF-related hemodynamic alterations are more manifest at the peripheral (aPOW) rather than at the upstream macrocirculatory level (PP). Restoring sinus rhythm increases mean peripheral microvascular perfusion and decreases variability of the microvascular hemodynamic signals. Future dedicated studies are required to determine if AF-induced peripheral microvascular alterations might relate to long-term prognostic effects.
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Affiliation(s)
- Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, ″Citta della Salute e della Scienza″ Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129, Turin, Italy.
| | - Daniela Canova
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, ″Citta della Salute e della Scienza″ Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, Cardiovascular and Thoracic Department, ″Citta della Salute e della Scienza″ Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
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Trivedi G, Sharma K, Saboo B, Kathirvel S, Konat A, Zapadia V, Prajapati PJ, Benani U, Patel K, Shah S. Humming (Simple Bhramari Pranayama) as a Stress Buster: A Holter-Based Study to Analyze Heart Rate Variability (HRV) Parameters During Bhramari, Physical Activity, Emotional Stress, and Sleep. Cureus 2023; 15:e37527. [PMID: 37193427 PMCID: PMC10182780 DOI: 10.7759/cureus.37527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
Objective In this study, our goal was to understand the comparative impact of humming, physical activity, emotional stress, and sleep on several heart rate variability (HRV) parameters, including the stress index (SI), and to assess the effectiveness of humming (simple Bhramari) as a stress buster based on the HRV parameters. Methods This pilot study assessed the long-term HRV parameters of 23 participants in terms of four activities: humming (simple Bhramari), physical activity, emotional stress, and sleep. The single-channel Holter device measured the readings, and data was analyzed using Kubios HRV Premium software for time and frequency-domain HRV parameters, including the stress index. Regarding statistical analysis, single-factor ANOVA followed by paired t-test was used to compare the results of HRV parameters "during" the four activities to understand if humming generates the outcome to enhance the autonomic nervous system. Results Our findings revealed that humming generates the lowest stress index compared to all three other activities (physical activity, emotional stress, and sleep). Several additional HRV parameters also supported the positive impact on the autonomic nervous, equivalent to stress reduction. Conclusions Humming (simple Bhramari) can be an effective stress-buster based on the assessment of several HRV parameters during its practice and in comparison with other activities. A regular daily humming routine can help enhance the parasympathetic nervous system and slow down sympathetic activation.
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Affiliation(s)
- Gunjan Trivedi
- Society for Energy & Emotions, Wellness Space, Ahmedabad, IND
| | - Kamal Sharma
- Cardiology, Dr. Kamal Sharma Cardiology Clinic, Ahmedabad, IND
| | - Banshi Saboo
- Department of Endocrinology, Diabetes Care & Hormone Clinic, Ahmedabad, IND
| | - Soundappan Kathirvel
- Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Ashwati Konat
- Department of Zoology, Biomedical Technology and Human Genetics, Gujarat University, Ahmedabad, IND
| | | | | | - Urva Benani
- Smt. NHL Municipal Medical College, Internal Medicine, Ahmedabad, IND
| | - Kahan Patel
- Internal Medicine, B J Medical College, Ahmedabad, IND
| | - Suchi Shah
- Internal Medicine, AMC MET Medical College, Ahmedabad, IND
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Four Sessions of Combining Wearable Devices and Heart Rate Variability (HRV) Biofeedback are Needed to Increase HRV Indices and Decrease Breathing Rates. Appl Psychophysiol Biofeedback 2023; 48:83-95. [PMID: 36350478 DOI: 10.1007/s10484-022-09567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/11/2022]
Abstract
Heart rate variability biofeedback (HRVB) is a behavioral intervention that uses resonance frequency breathing to synchronize the heart rate and breathing patterns. This study aimed to explore how many sessions of wearable HRVB devices are needed to increase the HRV index and decrease breathing rates and to compare the HRVB protocol with other psychological intervention programs in HRV indices and breathing rates. Sixty-four participants were randomly assigned to either the HRVB or relaxation training (RT) group. Both groups received interbeat intervals (IBIs) and breathing rates measurement at the pre-training baseline, during training, and post-training baseline from weeks 1 to 4. IBIs were transformed into HRV indices as the index of the autonomic nervous system. The Group × Week interaction effects significantly in HRV indices and breathing rates. The between-group comparison found a significant increase in HRV indices and decreased breathing rates in the HRVB group than in the RT group at week 4. The within-session comparison in the HRVB group revealed significantly increased HRV indices and decreased breathing rates at weeks 3 and 4 than at weeks 1 and 2. There was a significant increase in HRV indices and a decrease in breathing rates at mid- and post-training than pre-training in the HRVB group. Therefore, 4 weeks of HRVB combined with a wearable device are needed in increasing HRV indices and decrease breathing rates compared to the relaxation training. Three weeks of HRVB training are the minimum requirement for increasing HRV indices and reducing breathing rates compared to the first week of HRVB.
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36
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Rinkevičius M, Charlton PH, Bailón R, Marozas V. Influence of Photoplethysmogram Signal Quality on Pulse Arrival Time during Polysomnography. SENSORS (BASEL, SWITZERLAND) 2023; 23:2220. [PMID: 36850820 PMCID: PMC9967654 DOI: 10.3390/s23042220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Intervals of low-quality photoplethysmogram (PPG) signals might lead to significant inaccuracies in estimation of pulse arrival time (PAT) during polysomnography (PSG) studies. While PSG is considered to be a "gold standard" test for diagnosing obstructive sleep apnea (OSA), it also enables tracking apnea-related nocturnal blood pressure fluctuations correlated with PAT. Since the electrocardiogram (ECG) is recorded synchronously with the PPG during PSG, it makes sense to use the ECG signal for PPG signal-quality assessment. (1) Objective: to develop a PPG signal-quality assessment algorithm for robust PAT estimation, and investigate the influence of signal quality on PAT during various sleep stages and events such as OSA. (2) Approach: the proposed algorithm uses R and T waves from the ECG to determine approximate locations of PPG pulse onsets. The MESA database of 2055 PSG recordings was used for this study. (3) Results: the proportions of high-quality PPG were significantly lower in apnea-related oxygen desaturation (matched-pairs rc = 0.88 and rc = 0.97, compared to OSA and hypopnea, respectively, when p < 0.001) and arousal (rc = 0.93 and rc = 0.98, when p < 0.001) than in apnea events. The significantly large effect size of interquartile ranges of PAT distributions was between low- and high-quality PPG (p < 0.001, rc = 0.98), and regular and irregular pulse waves (p < 0.001, rc = 0.74), whereas a lower quality of the PPG signal was found to be associated with a higher interquartile range of PAT across all subjects. Suggested PPG signal quality-based PAT evaluation reduced deviations (e.g., rc = 0.97, rc = 0.97, rc = 0.99 in hypopnea, oxygen desaturation, and arousal stages, respectively, when p < 0.001) and allowed obtaining statistically larger differences between different sleep stages and events. (4) Significance: the implemented algorithm has the potential to increase the robustness of PAT estimation in PSG studies related to nocturnal blood pressure monitoring.
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Affiliation(s)
- Mantas Rinkevičius
- Biomedical Engineering Institute, Kaunas University of Technology, K. Baršausko Str. 59, LT-51423 Kaunas, Lithuania
| | - Peter H. Charlton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 1TN, UK
- Research Centre for Biomedical Engineering, University of London, London WC1E 7HU, UK
| | - Raquel Bailón
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragon Institute of Engineering Research (I3A), IIS Aragon, University of Zaragoza, 50009 Zaragoza, Spain
- Biomedical Research Networking Center (CIBER), 50018 Zaragoza, Spain
| | - Vaidotas Marozas
- Biomedical Engineering Institute, Kaunas University of Technology, K. Baršausko Str. 59, LT-51423 Kaunas, Lithuania
- Faculty of Electrical and Electronics Engineering, Kaunas University of Technology, Studentų Str. 50, LT-51368 Kaunas, Lithuania
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Benjamim CJR, Sousa YBA, Porto AA, de Moraes Pontes YM, Tavares SS, da Silva Rodrigues G, da Silva LSL, da Silva Goncalves L, Guimaraes CS, Rebelo MA, da Silva Sobrinho AC, Tanus-Santos JE, Valenti VE, Gualano B, Bueno Júnior CR. Nitrate-rich beet juice intake on cardiovascular performance in response to exercise in postmenopausal women with arterial hypertension: study protocol for a randomized controlled trial. Trials 2023; 24:94. [PMID: 36750904 PMCID: PMC9903428 DOI: 10.1186/s13063-023-07117-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/28/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND There is no evidence of the use of beetroot juice with a previously recommended dose of nitrate (NO3) (> 300 mg) on the cardiovascular performance during and recovery following exercise in postmenopausal women with systemic arterial hypertension (SAH). METHODS We will investigate the effects of beetroot juice rich in NO3 acutely (800 mg) and during a week with daily doses (400 mg) on blood pressure, heart rate (HR), cardiac autonomic control, endothelial function, inflammatory, hormonal, and stress biomarkers oxidative stress and enzymes involved in nitric oxide synthesis and mitochondrial regulation, under resting conditions, as well as mediated by submaximal aerobic exercise sessions. Through a randomized, crossover, triple-blind, placebo-controlled clinical trial, 25 physically inactive women with SAH will undergo an acute and 1-week trial, each with two intervention protocols: (1) placebo and (2) beetroot, in which will ingest beet juice with or without NO3 in its composition with a 7-day washout interval. On collection days, exercise will be performed on a treadmill for 40 min at a speed corresponding to 65-70% of VO2peak. The collection of variables (cardiovascular, autonomic, and blood samples for molecular analyses) of the study will take place at rest (135 min after ingestion of the intervention), during exercise (40 min), and in the effort recovery stage (during 60 min) based on previously validated protocols. The collections were arranged so that the measurement of one variable does not interfere with the other and that they have adequate intervals between them. DISCUSSION The results of this research may help in the real understanding of the nutritional compounds capable of generating safety to the cardiovascular system during physical exercise, especially for women who are aging and who have cardiovascular limitations (e.g., arterial hypertension) to perform physical exercise. Therefore, our results will be able to help specific nutritional recommendations to optimize cardiovascular health. TRIAL REGISTRATION ClinicalTrials.gov NCT05384340. Registered on May 20, 2022.
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Affiliation(s)
- Cicero Jonas R. Benjamim
- grid.11899.380000 0004 1937 0722Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Yaritza Brito Alves Sousa
- grid.11899.380000 0004 1937 0722Ribeirao Preto Nursing School, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Andrey Alves Porto
- grid.410543.70000 0001 2188 478XMovement Sciences, Autonomic Nervous System Center (CESNA), São Paulo State University (UNESP), Presidente Prudente, SP Brazil
| | - Yasmim Mota de Moraes Pontes
- grid.11899.380000 0004 1937 0722Ribeirao Preto School of Physical Education and Sports, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Simone Sakagute Tavares
- grid.11899.380000 0004 1937 0722Ribeirao Preto School of Physical Education and Sports, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Guilherme da Silva Rodrigues
- grid.11899.380000 0004 1937 0722Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Leonardo Santos Lopes da Silva
- grid.11899.380000 0004 1937 0722Ribeirao Preto School of Physical Education and Sports, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Leonardo da Silva Goncalves
- grid.11899.380000 0004 1937 0722Ribeirao Preto School of Physical Education and Sports, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Carolina Scoqui Guimaraes
- grid.11899.380000 0004 1937 0722Ribeirao Preto Nursing School, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Macário Arosti Rebelo
- grid.411087.b0000 0001 0723 2494Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas, Campinas, SP Brazil
| | - Andressa Crystine da Silva Sobrinho
- grid.11899.380000 0004 1937 0722Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Jose E. Tanus-Santos
- grid.11899.380000 0004 1937 0722Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP Brazil
| | - Vitor Engracia Valenti
- grid.410543.70000 0001 2188 478XAutonomic Nervous System Center (CESNA), São Paulo State University (UNESP), Marília, SP Brazil
| | - Bruno Gualano
- grid.11899.380000 0004 1937 0722Applied Physiology & Nutrition Research Group, University of São Paulo, Medical School (FMUSP), São Paulo, SP Brazil
| | - Carlos Roberto Bueno Júnior
- grid.11899.380000 0004 1937 0722Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP Brazil ,grid.11899.380000 0004 1937 0722Ribeirao Preto School of Physical Education and Sports, University of São Paulo, Ribeirão Preto, SP Brazil
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Natarajan A. Heart rate variability during mindful breathing meditation. Front Physiol 2023; 13:1017350. [PMID: 36756034 PMCID: PMC9899909 DOI: 10.3389/fphys.2022.1017350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/29/2022] [Indexed: 01/24/2023] Open
Abstract
We discuss Heart Rate Variability (HRV) measured during mindful breathing meditation. We provide a pedagogical computation of two commonly used heart rate variability metrics, i.e. the root mean square of successive differences (RMSSD) and the standard deviation of RR intervals (SDRR), in terms of Fourier components. It is shown that the root mean square of successive differences preferentially weights higher frequency Fourier modes, making it unsuitable as a biosignal for mindful breathing meditation which encourages slow breathing. We propose a new metric called the autonomic balance index (ABI) which uses Respiratory Sinus Arrhythmia to quantify the fraction of heart rate variability contributed by the parasympathetic nervous system. We apply this metric to heart rate variability data collected during two different meditation techniques, and show that the autonomic balance index is significantly elevated during mindful breathing, making it a good signal for biofeedback during meditation sessions.
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Discovery of associative patterns between workplace sound level and physiological wellbeing using wearable devices and empirical Bayes modeling. NPJ Digit Med 2023; 6:5. [PMID: 36639725 PMCID: PMC9839735 DOI: 10.1038/s41746-022-00727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/29/2022] [Indexed: 01/15/2023] Open
Abstract
We conducted a field study using multiple wearable devices on 231 federal office workers to assess the impact of the indoor environment on individual wellbeing. Past research has established that the workplace environment is closely tied to an individual's wellbeing. Since sound is the most-reported environmental factor causing stress and discomfort, we focus on quantifying its association with physiological wellbeing. Physiological wellbeing is represented as a latent variable in an empirical Bayes model with heart rate variability measures-SDNN and normalized-HF as the observed outcomes and with exogenous factors including sound level as inputs. We find that an individual's physiological wellbeing is optimal when sound level in the workplace is at 50 dBA. At lower (<50dBA) and higher (>50dBA) amplitude ranges, a 10 dBA increase in sound level is related to a 5.4% increase and 1.9% decrease in physiological wellbeing respectively. Age, body-mass-index, high blood pressure, anxiety, and computer use intensive work are person-level factors contributing to heterogeneity in the sound-wellbeing association.
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Campisi T, Šurdonja S, Tibljaš AD, Otković II. Monitoring speed variation and pedestrian crossing distraction in Enna (Sicily) during different pandemic phases. TRANSPORTATION RESEARCH PROCEDIA 2023; 69. [PMCID: PMC9945215 DOI: 10.1016/j.trpro.2023.02.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The growing phenomenon of teleworking and the recent covid-19 pandemic have caused the volumes of pedestrians who routinely cross the city to change since March 2020. This change may have resulted in further damage to the health of pedestrians due to limited activity. Some recent studies point to slight changes in walking speed and stride length compared to changes in the number of steps, these changes were consistently seen during the state of emergency, they showed that people tried to walk faster in their outdoor walking. For the safety of pedestrians, it is necessary to analyse not only the change in speed when crossing but also the potential factors influencing it. These factors include user-related variables (gender, age, weight) and variables related to potential distractors such as smartphone use or walking in groups. The results of measurements made during the pandemic period (4 different phases) in pedestrian traffic in the zebra crossing area are also presented. The research was conducted in a zebra crossing area located in a small town in Sicily (Enna) frequently used by workers, students and elderly people. The results showed that during the first and second pandemic phases (May to October 2021) there were significant changes in the way of moving and the speed of pedestrians at crossings. The same crossings were also examined in the late autumn of 2021 (third and fourth pandemic phases) and the data show further changes in pedestrian behaviour. The data collected can help to improve safety in the area of pedestrian crossings through infrastructural actions or educational programmes and campaigns, especially among vulnerable groups of pedestrians.
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Affiliation(s)
- Tiziana Campisi
- Faculty of Engineering and Architecture, University of Enna Kore, Cittadella Universitaria, 94100 Enna, Italy
| | - Sanja Šurdonja
- Faculty of Civil Engineering, University of Rijeka, 51000 Rijeka, Croatia
| | | | - Irena Ištoka Otković
- Faculty of Civil Engineering and Architecture Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Self-recorded heart rate variability profiles are associated with health and lifestyle markers in young adults. Clin Auton Res 2022; 32:507-518. [PMID: 35999422 DOI: 10.1007/s10286-022-00884-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/04/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE To quantify associations between self-recorded heart rate variability (HRV) profiles and various health and lifestyle markers in young adults. METHODS Otherwise healthy volunteers (n = 40, 50% male) recorded 60-s, post-waking HRV with a cost-free mobile application in supine and standing positions for 7 days. The 7-day average and coefficient of variation (CV, reflects daily fluctuation) for the mean RR interval and root mean square of successive differences (LnRMSSD) were assessed. 7-day sleep duration and physical activity profiles were characterized via wrist-worn accelerometer. Subsequent laboratory assessments included aerobic fitness ([Formula: see text]O2peak) and markers of cardiovascular, metabolic, and psychoemotional health. Associations were evaluated before and after [Formula: see text]O2peak adjustment. RESULTS Bivariate correlations (P < 0.05) demonstrated that higher 7-day averages and/or lower CV values were associated with higher activity levels and superior cardiovascular (lower systolic and diastolic blood pressure [BP] and aortic stiffness [cf-PWV]), metabolic (lower body fat percentage, fasting glucose, and low-density lipoprotein cholesterol [LDL-C]), and psychoemotional health (lower perceived stress) markers, with some variation between sexes and recording position. In males, associations between HRV parameters and cf-PWV remained significant following [Formula: see text]O2peak adjustment (P < 0.05). In females, HRV parameters were associated (P < 0.05) with numerous cardiovascular (systolic and diastolic BP, cf-PWV) and metabolic (fasting glucose and LDL-C) parameters following [Formula: see text]O2peak adjustment. CONCLUSIONS Higher or more stable supine and standing HRV were generally associated with superior health and lifestyle markers in males and females. These findings lay groundwork for future investigation into the usefulness of self-recorded ultra-short HRV as a health-promoting behavior-modification tool in young adults.
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Martínez-González-Moro I, Albertus Cámara I, Paredes Ruiz MJ. Influences of Intense Physical Effort on the Activity of the Autonomous Nervous System and Stress, as Measured with Photoplethysmography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16066. [PMID: 36498140 PMCID: PMC9735638 DOI: 10.3390/ijerph192316066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Background: The autonomic nervous system, which is composed of the sympathetic and parasympathetic nervous system, is closely related to the cardiovascular system. The temporal variation between each of the intervals between the consecutive “R” waves of an electrocardiogram is known as heart rate variability. Depending on the type of activity, both systems can be activated, and also influence the interval between “R” waves. Currently, with advancements in technology and electronic devices, photoplethysmography is used. Photoplethysmography detects changes in the intensity of reflected light that allow differentiation between systole and diastole and, therefore, determines the heart rate, its frequency and its variations. In this way, changes in the autonomic nervous system can be detected by devices such as the Max Pulse®. Objective: To determine whether the information provided by Max Pulse® on autonomic balance and stress is modified after intense physical exercise, thereby determining whether there is a relationship with body composition, and also whether there are differences with respect to gender. Materials and Methods: Fifty-three runners (38.9% female) with a mean age of 31.3 ± 8.1 years participated in the study. Two measurements (before and after intense physical effort) were performed with the Max Pulse® device. The flotoplethysmography measurement lasted 3 min, and was performed in the supine position. The exercise test was performed on a treadmill. It was initiated at a speed of 6 and 7 km/h for women and men, respectively. Subjects indicated the end of the test by making a hand gesture when unable to continue the test. Results: Autonomic nervous system activity and mental stress values decreased significantly (p < 0.05) in men and women, while autonomic nervous system balance decreased only in women. Physical stress increased (p < 0.05) in both sexes. Conclusions: Intense exercise causes changes in variables that assess autonomic nervous system balance and stress, as measured by a device based on photoplethysmography. The changes are evident in both sexes, and are not related to body composition.
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Evenson KR, Scherer E, Peter KM, Cuthbertson CC, Eckman S. Historical development of accelerometry measures and methods for physical activity and sedentary behavior research worldwide: A scoping review of observational studies of adults. PLoS One 2022; 17:e0276890. [PMID: 36409738 PMCID: PMC9678297 DOI: 10.1371/journal.pone.0276890] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 10/15/2022] [Indexed: 11/22/2022] Open
Abstract
This scoping review identified observational studies of adults that utilized accelerometry to assess physical activity and sedentary behavior. Key elements on accelerometry data collection were abstracted to describe current practices and completeness of reporting. We searched three databases (PubMed, Web of Science, and SPORTDiscus) on June 1, 2021 for articles published up to that date. We included studies of non-institutionalized adults with an analytic sample size of at least 500. The search returned 5686 unique records. After reviewing 1027 full-text publications, we identified and abstracted accelerometry characteristics on 155 unique observational studies (154 cross-sectional/cohort studies and 1 case control study). The countries with the highest number of studies included the United States, the United Kingdom, and Japan. Fewer studies were identified from the continent of Africa. Five of these studies were distributed donor studies, where participants connected their devices to an application and voluntarily shared data with researchers. Data collection occurred between 1999 to 2019. Most studies used one accelerometer (94.2%), but 8 studies (5.2%) used 2 accelerometers and 1 study (0.6%) used 4 accelerometers. Accelerometers were more commonly worn on the hip (48.4%) as compared to the wrist (22.3%), thigh (5.4%), other locations (14.9%), or not reported (9.0%). Overall, 12.7% of the accelerometers collected raw accelerations and 44.6% were worn for 24 hours/day throughout the collection period. The review identified 155 observational studies of adults that collected accelerometry, utilizing a wide range of accelerometer data processing methods. Researchers inconsistently reported key aspects of the process from collection to analysis, which needs addressing to support accurate comparisons across studies.
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Affiliation(s)
- Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Elissa Scherer
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Kennedy M. Peter
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Carmen C. Cuthbertson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephanie Eckman
- RTI International, Research Triangle Park, North Carolina, United States of America
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Sharifiheris Z, Rahmani A, Onwuka J, Bender M. The Utilization of Heart Rate Variability for Autonomic Nervous System Assessment in Healthy Pregnant Women: Systematic Review. JMIR BIOINFORMATICS AND BIOTECHNOLOGY 2022; 3:e36791. [PMID: 38935943 PMCID: PMC11135217 DOI: 10.2196/36791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/20/2022] [Accepted: 11/03/2022] [Indexed: 06/29/2024]
Abstract
BACKGROUND The autonomic nervous system (ANS) plays a central role in pregnancy-induced adaptations, and failure in the required adaptations is associated with adverse neonatal and maternal outcomes. Mapping maternal ANS function in healthy pregnancy may help to understand ANS function. OBJECTIVE This study aimed to systematically review studies on the use of heart rate variability (HRV) monitoring to measure ANS function during pregnancy and determine whether specific HRV patterns representing normal ANS function have been identified during pregnancy. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used to guide the systematic review. The CINAHL, PubMed, SCOPUS, and Web of Science databases were searched to comprehensively identify articles without a time span limitation. Studies were included if they assessed HRV in healthy pregnant individuals at least once during pregnancy or labor, with or without a comparison group (eg, complicated pregnancy). Quality assessment of the included literature was performed using the National Heart, Lung, and Blood Institute (NHLBI) tool. A narrative synthesis approach was used for data extraction and analysis, as the articles were heterogenous in scope, approaches, methods, and variables assessed, which precluded traditional meta-analysis approaches being used. RESULTS After full screening, 8 studies met the inclusion criteria. In 88% (7/8) of the studies, HRV was measured using electrocardiogram and operationalized in 3 different ways: linear frequency domain (FD), linear time domain (TD), and nonlinear methods. FD was measured in all (8/8), TD in 75% (6/8), and nonlinear methods in 25% (2/8) of the studies. The assessment duration varied from 5 minutes to 24 hours. TD indexes and most of the FD indexes decreased from the first to the third trimesters in the majority (5/7, 71%) of the studies. Of the FD indexes, low frequency (LF [nu]) and the LF/high frequency (HF) ratio showed an ascending trend from early to late pregnancy, indicating an increase in sympathetic activity toward the end of the pregnancy. CONCLUSIONS We identified 3 HRV operationalization methods along with potentially indicative HRV patterns. However, we found no justification for the selection of measurement tools, measurement time frames, and operationalization methods, which threaten the generalizability and reliability of pattern findings. More research is needed to determine the criteria and methods for determining HRV patterns corresponding to ANS functioning in healthy pregnant persons.
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Affiliation(s)
| | - Amir Rahmani
- University of California, Irvine, Irvine, CA, United States
| | - Joseph Onwuka
- University of California, Irvine, Irvine, CA, United States
| | - Miriam Bender
- University of California, Irvine, Irvine, CA, United States
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Rinella S, Massimino S, Fallica PG, Giacobbe A, Donato N, Coco M, Neri G, Parenti R, Perciavalle V, Conoci S. Emotion Recognition: Photoplethysmography and Electrocardiography in Comparison. BIOSENSORS 2022; 12:811. [PMID: 36290948 PMCID: PMC9599834 DOI: 10.3390/bios12100811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
Automatically recognizing negative emotions, such as anger or stress, and also positive ones, such as euphoria, can contribute to improving well-being. In real-life, emotion recognition is a difficult task since many of the technologies used for this purpose in both laboratory and clinic environments, such as electroencephalography (EEG) and electrocardiography (ECG), cannot realistically be used. Photoplethysmography (PPG) is a non-invasive technology that can be easily integrated into wearable sensors. This paper focuses on the comparison between PPG and ECG concerning their efficacy in detecting the psychophysical and affective states of the subjects. It has been confirmed that the levels of accuracy in the recognition of affective variables obtained by PPG technology are comparable to those achievable with the more traditional ECG technology. Moreover, the affective psychological condition of the participants (anxiety and mood levels) may influence the psychophysiological responses recorded during the experimental tests.
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Affiliation(s)
- Sergio Rinella
- Department of Educational Sciences, University of Catania, via Biblioteca 4, 95124 Catania, Italy
| | - Simona Massimino
- Department of Biomedical and Biotechnological Sciences, Section of Physiology, University of Catania, via S. Sofia 89, 95125 Catania, Italy
| | - Piero Giorgio Fallica
- INSTM (National Interuniversity Consortium of Science and Technology of Materials), via G. Giusti 9, 50121 Firenze, Italy
| | - Alberto Giacobbe
- Department of Engineering, University of Messina, Contrada Di Dio, 98158 Messina, Italy
| | - Nicola Donato
- Department of Engineering, University of Messina, Contrada Di Dio, 98158 Messina, Italy
| | - Marinella Coco
- Department of Educational Sciences, University of Catania, via Biblioteca 4, 95124 Catania, Italy
| | - Giovanni Neri
- Department of Engineering, University of Messina, Contrada Di Dio, 98158 Messina, Italy
| | - Rosalba Parenti
- Department of Biomedical and Biotechnological Sciences, Section of Physiology, University of Catania, via S. Sofia 89, 95125 Catania, Italy
| | - Vincenzo Perciavalle
- Department of Sciences of Life, Kore University of Enna, Cittadella Universitaria, 94100 Enna, Italy
| | - Sabrina Conoci
- Department of Chemical, Biological, Pharmaceutical and Environmental Science, University of Messina, Viale F. Stagno d’Alcontres 31, Vill. S. Agata, 98166 Messina, Italy
- LAB Sense Beyond Nano—URT Department of Sciences Physics and Technologies of Matter (DSFTM) CNR, Viale F. Stagno d’Alcontres 31, Vill. S. Agata, 98166 Messina, Italy
- Department of Chemistry ‘‘Giacomo Ciamician’’, University of Bologna, Via Selmi 2, 40126 Bologna, Italy
- Istituto per la Microelettronica e Microsistemi, Consiglio Nazionale delle Ricerche (CNR-IMM), Strada VIII n. 5, 95121 Catania, Italy
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Williamson S, Daniel-Watanabe L, Finnemann J, Powell C, Teed A, Allen M, Paulus M, Khalsa SS, Fletcher PC. The Hybrid Excess and Decay (HED) model: an automated approach to characterising changes in the photoplethysmography pulse waveform. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17855.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Photoplethysmography offers a widely used, convenient and non-invasive approach to monitoring basic indices of cardiovascular function, such as heart rate and blood oxygenation. Systematic analysis of the shape of the waveform generated by photoplethysmography might be useful to extract estimates of several physiological and psychological factors influencing the waveform. Here, we developed a robust and automated method for such a systematic analysis across individuals and across different physiological and psychological contexts. We describe a psychophysiologically-relevant model, the Hybrid Excess and Decay (HED) model, which characterises pulse wave morphology in terms of three underlying pressure waves and a decay function. We present the theoretical and practical basis for the model and demonstrate its performance when applied to a pharmacological dataset of 105 participants receiving intravenous administrations of the sympathomimetic drug isoproterenol (isoprenaline). We show that these parameters capture photoplethysmography data with a high degree of precision and, moreover, are sensitive to experimentally-induced changes in interoceptive arousal within individuals. We conclude by discussing the possible value in using the HED model as a complement to standard measures of photoplethysmography signals.
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Wilkie L, Fisher Z, Kemp AH. The Complex Construct of Wellbeing and the Role of Vagal Function. Front Integr Neurosci 2022; 16:925664. [PMID: 35875509 PMCID: PMC9301262 DOI: 10.3389/fnint.2022.925664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lowri Wilkie
- School of Psychology, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
- Regional Neuropsychology and Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
| | - Zoe Fisher
- Regional Neuropsychology and Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
- Health and Wellbeing Academy, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
| | - Andrew H. Kemp
- School of Psychology, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
- Regional Neuropsychology and Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
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Li CH, Ly FS, Woodhouse K, Chen J, Cheng Z, Santander T, Ashar N, Turki E, Yang HT, Miller M, Petzold L, Hansma PK. Dynamic Phase Extraction: Applications in Pulse Rate Variability. Appl Psychophysiol Biofeedback 2022; 47:213-222. [PMID: 35704121 DOI: 10.1007/s10484-022-09549-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/02/2022]
Abstract
Pulse rate variability is a physiological parameter that has been extensively studied and correlated with many physical ailments. However, the phase relationship between inter-beat interval, IBI, and breathing has very rarely been studied. Develop a technique by which the phase relationship between IBI and breathing can be accurately and efficiently extracted from photoplethysmography (PPG) data. A program based on Lock-in Amplifier technology was written in Python to implement a novel technique, Dynamic Phase Extraction. It was tested using a breath pacer and a PPG sensor on 6 subjects who followed a breath pacer at varied breathing rates. The data were then analyzed using both traditional methods and the novel technique (Dynamic Phase Extraction) utilizing a breath pacer. Pulse data was extracted using a PPG sensor. Dynamic Phase Extraction (DPE) gave the magnitudes of the variation in IBI associated with breathing [Formula: see text] measured with photoplethysmography during paced breathing (with premature ventricular contractions, abnormal arrhythmias, and other artifacts edited out). [Formula: see text] correlated well with two standard measures of pulse rate variability: the Standard Deviation of the inter-beat interval (SDNN) (ρ = 0.911) and with the integrated value of the Power Spectral Density between 0.04 and 0.15 Hz (Low Frequency Power or LF Power) (ρ = 0.885). These correlations were comparable to the correlation between the SDNN and the LF Power (ρ = 0.877). In addition to the magnitude [Formula: see text], Dynamic Phase Extraction also gave the phase between the breath pacer and the changes in the inter-beat interval (IBI) due to respiratory sinus arrythmia (RSA), and correlated well with the phase extracted using a Fourier transform (ρ = 0.857). Dynamic Phase Extraction can extract both the phase between the breath pacer and the changes in IBI due to the respiratory sinus arrhythmia component of pulse rate variability ([Formula: see text], but is limited by needing a breath pacer.
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Affiliation(s)
- Christopher H Li
- Department of Physics, University of California, Santa Barbara, Santa Barbara, USA.
| | - Franklin S Ly
- Department of Mechanical Engineering, University of California, Santa Barbara, Santa Barbara, USA
| | - Kegan Woodhouse
- Department of Mechanical Engineering, University of California, Santa Barbara, Santa Barbara, USA
| | - John Chen
- Department of Mechanical Engineering, University of California, Santa Barbara, Santa Barbara, USA
| | - Zhuowei Cheng
- Department of Computer Science, University of California, Santa Barbara, Santa Barbara, USA
| | - Tyler Santander
- Department of Psychological & Brain Sciences, University of California, Santa Barbara, Santa Barbara, USA
| | - Nirmit Ashar
- Department of Computer Science, University of California, Santa Barbara, Santa Barbara, USA
| | - Elyes Turki
- Department of Physics, University of California, Santa Barbara, Santa Barbara, USA
| | - Henry T Yang
- Department of Mechanical Engineering, University of California, Santa Barbara, Santa Barbara, USA
| | - Michael Miller
- Department of Psychological & Brain Sciences, University of California, Santa Barbara, Santa Barbara, USA
| | - Linda Petzold
- Department of Mechanical Engineering, University of California, Santa Barbara, Santa Barbara, USA.,Department of Computer Science, University of California, Santa Barbara, Santa Barbara, USA
| | - Paul K Hansma
- Department of Physics, University of California, Santa Barbara, Santa Barbara, USA.,Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, USA
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Hilty M, Oldrati P, Barrios L, Müller T, Blumer C, Foege M, consortium PHRT, Holz C, Lutterotti A. Continuous monitoring with wearables in multiple sclerosis reveals an association of cardiac autonomic dysfunction with disease severity. Mult Scler J Exp Transl Clin 2022; 8:20552173221103436. [PMID: 35677598 PMCID: PMC9168869 DOI: 10.1177/20552173221103436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background Dysfunction of the autonomic nervous system is common in multiple sclerosis
patients, and probably present years before diagnosis, but its role in the
disease is poorly understood. Objectives To study the autonomic nervous system in patients with multiple sclerosis
using cardiac autonomic regulation measured with a wearable. Methods In a two-week study, we present a method to standardize the measurement of
heart rate variability using a wearable sensor that allows the investigation
of circadian trends. Using this method, we investigate the relationship of
cardiac autonomic dysfunction with clinical hallmarks and subjective burden
of fatigue and autonomic symptoms. Results In 55 patients with multiple sclerosis and 24 healthy age- and gender-matched
controls, we assessed the cumulative circadian heart-rate variability trend
of two weeks. The trend analysis revealed an effect of inflammation
(P = 0.0490, SMD = -0.5466) and progressive
neurodegeneration (P = 0.0016, SMD = 1.1491) on cardiac
autonomic function. No association with subjective symptoms could be
found. Conclusions Trend-based heart rate variability measured with a wearable provides the
opportunity for unobtrusive long-term assessment of autonomic functions in
patients with multiple sclerosis. It revealed a general dysregulation in
patients with multiple sclerosis.
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Affiliation(s)
- Marc Hilty
- University and University Hospital of Zürich, Department of Neurology, Zürich, 8091, Switzerland
| | - Pietro Oldrati
- University and University Hospital of Zürich, Department of Neurology, Zürich, 8091, Switzerland
- University and University Hospital of Zürich, Department of Neurology, Zürich, 8091, Switzerland
| | - Liliana Barrios
- ETH Zürich, Department of Computer Science, Zürich, 8092, Switzerland
- University and University Hospital of Zürich, Department of Neurology, Zürich, 8091, Switzerland
| | - Tamara Müller
- University and University Hospital of Zürich, Department of Neurology, Zürich, 8091, Switzerland
| | - Claudia Blumer
- University and University Hospital of Zürich, Department of Neurology, Zürich, 8091, Switzerland
| | - Magdalena Foege
- University and University Hospital of Zürich, Department of Neurology, Zürich, 8091, Switzerland
| | | | - Christian Holz
- ETH Zürich, Department of Computer Science, Zürich, 8092, Switzerland
| | - Andreas Lutterotti
- University and University Hospital of Zürich, Department of Neurology, Zürich, 8091, Switzerland
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50
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Natarajan A, Su HW, Heneghan C. Occurrence of Relative Bradycardia and Relative Tachycardia in Individuals Diagnosed With COVID-19. Front Physiol 2022; 13:898251. [PMID: 35620612 PMCID: PMC9127385 DOI: 10.3389/fphys.2022.898251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/08/2022] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has become one of the worst global pandemics of the century. Wearable devices are well suited for continuously measuring heart rate. Here we show that the Resting Heart Rate is modified for several weeks following a COVID-19 infection. The Resting Heart Rate shows 3 phases: 1) elevated during symptom onset, with average peak increases relative to the baseline of 1.8% (3.4%) for females (males), 2) decrease thereafter, reaching a minimum on average ≈13 days after symptom onset, and 3) subsequent increase, reaching a second peak on average ≈28 days from symptom onset, before falling back to the baseline ≈112 days from symptom onset. All estimates vary with disease severity1.
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