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Zhang Y, Shi Y, Su Y, Cao Z, Li C, Xie Y, Niu X, Yuan Y, Ma L, Zhu S, Zhou Y, Wang Z, Hei X, Shi Z, Ren X, Liu H. Detection and severity assessment of obstructive sleep apnea according to deep learning of single-lead electrocardiogram signals. J Sleep Res 2024:e14285. [PMID: 39021352 DOI: 10.1111/jsr.14285] [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: 03/13/2024] [Revised: 05/12/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024]
Abstract
Developing a convenient detection method is important for diagnosing and treating obstructive sleep apnea. Considering availability and medical reliability, we established a deep-learning model that uses single-lead electrocardiogram signals for obstructive sleep apnea detection and severity assessment. The detection model consisted of signal preprocessing, feature extraction, time-frequency domain information fusion, and classification segments. A total of 375 patients who underwent polysomnography were included. The single-lead electrocardiogram signals obtained by polysomnography were used to train, validate and test the model. Moreover, the proposed model performance on a public dataset was compared with the findings of previous studies. In the test set, the accuracy of per-segment and per-recording detection were 82.55% and 85.33%, respectively. The accuracy values for mild, moderate and severe obstructive sleep apnea were 69.33%, 74.67% and 85.33%, respectively. In the public dataset, the accuracy of per-segment detection was 91.66%. A Bland-Altman plot revealed the consistency of true apnea-hypopnea index and predicted apnea-hypopnea index. We confirmed the feasibility of single-lead electrocardiogram signals and deep-learning model for obstructive sleep apnea detection and severity evaluation in both hospital and public datasets. The detection performance is high for patients with obstructive sleep apnea, especially those with severe obstructive sleep apnea.
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Affiliation(s)
- Yitong Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yewen Shi
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yonglong Su
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zine Cao
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chengjian Li
- School of Computer Science and Engineering, Xi'an University of Technology, Xi'an, China
| | - Yushan Xie
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoxin Niu
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuqi Yuan
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lina Ma
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Simin Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanuo Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zitong Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - XinHong Hei
- School of Computer Science and Engineering, Xi'an University of Technology, Xi'an, China
| | - Zhenghao Shi
- School of Computer Science and Engineering, Xi'an University of Technology, Xi'an, China
| | - Xiaoyong Ren
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Haiqin Liu
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Waqar S, Ghani Khan MU. Sleep stage prediction using multimodal body network and circadian rhythm. PeerJ Comput Sci 2024; 10:e1988. [PMID: 38686009 PMCID: PMC11057653 DOI: 10.7717/peerj-cs.1988] [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: 08/28/2023] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
Quality sleep plays a vital role in living beings as it contributes extensively to the healing process and the removal of waste products from the body. Poor sleep may lead to depression, memory deficits, heart, and metabolic problems, etc. Sleep usually works in cycles and repeats itself by transitioning into different stages of sleep. This study is unique in that it uses wearable devices to collect multiple parameters from subjects and uses this information to predict sleep stages and sleep patterns. For the multivariate multiclass sleep stage prediction problem, we have experimented with both memoryless (ML) and memory-based models on seven database instances, that is, five from the collected dataset and two from the existing datasets. The Random Forest classifier outclassed the ML models that are LR, MLP, kNN, and SVM with accuracy (ACC) of 0.96 and Cohen Kappa 0.96, and the memory-based model long short-term memory (LSTM) performed well on all the datasets with the maximum attained accuracy of 0.88 and Kappa 0.82. The proposed methodology was also validated on a longitudinal dataset, the Multiethnic Study of Atherosclerosis (MESA), with ACC and Kappa of 0.75 and 0.64 for ML models and 0.86 and 0.78 for memory-based models, respectively, and from another benchmarked Apple Watch dataset available on Physio-Net with ACC and Kappa of 0.93 and 0.93 for ML and 0.92 and 0.87 for memory-based models, respectively. The given methodology showed better results than the original work and indicates that the memory-based method works better to capture the sleep pattern.
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Affiliation(s)
- Sahar Waqar
- Department of Computer Engineering, University of Engineering and Technology, Lahore, Lahore, Punjab, Pakistan
| | - Muhammad Usman Ghani Khan
- Department of Computer Science, University of Engineering and Technology, Lahore, Lahore, Punjab, Pakistan
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Baur DM, Dornbierer DA, Landolt HP. Concentration-effect relationships of plasma caffeine on EEG delta power and cardiac autonomic activity during human sleep. J Sleep Res 2024:e14140. [PMID: 38221756 DOI: 10.1111/jsr.14140] [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: 09/26/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
Acute caffeine intake affects brain and cardiovascular physiology, yet the concentration-effect relationships on the electroencephalogram and cardiac autonomic activity during sleep are poorly understood. To tackle this question, we simultaneously quantified the plasma caffeine concentration with ultra-high-performance liquid chromatography, as well as the electroencephalogram, heart rate and high-frequency (0.15-0.4 Hz) spectral power in heart rate variability, representing parasympathetic activity, with standard polysomnography during undisturbed human sleep. Twenty-one healthy young men in randomized, double-blind, crossover fashion, ingested 160 mg caffeine or placebo in a delayed, pulsatile-release caffeine formula at their habitual bedtime, and initiated a 4-hr sleep opportunity 4.5 hr later. The mean caffeine levels during sleep exhibited high individual variability between 0.2 and 18.4 μmol L-1 . Across the first two non-rapid-eye-movement (NREM)-rapid-eye-movement sleep cycles, electroencephalogram delta (0.75-2.5 Hz) activity and heart rate were reliably modulated by waking and sleep states. Caffeine dose-dependently reduced delta activity and heart rate, and increased high-frequency heart rate variability in NREM sleep when compared with placebo. The average reduction in heart rate equalled 3.24 ± 0.77 beats per minute. Non-linear statistical models suggest that caffeine levels above ~7.4 μmol L-1 decreased electroencephalogram delta activity, whereas concentrations above ~4.3 μmol L-1 and ~ 4.9 μmol L-1 , respectively, reduced heart rate and increased high-frequency heart rate variability. These findings provide quantitative concentration-effect relationships of caffeine, electroencephalogram delta power and cardiac autonomic activity, and suggest increased parasympathetic activity during sleep after intake of caffeine.
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Affiliation(s)
- Diego M Baur
- Institute of Pharmacology & Toxicology, University of Zurich, Zurich, Switzerland
- Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - Dario A Dornbierer
- Institute of Pharmacology & Toxicology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Hans-Peter Landolt
- Institute of Pharmacology & Toxicology, University of Zurich, Zurich, Switzerland
- Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
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Fudolig MI, Bloomfield LS, Price M, Bird YM, Hidalgo JE, Kim JN, Llorin J, Lovato J, McGinnis EW, McGinnis RS, Ricketts T, Stanton K, Dodds PS, Danforth CM. The Two Fundamental Shapes of Sleep Heart Rate Dynamics and Their Connection to Mental Health in College Students. Digit Biomark 2024; 8:120-131. [PMID: 39015512 PMCID: PMC11250749 DOI: 10.1159/000539487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/17/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Wearable devices are rapidly improving our ability to observe health-related processes for extended durations in an unintrusive manner. In this study, we use wearable devices to understand how the shape of the heart rate curve during sleep relates to mental health. Methods As part of the Lived Experiences Measured Using Rings Study (LEMURS), we collected heart rate measurements using the Oura ring (Gen3) for over 25,000 sleep periods and self-reported mental health indicators from roughly 600 first-year university students in the USA during the fall semester of 2022. Using clustering techniques, we find that the sleeping heart rate curves can be broadly separated into two categories that are mainly differentiated by how far along the sleep period the lowest heart rate is reached. Results Sleep periods characterized by reaching the lowest heart rate later during sleep are also associated with shorter deep and REM sleep and longer light sleep, but not a difference in total sleep duration. Aggregating sleep periods at the individual level, we find that consistently reaching the lowest heart rate later during sleep is a significant predictor of (1) self-reported impairment due to anxiety or depression, (2) a prior mental health diagnosis, and (3) firsthand experience in traumatic events. This association is more pronounced among females. Conclusion Our results show that the shape of the sleeping heart rate curve, which is only weakly correlated with descriptive statistics such as the average or the minimum heart rate, is a viable but mostly overlooked metric that can help quantify the relationship between sleep and mental health.
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Affiliation(s)
- Mikaela Irene Fudolig
- Vermont Complex Systems Center, MassMutual Center of Excellence for Complex Systems and Data Science, University of Vermont, Burlington, VT, USA
- Department of Mathematics and Statistics, University of Vermont, Burlington, VT, USA
- Computational Story Lab, MassMutual Center of Excellence for Complex Systems and Data Science, University of Vermont, Burlington, VT, USA
| | - Laura S.P. Bloomfield
- Vermont Complex Systems Center, MassMutual Center of Excellence for Complex Systems and Data Science, University of Vermont, Burlington, VT, USA
- Department of Mathematics and Statistics, University of Vermont, Burlington, VT, USA
- Computational Story Lab, MassMutual Center of Excellence for Complex Systems and Data Science, University of Vermont, Burlington, VT, USA
- Gund Institute for Environment, University of Vermont, Burlington, VT, USA
| | - Matthew Price
- Vermont Complex Systems Center, MassMutual Center of Excellence for Complex Systems and Data Science, University of Vermont, Burlington, VT, USA
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Yoshi M. Bird
- Vermont Complex Systems Center, MassMutual Center of Excellence for Complex Systems and Data Science, University of Vermont, Burlington, VT, USA
- Computational Story Lab, MassMutual Center of Excellence for Complex Systems and Data Science, University of Vermont, Burlington, VT, USA
| | - Johanna E. Hidalgo
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Julia N. Kim
- Project LEMURS, University of Vermont, Burlington, VT, USA
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, USA
| | - Jordan Llorin
- Project LEMURS, University of Vermont, Burlington, VT, USA
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, USA
| | - Juniper Lovato
- Vermont Complex Systems Center, MassMutual Center of Excellence for Complex Systems and Data Science, University of Vermont, Burlington, VT, USA
- Computational Story Lab, MassMutual Center of Excellence for Complex Systems and Data Science, University of Vermont, Burlington, VT, USA
- Department of Computer Science, University of Vermont, Burlington, VT, USA
| | | | - Ryan S. McGinnis
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Taylor Ricketts
- Gund Institute for Environment, University of Vermont, Burlington, VT, USA
- Rubenstein School of Environment and Natural Resources, University of Vermont, Burlington, VT, USA
| | - Kathryn Stanton
- Project LEMURS, University of Vermont, Burlington, VT, USA
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, USA
| | - Peter Sheridan Dodds
- Vermont Complex Systems Center, MassMutual Center of Excellence for Complex Systems and Data Science, University of Vermont, Burlington, VT, USA
- Computational Story Lab, MassMutual Center of Excellence for Complex Systems and Data Science, University of Vermont, Burlington, VT, USA
- Department of Computer Science, University of Vermont, Burlington, VT, USA
- Santa Fe Institute, Santa Fe, NM, USA
| | - Christopher M. Danforth
- Vermont Complex Systems Center, MassMutual Center of Excellence for Complex Systems and Data Science, University of Vermont, Burlington, VT, USA
- Department of Mathematics and Statistics, University of Vermont, Burlington, VT, USA
- Computational Story Lab, MassMutual Center of Excellence for Complex Systems and Data Science, University of Vermont, Burlington, VT, USA
- Gund Institute for Environment, University of Vermont, Burlington, VT, USA
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García-Vicente C, Gutiérrez-Tobal GC, Jiménez-García J, Martín-Montero A, Gozal D, Hornero R. ECG-based convolutional neural network in pediatric obstructive sleep apnea diagnosis. Comput Biol Med 2023; 167:107628. [PMID: 37918264 DOI: 10.1016/j.compbiomed.2023.107628] [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: 06/23/2023] [Revised: 09/28/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Obstructive sleep apnea (OSA) is a prevalent respiratory condition in children and is characterized by partial or complete obstruction of the upper airway during sleep. The respiratory events in OSA induce transient alterations of the cardiovascular system that ultimately can lead to increased cardiovascular risk in affected children. Therefore, a timely and accurate diagnosis is of utmost importance. However, polysomnography (PSG), the standard diagnostic test for pediatric OSA, is complex, uncomfortable, costly, and relatively inaccessible, particularly in low-resource environments, thereby resulting in substantial underdiagnosis. Here, we propose a novel deep-learning approach to simplify the diagnosis of pediatric OSA using raw electrocardiogram tracing (ECG). Specifically, a new convolutional neural network (CNN)-based regression model was implemented to automatically predict pediatric OSA by estimating its severity based on the apnea-hypopnea index (AHI) and deriving 4 OSA severity categories. For this purpose, overnight ECGs from 1,610 PSG recordings obtained from the Childhood Adenotonsillectomy Trial (CHAT) database were used. The database was randomly divided into approximately 60%, 20%, and 20% for training, validation, and testing, respectively. The diagnostic performance of the proposed CNN model largely outperformed the most accurate previous algorithms that relied on ECG-derived features (4-class Cohen's kappa coefficient of 0.373 versus 0.166). Specifically, for AHI cutoff values of 1, 5, and 10 events/hour, the binary classification achieved sensitivities of 84.19%, 76.67%, and 53.66%; specificities of 46.15%, 91.39%, and 98.06%; and accuracies of 75.92%, 86.96%, and 91.97%, respectively. Therefore, pediatric OSA can be readily identified by our proposed CNN model, which provides a simpler, faster, and more accessible diagnostic test that can be implemented in clinical practice.
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Affiliation(s)
| | - Gonzalo C Gutiérrez-Tobal
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Jorge Jiménez-García
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - Adrián Martín-Montero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
| | - David Gozal
- Office of The Dean, Joan C. Edwards School of Medicine, Marshall University, 1600 Medical Center Dr, Huntington, WV, 25701, USA
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Valladolid, Spain
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Cairo B, Bari V, Gelpi F, De Maria B, Porta A. Assessing cardiorespiratory interactions via lagged joint symbolic dynamics during spontaneous and controlled breathing. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1211848. [PMID: 37602202 PMCID: PMC10436098 DOI: 10.3389/fnetp.2023.1211848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023]
Abstract
Introduction: Joint symbolic analysis (JSA) can be utilized to describe interactions between time series while accounting for time scales and nonlinear features. JSA is based on the computation of the rate of occurrence of joint patterns built after symbolization. Lagged JSA (LJSA) is obtained from the more classical JSA by introducing a delay/lead between patterns built over the two series and combined to form the joint scheme, thus monitoring coordinated patterns at different lags. Methods: In the present study, we applied LJSA for the assessment of cardiorespiratory coupling (CRC) from heart period (HP) variability and respiratory activity (R) in 19 healthy subjects (age: 27-35 years; 8 males, 11 females) during spontaneous breathing (SB) and controlled breathing (CB). The R rate of CB was selected to be indistinguishable from that of SB, namely, 15 breaths·minute-1 (CB15), or slower than SB, namely, 10 breaths·minute-1 (CB10), but in both cases, very rapid interactions between heart rate and R were known to be present. The ability of the LJSA approach to follow variations of the coupling strength was tested over a unidirectionally or bidirectionally coupled stochastic process and using surrogate data to test the null hypothesis of uncoupling. Results: We found that: i) the analysis of surrogate data proved that HP and R were significantly coupled in any experimental condition, and coupling was not more likely to occur at a specific time lag; ii) CB10 reduced CRC strength at the fastest time scales while increasing that at intermediate time scales, thus leaving the overall CRC strength unvaried; iii) despite exhibiting similar R rates and respiratory sinus arrhythmia, SB and CB15 induced different cardiorespiratory interactions; iv) no dominant temporal scheme was observed with relevant contributions of HP patterns either leading or lagging R. Discussion: LJSA is a useful methodology to explore HP-R dynamic interactions while accounting for time shifts and scales.
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Affiliation(s)
- Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Vlasta Bari
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato Milanese, Milan, Italy
| | - Francesca Gelpi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato Milanese, Milan, Italy
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Moon KS, Lee SQ. A Wearable Multimodal Wireless Sensing System for Respiratory Monitoring and Analysis. SENSORS (BASEL, SWITZERLAND) 2023; 23:6790. [PMID: 37571572 PMCID: PMC10422350 DOI: 10.3390/s23156790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/15/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023]
Abstract
Wireless sensing systems are required for continuous health monitoring and data collection. It allows for patient data collection in real time rather than through time-consuming and expensive hospital or lab visits. This technology employs wearable sensors, signal processing, and wireless data transfer to remotely monitor patients' health. The research offers a novel approach to providing primary diagnostics remotely with a digital health system for monitoring pulmonary health status using a multimodal wireless sensor device. The technology uses a compact wearable with new integration of acoustics and biopotentials sensors to monitor cardiovascular and respiratory activity to provide comprehensive and fast health status monitoring. Furthermore, the small wearable sensor size may stick to human skin and record heart and lung activities to monitor respiratory health. This paper proposes a sensor data fusion method of lung sounds and cardiograms for potential real-time respiration pattern diagnostics, including respiratory episodes like low tidal volume and coughing. With a p-value of 0.003 for sound signals and 0.004 for electrocardiogram (ECG), preliminary tests demonstrated that it was possible to detect shallow breathing and coughing at a meaningful level.
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Affiliation(s)
- Kee S. Moon
- Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, USA
| | - Sung Q Lee
- Electronics and Telecommunications Research Institute, Daejeon 34129, Republic of Korea
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Cairo B, Bari V, de Abreu RM, Gelpi F, De Maria B, Catai AM, Porta A. Characterization of Multiple Regimes of Cardiorespiratory Phase Synchronization in Athletes Undergoing Inspiratory Muscle Training. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083759 DOI: 10.1109/embc40787.2023.10339951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Cardiorespiratory phase synchronization (CRPS) is defined as the stable occurrence of n heartbeats within m respiratory cycles according to the n:m phase locking ratio (PLR). Since CRPS is an intermittent phenomenon where different phase synchronization regimes and epochs of phase unlocking can alternate within the same recording, an index of CRPS ideally should assess all potential PLRs present in the recording. However, traditional approaches compute the synchronization index (SYNC%) over a single n:m PLR, namely the one that maximizes CRPS. In the present work, we tested a synchronization index assessing the total percentage of heartbeats coupled to the inspiratory onset regardless of phase locking regimes (SYNC%sum) and we compared its efficacy to the more traditional SYNC%. Analysis was carried out in a cohort of 25 male amateur cyclists (age: 20-40 yrs) undergoing inspiratory muscle training (IMT) at different intensities. CRPS was assessed before and after the IMT protocol, during an experimental condition known to modify CRPS, namely active standing (STAND). We found that after a moderate intensity IMT at 60% of the maximal inspiratory pressure, SYNC%sum could detect the decrease in CRPS following STAND. This result was not visible using the more traditional SYNC%. Therefore, we stress the significant presence of different phase locking regimes in athletes and the importance of accounting for multiple PLRs in CRPS analysis.Clinical Relevance- Multiple phase locking regimes contribute significantly to cardiorespiratory control in amateur cyclists especially after inspiratory muscle training of moderate intensity.
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Mutti C, Pollara I, Abramo A, Soglia M, Rapina C, Mastrillo C, Alessandrini F, Rosenzweig I, Rausa F, Pizzarotti S, Salvatelli ML, Balella G, Parrino L. The Contribution of Sleep Texture in the Characterization of Sleep Apnea. Diagnostics (Basel) 2023; 13:2217. [PMID: 37443611 PMCID: PMC10340273 DOI: 10.3390/diagnostics13132217] [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: 05/29/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Obstructive sleep apnea (OSA) is multi-faceted world-wide-distributed disorder exerting deep effects on the sleeping brain. In the latest years, strong efforts have been dedicated to finding novel measures assessing the real impact and severity of the pathology, traditionally trivialized by the simplistic apnea/hypopnea index. Due to the unavoidable connection between OSA and sleep, we reviewed the key aspects linking the breathing disorder with sleep pathophysiology, focusing on the role of cyclic alternating pattern (CAP). Sleep structure, reflecting the degree of apnea-induced sleep instability, may provide topical information to stratify OSA severity and foresee some of its dangerous consequences such as excessive daytime sleepiness and cognitive deterioration. Machine learning approaches may reinforce our understanding of this complex multi-level pathology, supporting patients' phenotypization and easing in a more tailored approach for sleep apnea.
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Affiliation(s)
- Carlotta Mutti
- Sleep Disorders Center, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.M.); (I.P.); (A.A.); (M.S.); (C.R.); (C.M.); (F.A.); (F.R.); (S.P.); (M.l.S.); (G.B.)
| | - Irene Pollara
- Sleep Disorders Center, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.M.); (I.P.); (A.A.); (M.S.); (C.R.); (C.M.); (F.A.); (F.R.); (S.P.); (M.l.S.); (G.B.)
| | - Anna Abramo
- Sleep Disorders Center, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.M.); (I.P.); (A.A.); (M.S.); (C.R.); (C.M.); (F.A.); (F.R.); (S.P.); (M.l.S.); (G.B.)
| | - Margherita Soglia
- Sleep Disorders Center, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.M.); (I.P.); (A.A.); (M.S.); (C.R.); (C.M.); (F.A.); (F.R.); (S.P.); (M.l.S.); (G.B.)
| | - Clara Rapina
- Sleep Disorders Center, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.M.); (I.P.); (A.A.); (M.S.); (C.R.); (C.M.); (F.A.); (F.R.); (S.P.); (M.l.S.); (G.B.)
| | - Carmela Mastrillo
- Sleep Disorders Center, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.M.); (I.P.); (A.A.); (M.S.); (C.R.); (C.M.); (F.A.); (F.R.); (S.P.); (M.l.S.); (G.B.)
| | - Francesca Alessandrini
- Sleep Disorders Center, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.M.); (I.P.); (A.A.); (M.S.); (C.R.); (C.M.); (F.A.); (F.R.); (S.P.); (M.l.S.); (G.B.)
| | - Ivana Rosenzweig
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK;
| | - Francesco Rausa
- Sleep Disorders Center, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.M.); (I.P.); (A.A.); (M.S.); (C.R.); (C.M.); (F.A.); (F.R.); (S.P.); (M.l.S.); (G.B.)
| | - Silvia Pizzarotti
- Sleep Disorders Center, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.M.); (I.P.); (A.A.); (M.S.); (C.R.); (C.M.); (F.A.); (F.R.); (S.P.); (M.l.S.); (G.B.)
| | - Marcello luigi Salvatelli
- Sleep Disorders Center, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.M.); (I.P.); (A.A.); (M.S.); (C.R.); (C.M.); (F.A.); (F.R.); (S.P.); (M.l.S.); (G.B.)
- Neurology Unit, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Giulia Balella
- Sleep Disorders Center, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.M.); (I.P.); (A.A.); (M.S.); (C.R.); (C.M.); (F.A.); (F.R.); (S.P.); (M.l.S.); (G.B.)
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK;
| | - Liborio Parrino
- Sleep Disorders Center, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.M.); (I.P.); (A.A.); (M.S.); (C.R.); (C.M.); (F.A.); (F.R.); (S.P.); (M.l.S.); (G.B.)
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10
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Nevels TL, Wirth MD, Ginsberg JP, McLain AC, Burch JB. The role of sleep and heart rate variability in metabolic syndrome: evidence from the Midlife in the United States study. Sleep 2023; 46:zsad013. [PMID: 36727300 PMCID: PMC10171632 DOI: 10.1093/sleep/zsad013] [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: 05/10/2022] [Revised: 12/11/2022] [Indexed: 02/03/2023] Open
Abstract
STUDY OBJECTIVES Poor sleep and autonomic dysregulation can both disrupt metabolic processes. This study examined the individual and combined effects of poor sleep and reduced heart rate variability (HRV) on metabolic syndrome among 966 participants in the Midlife in the United States II (MIDUS II) study. METHODS Self-reported sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI). HRV was acquired from 11-minute resting heart rate recordings. Spearman correlations, general linear regression, and logistic regression models were used to examine the study hypotheses. RESULTS Poor sleep quality was associated with metabolic syndrome when global PSQI scores were evaluated as a continuous (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.03 to 1.11) or categorical measure (cutoff > 5, OR: 1.58, 95% CI: 1.19 to 2.10), after adjustment for confounding. There also was an association between reduced HRV and metabolic syndrome (ln [HF-HRV] OR: 0.89, 95% CI: 0.80 to 0.99; ln [LF-HRV] OR: 0.82, 95% CI: 0.72 to 0.92; ln [SDRR] OR: 0.59, 95% CI: 0.43 to 0.79; ln [RMSSD] OR: 0.75, 95% CI: 0.60 to 0.94). When the combined effects of poor sleep and low HRV were examined, the association with metabolic syndrome was further strengthened relative to those with normal sleep and HRV. CONCLUSIONS To the best of the author's knowledge, this is the first study to suggest a combined effect of poor sleep and low HRV on the odds of metabolic syndrome.
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Affiliation(s)
- Torrance L Nevels
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Columbia Veterans Affairs Health Care System, Columbia, SC, USA
- U.S. Military Interservice Physician Assistant Program, MEDCoE, Joint Base San Antonio-Fort Sam Houston, TX, USA
| | - Michael D Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - J P Ginsberg
- Department of Pathology, Microbiology, and Immunology, Saybrook University, Pasadena, CA, USA
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James B Burch
- Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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11
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Porta A, Bari V, Gelpi F, Cairo B, De Maria B, Tonon D, Rossato G, Faes L. On the Different Abilities of Cross-Sample Entropy and K-Nearest-Neighbor Cross-Unpredictability in Assessing Dynamic Cardiorespiratory and Cerebrovascular Interactions. ENTROPY (BASEL, SWITZERLAND) 2023; 25:e25040599. [PMID: 37190390 PMCID: PMC10137562 DOI: 10.3390/e25040599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 05/17/2023]
Abstract
Nonlinear markers of coupling strength are often utilized to typify cardiorespiratory and cerebrovascular regulations. The computation of these indices requires techniques describing nonlinear interactions between respiration (R) and heart period (HP) and between mean arterial pressure (MAP) and mean cerebral blood velocity (MCBv). We compared two model-free methods for the assessment of dynamic HP-R and MCBv-MAP interactions, namely the cross-sample entropy (CSampEn) and k-nearest-neighbor cross-unpredictability (KNNCUP). Comparison was carried out first over simulations generated by linear and nonlinear unidirectional causal, bidirectional linear causal, and lag-zero linear noncausal models, and then over experimental data acquired from 19 subjects at supine rest during spontaneous breathing and controlled respiration at 10, 15, and 20 breaths·minute-1 as well as from 13 subjects at supine rest and during 60° head-up tilt. Linear markers were computed for comparison. We found that: (i) over simulations, CSampEn and KNNCUP exhibit different abilities in evaluating coupling strength; (ii) KNNCUP is more reliable than CSampEn when interactions occur according to a causal structure, while performances are similar in noncausal models; (iii) in healthy subjects, KNNCUP is more powerful in characterizing cardiorespiratory and cerebrovascular variability interactions than CSampEn and linear markers. We recommend KNNCUP for quantifying cardiorespiratory and cerebrovascular coupling.
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Affiliation(s)
- Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Vlasta Bari
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Francesca Gelpi
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | | | - Davide Tonon
- Department of Neurology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy
| | - Gianluca Rossato
- Department of Neurology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy
| | - Luca Faes
- Department of Engineering, University of Palermo, 90128 Palermo, Italy
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12
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Romero D, Jané R. Dynamic Bayesian Model for Detecting Obstructive Respiratory Events by Using an Experimental Model. SENSORS (BASEL, SWITZERLAND) 2023; 23:3371. [PMID: 37050431 PMCID: PMC10097311 DOI: 10.3390/s23073371] [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: 02/06/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
In this study, we propose a model-based tool for the detection of obstructive apnea episodes by using ECG features from a single lead channel. Several sequences of recurrent apnea were provoked in separate 15-min periods in anesthetized rats during an experimental model of obstructive sleep apnea (OSA). Morphology-based ECG markers and the beat-to-beat interval (RR) were assessed in each sequence. These markers were used to train dynamic Bayesian networks (DBN) with different orders and feature combinations to find a good tradeoff between network complexity and apnea-detection performance. By using a filtering approach, the resulting DBNs were used to infer the apnea probability signal for subsequent episodes in the same rat. These signals were then processed using by 15-s epochs to determine whether epochs were classified as apneic or nonapneic. Our results showed that fifth-order models provided suitable RMSE values, since higher order models become significantly more complex and present worse generalization. A global threshold of 0.2 gave the best overall performance for all combinations tested, with Acc = 81.3%, Se = 69.8% and Sp = 81.5%, using only two parameters including the RR and Ds (R-wave downslope) markers. We concluded that multivariate models using DBNs represent a powerful tool for detecting obstructive apnea episodes in short segments, which may also serve to estimate the number of total events in a given time period.
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Affiliation(s)
- Daniel Romero
- ESAII Department, Universitat Politècnica de Catalunya—BarcelonaTech (UPC), 08019 Barcelona, Spain
- Institute for Bioengineering of Catalonia (IBEC-BIST), 08028 Barcelona, Spain
- CIBER of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain
| | - Raimon Jané
- ESAII Department, Universitat Politècnica de Catalunya—BarcelonaTech (UPC), 08019 Barcelona, Spain
- Institute for Bioengineering of Catalonia (IBEC-BIST), 08028 Barcelona, Spain
- CIBER of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain
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13
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Yin J, Xu J, Ren TL. Recent Progress in Long-Term Sleep Monitoring Technology. BIOSENSORS 2023; 13:395. [PMID: 36979607 PMCID: PMC10046225 DOI: 10.3390/bios13030395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
Sleep is an essential physiological activity, accounting for about one-third of our lives, which significantly impacts our memory, mood, health, and children's growth. Especially after the COVID-19 epidemic, sleep health issues have attracted more attention. In recent years, with the development of wearable electronic devices, there have been more and more studies, products, or solutions related to sleep monitoring. Many mature technologies, such as polysomnography, have been applied to clinical practice. However, it is urgent to develop wearable or non-contacting electronic devices suitable for household continuous sleep monitoring. This paper first introduces the basic knowledge of sleep and the significance of sleep monitoring. Then, according to the types of physiological signals monitored, this paper describes the research progress of bioelectrical signals, biomechanical signals, and biochemical signals used for sleep monitoring. However, it is not ideal to monitor the sleep quality for the whole night based on only one signal. Therefore, this paper reviews the research on multi-signal monitoring and introduces systematic sleep monitoring schemes. Finally, a conclusion and discussion of sleep monitoring are presented to propose potential future directions and prospects for sleep monitoring.
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Affiliation(s)
- Jiaju Yin
- School of Integrated Circuits, Tsinghua University, Beijing 100084, China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Jiandong Xu
- School of Integrated Circuits, Tsinghua University, Beijing 100084, China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
| | - Tian-Ling Ren
- School of Integrated Circuits, Tsinghua University, Beijing 100084, China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, China
- Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, China
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14
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Cardiorespiratory coupling in mechanically ventilated patients studied via synchrogram analysis. Med Biol Eng Comput 2023; 61:1329-1341. [PMID: 36698031 DOI: 10.1007/s11517-023-02784-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/15/2023] [Indexed: 01/27/2023]
Abstract
Respiration and cardiac activity are strictly interconnected with reciprocal influences. They act as weakly coupled oscillators showing varying degrees of phase synchronization and their interactions are affected by mechanical ventilation. The study aims at differentiating the impact of three ventilatory modes on the cardiorespiratory phase coupling in critically ill patients. The coupling between respiration and heartbeat was studied through cardiorespiratory phase synchronization analysis carried out via synchrogram during pressure control ventilation (PCV), pressure support ventilation (PSV), and neurally adjusted ventilatory assist (NAVA) in critically ill patients. Twenty patients were studied under all the three ventilatory modes. Cardiorespiratory phase synchronization changed significantly across ventilatory modes. The highest synchronization degree was found during PCV session, while the lowest one with NAVA. The percentage of all epochs featuring synchronization regardless of the phase locking ratio was higher with PCV (median: 33.9%, first-third quartile: 21.3-39.3) than PSV (median: 15.7%; first-third quartile: 10.9-27.8) and NAVA (median: 3.7%; first-third quartile: 3.3-19.2). PCV induces a significant amount of cardiorespiratory phase synchronization in critically ill mechanically ventilated patients. Synchronization induced by patient-driven ventilatory modes was weaker, reaching the minimum with NAVA. Findings can be explained as a result of the more regular and powerful solicitation of the cardiorespiratory system induced by PCV. The degree of phase synchronization between cardiac and respiratory activities in mechanically ventilated humans depends on the ventilatory mode.
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15
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de Abreu RM, Cairo B, Porta A. On the significance of estimating cardiorespiratory coupling strength in sports medicine. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 2:1114733. [PMID: 36926078 PMCID: PMC10013023 DOI: 10.3389/fnetp.2022.1114733] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/16/2022] [Indexed: 06/18/2023]
Abstract
The estimation of cardiorespiratory coupling (CRC) is attracting interest in sports physiology as an important tool to characterize cardiac neural regulation genuinely driven by respiration. When applied in sports medicine, cardiorespiratory coupling measurements can provide information on the effects of training, pre-competition stress, as well as cardiovascular adjustments during stressful stimuli. Furthermore, since the cardiorespiratory coupling is strongly affected by physical activity, the study of the cardiorespiratory coupling can guide the application of specific training methods to optimize the coupling between autonomic activity and heart with possible effects on performance. However, a consensus about the physiological mechanisms, as well as methodological gold standard methods to quantify the cardiorespiratory coupling, has not been reached yet, thus limiting its application in experimental settings. This review supports the relevance of assessing cardiorespiratory coupling in the sports medicine, examines the possible physiological mechanisms involved, and lists a series of methodological approaches. cardiorespiratory coupling strength seems to be increased in athletes when compared to sedentary subjects, in addition to being associated with positive physiological outcomes, such as a possible better interaction of neural subsystems to cope with stressful stimuli. Moreover, cardiorespiratory coupling seems to be influenced by specific training modalities, such as inspiratory muscle training. However, the impact of cardiorespiratory coupling on sports performance still needs to be better explored through ad hoc physical exercise tests and protocols. In addition, this review stresses that several bivariate and multivariate methods have been proposed to assess cardiorespiratory coupling, thus opening new possibilities in estimating cardiorespiratory interactions in athletes.
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Affiliation(s)
- Raphael Martins de Abreu
- Department of Physiotherapy, LUNEX University, International University of Health, Exercise & Sports S.A., Differdange, Luxembourg
- LUNEX ASBL Luxembourg Health & Sport Sciences Research Institute, Differdange, Luxembourg
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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16
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Deep Learning Forecasts the Occurrence of Sleep Apnea from Single-Lead ECG. Cardiovasc Eng Technol 2022; 13:809-815. [PMID: 35301676 DOI: 10.1007/s13239-022-00615-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/15/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Sleep apnea is the most common sleep disorder that leads to serious health complications if not treated early. Forecasting apnea occurrence ahead in time provides the opportunity to take appropriate actions to control and manage it. METHODS A novel framework for forecasting the occurrence of apnea from single-lead electrocardiogram (ECG) based on deep recurrent neural networks is proposed. ECG R-peak amplitudes and R-R intervals are extracted and aligned using power spectral analysis, and recurrent deep learning models are developed to extract the most predictive ECG features and forecast the occurrence of apnea. RESULTS The performance of the proposed approach was validated in forecasting apnea events up to five minutes in future on a dataset of 70 sleep recordings. A forecasting accuracy of up to 94.95% was achieved which was higher than the performance of conventional multilayer perceptron (p < 0.05) and other state-of-the-art techniques. CONCLUSIONS The proposed deep learning approach was successful in forecasting the occurrence of sleep apnea from single-lead ECG. It can therefore be adopted in wearable sleep monitors for the management of sleep apnea. Our developed algorithms are publicly available on GitHub.
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17
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Mano M, Nomura A, Hori R, Sasanabe R. Association between Rapid Eye Movement Obstructive Sleep Apnea and Metabolic Syndrome in a Japanese Population. Intern Med 2022. [PMID: 36384898 PMCID: PMC10372281 DOI: 10.2169/internalmedicine.0336-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Rapid eye movement (REM) obstructive sleep apnea (OSA) is characterized by apnea and hypopnea events due to airway collapse occurring predominantly or exclusively during REM sleep. OSA is a potential risk factor for metabolic dysfunction. However, the association between REM OSA and risk of adverse health outcomes remains unclear. The present study investigated the association between REM OSA and metabolic syndrome (MetS), including the MetS components of hypertension, dyslipidemia, and hyperglycemia, in the Japanese population. Methods In total, 836 Japanese patients with mild to moderate OSA were enrolled in this study. We compared the prevalence of MetS, including hypertension, dyslipidemia, and hyperglycemia, between REM OSA and non-REM OSA via univariate analyses of descriptive statistics and logistic regression analyses. Results The prevalence of hypertension was 68.3% in the REM OSA group and 56.6% in the non-REM OSA group (p<0.05). In addition, the prevalence of metabolic syndrome was significantly higher (37.0%) in the REM OSA group than in the non-REM-OSA group (25.2%). Logistic regression analyses showed that the prevalence of hypertension and Mets was significantly greater in the REM OSA group than in the non-REM-OSA group. Conclusion Our findings suggest that patients with REM OSA, regardless of age, sex, and body mass index, are at a higher risk of developing hypertension and MetS than patients with non-REM OSA.
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Affiliation(s)
- Mamiko Mano
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Atsuhiko Nomura
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Reiko Hori
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Ryujiro Sasanabe
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
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18
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Porta A, Bari V, Gelpi F, Cairo B, De Maria B, Tonon D, Rossato G, Faes L. Comparing Cross-Sample Entropy and K-Nearest-Neighbor Cross-Predictability Approaches for the Evaluation of Cardiorespiratory and Cerebrovascular Dynamic Interactions. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:127-130. [PMID: 36085935 DOI: 10.1109/embc48229.2022.9871239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Quantification of the cardiorespiratory and cerebrovascular couplings is a relevant clinical issue given that their changes are considered signs of pathological status. The inherent nonlinearity of mechanisms underlying cardiorespiratory and cerebrovascular links requires nonlinear tools for their reliable evaluation. In the present study we compare two nonlinear methods for the assessment of coupling strength between two time series, namely cross-sample entropy (CSampEn) and k-nearest-neighbor cross-predictability (KNNCP). CSampEn uses a strategy that fixes the pattern length, while KNNCP optimizes the pattern length to maximize cross-predictability. CSampEn and KNNCP were applied to the beat-to-beat series of heart period (HP) and respiration (R) during a controlled breathing protocol with the aim at assessing cardiorespiratory coupling and to the beat-to-beat series of mean cerebral blood flow (MCBF) and mean arterial pressure (MAP) during an orthostatic stressor with the aim at evaluating cerebrovascular coupling. Although both the methods have the possibility to quantify the degree of HP-R and MCBF-MAP association, they exhibited different statistical power and even diverse trends in response to the considered physiological challenges. CSampEn and KNNCP are not interchangeable and should be utilized in association more than in alternative for the quantification of the HP-R and MCBF-MAP coupling strength. Clinical Relevance - This study proves that cross-entropy and cross-predictability might lead to different conclusions about cardiorespiratory and cerebrovascular couplings.
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19
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Gutiérrez-Tobal GC, Kheirandish-Gozal L, Gozal D, Hornero R. Editorial: Unraveling Sleep and Its Disorders Using Novel Analytical Approaches. Front Neurosci 2022; 16:924359. [PMID: 35663551 PMCID: PMC9159350 DOI: 10.3389/fnins.2022.924359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Gonzalo C. Gutiérrez-Tobal
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- Centro de Investigacion Biomedica en Red en Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN), Valladolid, Spain
- *Correspondence: Gonzalo C. Gutiérrez-Tobal
| | - Leila Kheirandish-Gozal
- Department of Child Health, Child Health Research Institute, The University of Missouri School of Medicine, Columbia, MO, United States
| | - David Gozal
- Department of Child Health, Child Health Research Institute, The University of Missouri School of Medicine, Columbia, MO, United States
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- Centro de Investigacion Biomedica en Red en Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN), Valladolid, Spain
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20
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Sensitivity of Machine Learning Approaches to Fake and Untrusted Data in Healthcare Domain. JOURNAL OF SENSOR AND ACTUATOR NETWORKS 2022. [DOI: 10.3390/jsan11020021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Machine Learning models are susceptible to attacks, such as noise, privacy invasion, replay, false data injection, and evasion attacks, which affect their reliability and trustworthiness. Evasion attacks, performed to probe and identify potential ML-trained models’ vulnerabilities, and poisoning attacks, performed to obtain skewed models whose behavior could be driven when specific inputs are submitted, represent a severe and open issue to face in order to assure security and reliability to critical domains and systems that rely on ML-based or other AI solutions, such as healthcare and justice, for example. In this study, we aimed to perform a comprehensive analysis of the sensitivity of Artificial Intelligence approaches to corrupted data in order to evaluate their reliability and resilience. These systems need to be able to understand what is wrong, figure out how to overcome the resulting problems, and then leverage what they have learned to overcome those challenges and improve their robustness. The main research goal pursued was the evaluation of the sensitivity and responsiveness of Artificial Intelligence algorithms to poisoned signals by comparing several models solicited with both trusted and corrupted data. A case study from the healthcare domain was provided to support the pursued analyses. The results achieved with the experimental campaign were evaluated in terms of accuracy, specificity, sensitivity, F1-score, and ROC area.
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21
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JeyaJothi ES, Anitha J, Rani S, Tiwari B. A Comprehensive Review: Computational Models for Obstructive Sleep Apnea Detection in Biomedical Applications. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7242667. [PMID: 35224099 PMCID: PMC8866013 DOI: 10.1155/2022/7242667] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023]
Abstract
Obstructive sleep apnea (OSA) is a sleep disorder characterized by periodic episodes of partial or complete upper airway obstruction caused by narrowing or collapse of the pharyngeal airway despite ongoing breathing efforts during sleep. Fall in the blood oxygen saturation and cortical arousals are prompted by this reduction in the airflow which lasts for at least 10 seconds. Impaired labor performance, debilitated quality of life, excessive daytime sleepiness, high snoring, and tiredness even after a whole night's sleep are the primary symptoms of OSA. In due course, the long-standing contributions of OSA culminate in hypertension, arrhythmia, cerebrovascular disease, and heart failure. The traditional diagnostic approach of OSA is the laboratory-based polysomnography (PSG) overnight sleep study, which is a tedious and labor-intensive process that exaggerates the discomfort to the patient. With the advent of computer-aided diagnosis (CAD), automatic detection of OSA has gained increasing interest among researchers in the area of sleep disorders as it influences both diagnostic and therapeutic decisions. The research literature on sleep apnea published during the last decade has been surveyed, focusing on the varied screening approaches accustomed to identifying OSA events and the developmental knowledge offered by multiple contributors from the software perspective. The current study presents an overview of the pathophysiology of OSA, the detection methods, physiological signals related to OSA, the different preprocessing, feature extraction, feature selection, and classification techniques employed for the detection and classification of OSA. Consequently, the research challenges and research gaps in the diagnosis of OSA are identified, critically analyzed, and presented in the best possible light.
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Affiliation(s)
- E. Smily JeyaJothi
- Department of Biomedical Instrumentation Engineering, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore 641108, India
| | - J. Anitha
- Department of Electronics and Communication Engineering, Karunya Institute of Technology and Sciences, Coimbatore 641114, India
| | - Shalli Rani
- Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura Punjab-140401, India
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22
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Glos M, Triché D. Home Sleep Testing of Sleep Apnea. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:147-157. [PMID: 36217083 DOI: 10.1007/978-3-031-06413-5_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Measurement methods with graded complexity for use in the lab as well as for home sleep testing (HST) are available for the diagnosis of sleep apnea, and there are different classification systems in existence. Simplified HST measurements, which record fewer parameters than traditional four- to six-channel devices, can indicate sleep apnea and can be used as screening tool in high-prevalence patient groups. Peripheral arterial tonometry (PAT) is a technique which can be suitable for the diagnosis of sleep apnea in certain cases. Different measurement methods are used, which has an influence on the significance of the results. New minimal-contact and non-contact technologies of recording and analysis of surrogate parameters are under development. If they are validated by clinical studies, it will be possible to detect sleep apnea in need of treatment more effectively. In addition, this could become a solution to monitor the effectiveness of such treatment.
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Affiliation(s)
- Martin Glos
- Interdisciplinary Center for Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Dora Triché
- Department of Respiratory Medicine, Allergology, Sleep Medicine, Paracelsus Medical University Nuremberg, Nuremberg General Hospital, Nuremberg, Germany
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Cheng YC, Huang YC, Huang WL. Heart rate variability in patients with dementia or neurocognitive disorders: A systematic review and meta-analysis. Aust N Z J Psychiatry 2022; 56:16-27. [PMID: 33287558 DOI: 10.1177/0004867420976853] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Heart rate variability, a quantitative measure of mainly parasympathetic activity, has been applied in evaluating many types of psychiatric and neurological disorders, including dementia (or neurocognitive disorders). However, although dementia patients often showed significantly lower heart rate variability (various indices) than healthy controls, and different types of dementia had distinct heart rate variability features, the results were not identical across studies. We designed a systematic review and meta-analysis for incorporating data from different studies. METHODS We gathered studies comparing heart rate variability in patients with dementia and in healthy controls. Heart rate variability was analysed in several ways: parasympathetic function in hierarchical order (main analysis), total variability, comparison of heart rate variability between different subtypes of dementia, specific indices of heart rate variability and heart rate variability reactivity. RESULTS In the initial search, we found 3425 relevant articles, from which 24 studies with a total of 1107 dementia patients and 1017 control participants finally entered the main meta-analysis. The dementia patients had a significantly lower resting heart rate variability for parasympathetic function (Hedges' g = -0.3596, p = 0.0002) and total variability (Hedges' g = -0.3059, p = 0.0002) than the controls. For diagnostic subgroup analysis relative to the controls, heart rate variability was significantly lower in patients with mild cognitive impairment (Hedges' g = -0.3060) and in patients with dementia with Lewy bodies (Hedges' g = -1.4154, p < 0.0001). Relative to patients with Alzheimer's disease, heart rate variability in patients with dementia with Lewy bodies was significantly lower (Hedges' g = -1.5465, p = 0.0381). Meta-regression revealed that gender proportion was significantly associated with effect size. CONCLUSION Our results show that dementia patients (especially those with dementia with Lewy bodies and mild cognitive impairment) have lower parasympathetic activity than healthy people. The influence of gender on the results should be carefully interpreted.
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Affiliation(s)
- Ying-Chih Cheng
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu.,Department of Public Health and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei.,Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Yu-Chen Huang
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei.,Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei.,Department of Dermatology, School of Medicine and College of Medicine, Taipei Medical University, Taipei
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin.,Department of Psychiatry, National Taiwan University Hospital, Taipei.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei
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24
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Günther M, Kantelhardt JW, Bartsch RP. The Reconstruction of Causal Networks in Physiology. FRONTIERS IN NETWORK PHYSIOLOGY 2022; 2:893743. [PMID: 36926108 PMCID: PMC10013035 DOI: 10.3389/fnetp.2022.893743] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022]
Abstract
We systematically compare strengths and weaknesses of two methods that can be used to quantify causal links between time series: Granger-causality and Bivariate Phase Rectified Signal Averaging (BPRSA). While a statistical test method for Granger-causality has already been established, we show that BPRSA causality can also be probed with existing statistical tests. Our results indicate that more data or stronger interactions are required for the BPRSA method than for the Granger-causality method to detect an existing link. Furthermore, the Granger-causality method can distinguish direct causal links from indirect links as well as links that arise from a common source, while BPRSA cannot. However, in contrast to Granger-causality, BPRSA is suited for the analysis of non-stationary data. We demonstrate the practicability of the Granger-causality method by applying it to polysomnography data from sleep laboratories. An algorithm is presented, which addresses the stationarity condition of Granger-causality by splitting non-stationary data into shorter segments until they pass a stationarity test. We reconstruct causal networks of heart rate, breathing rate, and EEG amplitude from young healthy subjects, elderly healthy subjects, and subjects with obstructive sleep apnea, a condition that leads to disruption of normal respiration during sleep. These networks exhibit differences not only between different sleep stages, but also between young and elderly healthy subjects on the one hand and subjects with sleep apnea on the other hand. Among these differences are 1) weaker interactions in all groups between heart rate, breathing rate and EEG amplitude during deep sleep, compared to light and REM sleep, 2) a stronger causal link from heart rate to breathing rate but disturbances in respiratory sinus arrhythmia (breathing to heart rate coupling) in subjects with sleep apnea, 3) a stronger causal link from EEG amplitude to breathing rate during REM sleep in subjects with sleep apnea. The Granger-causality method, although initially developed for econometric purposes, can provide a quantitative, testable measure for causality in physiological networks.
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Affiliation(s)
| | - Jan W Kantelhardt
- Institute of Physics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Ronny P Bartsch
- Department of Physics, Bar-Ilan University, Ramat Gan, Israel
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25
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Cairo B, de Abreu RM, Bari V, Gelpi F, De Maria B, Rehder-Santos P, Sakaguchi CA, da Silva CD, De Favari Signini É, Catai AM, Porta A. Optimizing phase variability threshold for automated synchrogram analysis of cardiorespiratory interactions in amateur cyclists. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2021; 379:20200251. [PMID: 34689616 DOI: 10.1098/rsta.2020.0251] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 06/13/2023]
Abstract
We propose a procedure suitable for automated synchrogram analysis for setting the threshold below which phase variability between two marker event series is of such a negligible amount that the null hypothesis of phase desynchronization can be rejected. The procedure exploits the principle of maximizing the likelihood of detecting phase synchronization epochs and it is grounded on a surrogate data approach testing the null hypothesis of phase uncoupling. The approach was applied to assess cardiorespiratory phase interactions between heartbeat and inspiratory onset in amateur cyclists before and after 11-week inspiratory muscle training (IMT) at different intensities and compared to a more traditional approach to set phase variability threshold. The proposed procedure was able to detect the decrease in cardiorespiratory phase locking strength during vagal withdrawal induced by the modification of posture from supine to standing. IMT had very limited effects on cardiorespiratory phase synchronization strength and this result held regardless of the training intensity. In amateur athletes training, the inspiratory muscles did not limit the decrease in cardiorespiratory phase synchronization observed in the upright position as a likely consequence of the modest impact of this respiratory exercise, regardless of its intensity, on cardiac vagal control. This article is part of the theme issue 'Advanced computation in cardiovascular physiology: new challenges and opportunities'.
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Affiliation(s)
- Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan 20133, Italy
| | - Raphael Martins de Abreu
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo 13565-905, Brazil
| | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan 20097, Italy
| | - Francesca Gelpi
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan 20097, Italy
| | | | - Patrícia Rehder-Santos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo 13565-905, Brazil
| | - Camila Akemi Sakaguchi
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo 13565-905, Brazil
| | - Claudio Donisete da Silva
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo 13565-905, Brazil
| | - Étore De Favari Signini
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo 13565-905, Brazil
| | - Aparecida Maria Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo 13565-905, Brazil
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan 20133, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan 20097, Italy
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26
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Borovkova EI, Hramkov AN, Karavaev AS, Ponomarenko VI, Prokhorov MD, Ishbulatov YM, Penzel T. Directional Couplings Between Electroencephalogram and Interbeat Intervals Signals in Awake State and Different Stages of Sleep. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5398-5402. [PMID: 34892347 DOI: 10.1109/embc46164.2021.9630385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Purpose of the work is to identify the directional coupling between the structures of the brain and the autonomic control of the heart rate variability, to analyze the changes in these coupling in sleep and in wakefulness. Infra-slow oscillations of the electroencephalograms potential and low-frequency components (0.04-0.15 Hz) of the interbeat intervals signal where analyzed using a sensitive method for identifying the directional coupling. The technique, based on modeling the dynamics of instantaneous phases of oscillations, made it possible to reveal the presence and quantify the directional couplings between the structures of the brain and the autonomic control of the heart rate variability. It was shown that the coupling coefficients in the frequency band of 0.04-0.15 Hz (associated mainly with sympathetic control of blood circulation), on average, decrease with falling asleep. We have also shown the asymmetry of coupling. At the same time, stronger connections were revealed in the direction from the autonomic control of the heart rate variability to the brain structures than in the opposite direction. It has been shown that the strength of such couplings decreases with increasing of sleep depth.
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27
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Magnusdottir S, Hilmisson H, Raymann RJEM, Witmans M. Characteristics of Children Likely to Have Spontaneous Resolution of Obstructive Sleep Apnea: Results from the Childhood Adenotonsillectomy Trial (CHAT). CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8110980. [PMID: 34828693 PMCID: PMC8620731 DOI: 10.3390/children8110980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate if cardiopulmonary coupling (CPC) calculated sleep quality (SQI) may have a role in identifying children that may benefit from other intervention than early adenotonsillectomy (eAT) in management of obstructive sleep apnea (OSA). METHODS A secondary analysis of electrocardiogram-signals (ECG) and oxygen saturation-data (SpO2) collected during polysomnography-studies in the prospective multicenter Childhood Adenotonsillectomy Trial (CHAT) to calculate CPC-SQI and apnea hypopnea index (AHI) was executed. In the CHAT, children 5-9 years with OSA without prolonged oxyhemoglobin desaturations were randomly assigned to adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC). The primary outcomes were to document change in attention and executive function evaluated with the Developmental Neuropsychological Assessment (NEPSY). In our analysis, children in the WWSC-group with spontaneous resolution of OSA (AHIObstructive < 1.0) and high-sleep quality (SQI ≥ 75) after 7-months were compared with children that showed residual OSA. RESULTS Of the 227 children randomized to WWSC, 203 children had available data at both baseline and 7-month follow-up. The group that showed resolution of OSA at month 7 (n = 43, 21%) were significantly more likely to have high baseline SQI 79.96 [CI95% 75.05, 84.86] vs. 72.44 [CI95% 69.50, 75.39], p = 0.005, mild OSA AHIObstructive 4.01 [CI95% 2.34, 5.68] vs. 6.52 [CI95% 5.47, 7.57], p= 0.005, higher NEPSY-attention-executive function score 106.22 [CI95% 101.67, 110.77] vs. 101.14 [CI95% 98.58, 103.72], p = 0.038 and better quality of life according to parents 83.74 [CI95% 78.95, 88.54] vs. 77.51 [74.49, 80.53], p = 0.015. The groups did not differ when clinically evaluated by Mallampati score, Friedman palate position or sleep related questionnaires. CONCLUSIONS Children that showed resolution of OSA were more likely to have high-SQI and mild OSA, be healthy-weight and have better attention and executive function and quality of life at baseline. As this simple method to evaluate sleep quality and OSA is based on analyzing signals that are simple to collect, the method is practical for sleep-testing, over multiple nights and on multiple occasions. This method may assist physicians and parents to determine the most appropriate therapy for their child as some children may benefit from WWSC rather than interventions. If the parameters can be used to plan care a priori, this would provide a fundamental shift in how childhood OSA is diagnosed and managed.
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Affiliation(s)
- Solveig Magnusdottir
- MyCardio LLC, SleepImage, 3003 E 3rd Avenue, Denver, CO 80206, USA; (H.H.); (R.J.E.M.R.)
| | - Hugi Hilmisson
- MyCardio LLC, SleepImage, 3003 E 3rd Avenue, Denver, CO 80206, USA; (H.H.); (R.J.E.M.R.)
| | - Roy J. E. M. Raymann
- MyCardio LLC, SleepImage, 3003 E 3rd Avenue, Denver, CO 80206, USA; (H.H.); (R.J.E.M.R.)
| | - Manisha Witmans
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
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28
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Lechat B, Scott H, Naik G, Hansen K, Nguyen DP, Vakulin A, Catcheside P, Eckert DJ. New and Emerging Approaches to Better Define Sleep Disruption and Its Consequences. Front Neurosci 2021; 15:751730. [PMID: 34690688 PMCID: PMC8530106 DOI: 10.3389/fnins.2021.751730] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/16/2021] [Indexed: 01/07/2023] Open
Abstract
Current approaches to quantify and diagnose sleep disorders and circadian rhythm disruption are imprecise, laborious, and often do not relate well to key clinical and health outcomes. Newer emerging approaches that aim to overcome the practical and technical constraints of current sleep metrics have considerable potential to better explain sleep disorder pathophysiology and thus to more precisely align diagnostic, treatment and management approaches to underlying pathology. These include more fine-grained and continuous EEG signal feature detection and novel oxygenation metrics to better encapsulate hypoxia duration, frequency, and magnitude readily possible via more advanced data acquisition and scoring algorithm approaches. Recent technological advances may also soon facilitate simple assessment of circadian rhythm physiology at home to enable sleep disorder diagnostics even for “non-circadian rhythm” sleep disorders, such as chronic insomnia and sleep apnea, which in many cases also include a circadian disruption component. Bringing these novel approaches into the clinic and the home settings should be a priority for the field. Modern sleep tracking technology can also further facilitate the transition of sleep diagnostics from the laboratory to the home, where environmental factors such as noise and light could usefully inform clinical decision-making. The “endpoint” of these new and emerging assessments will be better targeted therapies that directly address underlying sleep disorder pathophysiology via an individualized, precision medicine approach. This review outlines the current state-of-the-art in sleep and circadian monitoring and diagnostics and covers several new and emerging approaches to better define sleep disruption and its consequences.
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Affiliation(s)
- Bastien Lechat
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Hannah Scott
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Ganesh Naik
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Kristy Hansen
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Duc Phuc Nguyen
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Peter Catcheside
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
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29
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Vanbuis J, Feuilloy M, Baffet G, Meslier N, Gagnadoux F, Girault JM. A New Sleep Staging System for Type III Sleep Studies Equipped with a Tracheal Sound Sensor. IEEE Trans Biomed Eng 2021; 69:1225-1236. [PMID: 34665717 DOI: 10.1109/tbme.2021.3120927] [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: 11/10/2022]
Abstract
Type III sleep studies record cardio-respiratory channels only. Compared with polysomnography, which also records electrophysiological channels, they present many advantages: they are less expensive, less time-consuming, and more likely to be performed at home. However, their accuracy is limited by missing sleep information. That is why many studies present specific cardio-respiratory parameters to assess the causal effects of sleep stages upon cardiac or respiratory activities. For this paper, we gathered many parameters proposed in literature, leading to 1,111 features. The pulse oximeter, the PneaVoX sensor (recording tracheal sounds), respiratory inductance plethysmography belts, the nasal cannula and the actimeter provided the 112 worthiest ones for automatic sleep scoring. Then, a 3-step model was implemented: classification with a multi-layer perceptron, sleep transition rules corrections (from the AASM guidelines), and sequence corrections using a Viterbi hidden Markov model. The whole process was trained and tested using 300 and 100 independent recordings provided from patients suspected of having sleep breathing disorders. Results indicated that the system achieves substantial agreement with manual scoring for classifications into 2 stages (wake vs. sleep: mean Cohen's Kappa of 0.63 and accuracy rate Acc of 87.8%) and 3 stages (wake vs. R stage vs. NREM stage: mean of 0.60 and Acc of 78.5%). It indicates that the method could provide information to help specialists while diagnosing sleep. The presented model had promising results and may enhance clinical diagnosis.
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30
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Mikutta C, Wenke M, Spiegelhalder K, Hertenstein E, Maier JG, Schneider CL, Fehér K, Koenig J, Altorfer A, Riemann D, Nissen C, Feige B. Co-ordination of brain and heart oscillations during non-rapid eye movement sleep. J Sleep Res 2021; 31:e13466. [PMID: 34467582 PMCID: PMC9285890 DOI: 10.1111/jsr.13466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/26/2021] [Accepted: 07/23/2021] [Indexed: 12/25/2022]
Abstract
Oscillatory activities of the brain and heart show a strong variation across wakefulness and sleep. Separate lines of research indicate that non‐rapid eye movement (NREM) sleep is characterised by electroencephalographic slow oscillations (SO), sleep spindles, and phase–amplitude coupling of these oscillations (SO–spindle coupling), as well as an increase in high‐frequency heart rate variability (HF‐HRV), reflecting enhanced parasympathetic activity. The present study aimed to investigate further the potential coordination between brain and heart oscillations during NREM sleep. Data were derived from one sleep laboratory night with polysomnographic monitoring in 45 healthy participants (22 male, 23 female; mean age 37 years). The associations between the strength (modulation index [MI]) and phase direction of SO–spindle coupling (circular measure) and HF‐HRV during NREM sleep were investigated using linear modelling. First, a significant SO–spindle coupling (MI) was observed for all participants during NREM sleep, with spindle peaks preferentially occurring during the SO upstate (phase direction). Second, linear model analyses of NREM sleep showed a significant relationship between the MI and HF‐HRV (F = 20.1, r2 = 0.30, p < 0.001) and a tentative circular‐linear correlation between phase direction and HF‐HRV (F = 3.07, r2 = 0.12, p = 0.056). We demonstrated a co‐ordination between SO–spindle phase–amplitude coupling and HF‐HRV during NREM sleep, presumably related to parallel central nervous and peripheral vegetative arousal systems regulation. Further investigating the fine‐graded co‐ordination of brain and heart oscillations might improve our understanding of the links between sleep and cardiovascular health.
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Affiliation(s)
- Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.,Privatklinik Meiringen, Meiringen, Switzerland
| | - Marion Wenke
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Jonathan G Maier
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Kristoffer Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andreas Altorfer
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.,Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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31
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Ebrahimi F, Alizadeh I. Automatic sleep staging by cardiorespiratory signals: a systematic review. Sleep Breath 2021; 26:965-981. [PMID: 34322822 DOI: 10.1007/s11325-021-02435-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/22/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Because of problems with the recording and analysis of the EEG signal, automatic sleep staging using cardiorespiratory signals has been employed as an alternative. This study reports on certain critical points which hold considerable promise for the improvement of the results of the automatic sleep staging using cardiorespiratory signals. METHODS A systematic review. RESULTS The review and analysis of the literature in this area revealed four outstanding points: (1) the feature extraction epoch length, denoting that the standard 30-s segments of cardiorespiratory signals do not carry enough information for automatic sleep staging and that a 4.5-min length segment centering on each 30-s segment is proper for staging, (2) the time delay between the EEG signal extracted from the central nervous system activity and the cardiorespiratory signals extracted from the autonomic nervous system activity should be considered in the automatic sleep staging using cardiorespiratory signals, (3) the information in the morphology of ECG signals can contribute to the improvement of sleep staging, and (4) applying convolutional neural network (CNN) and long short-term memory network (LSTM) deep structures simultaneously to a large PSG recording database can lead to more reliable automatic sleep staging results. CONCLUSIONS Considering the above-mentioned points simultaneously can improve automatic sleep staging by cardiorespiratory signals. It is hoped that by considering the points, staging sleep automatically using cardiorespiratory signals, which does not have problems with the recording and analysis of EEG signals, yields results acceptably close to the results of automatic sleep staging by EEG signals.
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Affiliation(s)
- Farideh Ebrahimi
- Faculty of Electrical and Computer Engineering, Babol Noshirvani University of Technology, Babol, Mazandaran, Iran.
| | - Iman Alizadeh
- English Language Department, School of Paramedical Sciences, Guilan University of Medical Sciences, Rasht, Iran
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32
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Heiser C, Steffen A, Hofauer B, Mehra R, Strollo PJ, Vanderveken OM, Maurer JT. Effect of Upper Airway Stimulation in Patients with Obstructive Sleep Apnea (EFFECT): A Randomized Controlled Crossover Trial. J Clin Med 2021; 10:jcm10132880. [PMID: 34209581 PMCID: PMC8269272 DOI: 10.3390/jcm10132880] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Several single-arm prospective studies have demonstrated the safety and effectiveness of upper airway stimulation (UAS) for obstructive sleep apnea. There is limited evidence from randomized, controlled trials of the therapy benefit in terms of OSA burden and its symptoms. Methods: We conducted a multicenter, double-blinded, randomized, sham-controlled, crossover trial to examine the effect of therapeutic stimulation (Stim) versus sham stimulation (Sham) on the apnea-hypopnea index (AHI) and the Epworth Sleepiness Scale (ESS). We also examined the Functional Outcomes of Sleep Questionnaire (FOSQ) on sleep architecture. We analyzed crossover outcome measures after two weeks using repeated measures models controlling for treatment order. Results: The study randomized 89 participants 1:1 to Stim (45) versus Sham (44). After one week, the AHI response rate was 76.7% with Stim and 29.5% with Sham, a difference of 47.2% (95% CI: 24.4 to 64.9, p < 0.001) between the two groups. Similarly, ESS was 7.5 ± 4.9 with Stim and 12.0 ± 4.3 with Sham, with a significant difference of 4.6 (95% CI: 3.1 to 6.1) between the two groups. The crossover phase showed no carryover effect. Among 86 participants who completed both phases, the treatment difference between Stim vs. Sham for AHI was −15.5 (95% CI −18.3 to −12.8), for ESS it was −3.3 (95% CI −4.4 to −2.2), and for FOSQ it was 2.1 (95% CI 1.4 to 2.8). UAS effectively treated both REM and NREM sleep disordered breathing. Conclusions: In comparison with sham stimulation, therapeutic UAS reduced OSA severity, sleepiness symptoms, and improved quality of life among participants with moderate-to-severe OSA.
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Affiliation(s)
- Clemens Heiser
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 München, Germany;
- Correspondence:
| | - Armin Steffen
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Luebeck, 23562 Luebeck, Germany;
| | - Benedikt Hofauer
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 München, Germany;
| | - Reena Mehra
- Department of Sleep Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
| | - Patrick J. Strollo
- Department of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Olivier M. Vanderveken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, 2650 Edegem, Antwerp, Belgium;
| | - Joachim T. Maurer
- Department of ORL-HNS, Division of Sleep Medicine, University Medical Centre Mannheim, University Heidelberg, 68167 Mannheim, Germany;
- Department of Information Technology, University of Applied Sciences, 68163 Mannheim, Germany
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33
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Frolov N, Hramov A. Extreme synchronization events in a Kuramoto model: The interplay between resource constraints and explosive transitions. CHAOS (WOODBURY, N.Y.) 2021; 31:063103. [PMID: 34241300 DOI: 10.1063/5.0055156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 06/13/2023]
Abstract
Many living and artificial systems possess structural and dynamical properties of complex networks. One of the most exciting living networked systems is the brain, in which synchronization is an essential mechanism of its normal functioning. On the other hand, excessive synchronization in neural networks reflects undesired pathological activity, including various forms of epilepsy. In this context, network-theoretical approach and dynamical modeling may uncover deep insight into the origins of synchronization-related brain disorders. However, many models do not account for the resource consumption needed for the neural networks to synchronize. To fill this gap, we introduce a phenomenological Kuramoto model evolving under the excitability resource constraints. We demonstrate that the interplay between increased excitability and explosive synchronization induced by the hierarchical organization of the network forces the system to generate short-living extreme synchronization events, which are well-known signs of epileptic brain activity. Finally, we establish that the network units occupying the medium levels of hierarchy most strongly contribute to the birth of extreme events emphasizing the focal nature of their origin.
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Affiliation(s)
- Nikita Frolov
- Neuroscience and Cognitive Technology Laboratory, Center for Technologies in Robotics and Mechatronics Components, Innopolis University, 420500 Innopolis, The Republic of Tatarstan, Russia
| | - Alexander Hramov
- Neuroscience and Cognitive Technology Laboratory, Center for Technologies in Robotics and Mechatronics Components, Innopolis University, 420500 Innopolis, The Republic of Tatarstan, Russia
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Morales J, Moeyersons J, Armanac P, Orini M, Faes L, Overeem S, Van Gilst M, Van Dijk J, Van Huffel S, Bailon R, Varon C. Model-Based Evaluation of Methods for Respiratory Sinus Arrhythmia Estimation. IEEE Trans Biomed Eng 2021; 68:1882-1893. [PMID: 33001798 DOI: 10.1109/tbme.2020.3028204] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Respiratory sinus arrhythmia (RSA) refers to heart rate oscillations synchronous with respiration, and it is one of the major representations of cardiorespiratory coupling. Its strength has been suggested as a biomarker to monitor different conditions, and diseases. Some approaches have been proposed to quantify the RSA, but it is unclear which one performs best in specific scenarios. The main objective of this study is to compare seven state-of-the-art methods for RSA quantification using data generated with a model proposed to simulate, and control the RSA. These methods are also compared, and evaluated on a real-life application, for their ability to capture changes in cardiorespiratory coupling during sleep. METHODS A simulation model is used to create a dataset of heart rate variability, and respiratory signals with controlled RSA, which is used to compare the RSA estimation approaches. To compare the methods objectively in real-life applications, regression models trained on the simulated data are used to map the estimates to the same measurement scale. Results, and conclusion: RSA estimates based on cross entropy, time-frequency coherence, and subspace projections showed the best performance on simulated data. In addition, these estimates captured the expected trends in the changes in cardiorespiratory coupling during sleep similarly. SIGNIFICANCE An objective comparison of methods for RSA quantification is presented to guide future analyses. Also, the proposed simulation model can be used to compare existing, and newly proposed RSA estimates. It is freely accessible online.
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Abstract
PURPOSE OF REVIEW Diagnosis of sleep apnoea was performed in sleep laboratories with polysomnography. This requires a room with supervision and presence of technologists and trained sleep experts. Today, clinical guidelines in most countries recommend home sleep apnoea testing with simple systems using six signals only. If criteria for signal quality, recording conditions, and patient selection are considered, then this is a reliable test with high accuracy. RECENT FINDINGS Recently diagnostic tools for sleep apnoea diagnosis become even more simple: smartwatches and wearables with smart apps claim to diagnose sleep apnoea when these devices are tracking sleep and sleep quality as part of new consumer health checking. Alternative and new devices range from excellent diagnostic tools with high accuracy and full validation studies down to very low-quality tools which only result in random diagnostic reports. Due to the high prevalence of sleep apnoea, even a random diagnosis may match a real disorder sometimes. SUMMARY Until now, there are no metrics established how to evaluate these alternative algorithms and simple devices. Proposals for evaluating smartwatches, smartphones, single-use sensors, and new algorithms are presented. New assessments may help to overcome current limitations in sleep apnoea severity metrics. VIDEO ABSTRACT: http://links.lww.com/COPM/A28.
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Sun H, Ganglberger W, Panneerselvam E, Leone MJ, Quadri SA, Goparaju B, Tesh RA, Akeju O, Thomas RJ, Westover MB. Sleep staging from electrocardiography and respiration with deep learning. Sleep 2021; 43:5682785. [PMID: 31863111 DOI: 10.1093/sleep/zsz306] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/13/2019] [Indexed: 01/08/2023] Open
Abstract
STUDY OBJECTIVES Sleep is reflected not only in the electroencephalogram but also in heart rhythms and breathing patterns. We hypothesized that it is possible to accurately stage sleep based on the electrocardiogram (ECG) and respiratory signals. METHODS Using a dataset including 8682 polysomnograms, we develop deep neural networks to stage sleep from ECG and respiratory signals. Five deep neural networks consisting of convolutional networks and long- and short-term memory networks are trained to stage sleep using heart and breathing, including the timing of R peaks from ECG, abdominal and chest respiratory effort, and the combinations of these signals. RESULTS ECG in combination with the abdominal respiratory effort achieved the best performance for staging all five sleep stages with a Cohen's kappa of 0.585 (95% confidence interval ±0.017); and 0.760 (±0.019) for discriminating awake vs. rapid eye movement vs. nonrapid eye movement sleep. Performance is better for younger ages, whereas it is robust for body mass index, apnea severity, and commonly used outpatient medications. CONCLUSIONS Our results validate that ECG and respiratory effort provide substantial information about sleep stages in a large heterogeneous population. This opens new possibilities in sleep research and applications where electroencephalography is not readily available or may be infeasible.
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Affiliation(s)
- Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | | | | | - Michael J Leone
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Syed A Quadri
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Balaji Goparaju
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Ryan A Tesh
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Robert J Thomas
- Division of Pulmonary, Critical Care & Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Natural History of Sleep-disordered Breathing during Rapid Eye Movement Sleep. Relevance for Incident Cardiovascular Disease. Ann Am Thorac Soc 2021; 17:614-620. [PMID: 32011165 DOI: 10.1513/annalsats.201907-524oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Rationale: Sleep-disordered breathing (SDB) occurring primarily during rapid eye movement (REM) sleep is a common clinical problem. The natural history of REM-related SDB and the associated cardiovascular sequelae of disease progression remain to be determined.Objectives: The objective of the current study was to describe the natural history of REM-related SDB, ascertain predictors of progression, and determine whether the evolution of REM-related SDB into non-REM (NREM) sleep is associated with incident cardiovascular events.Methods: Participants from the Sleep Heart Health Study with a baseline NREM apnea-hypopnea index (NREM-AHI) of <5 events/h and data from a follow-up sleep study along with information on incident cardiovascular disease were included in the study. Bivariate logistic regression was used to jointly model the predictors of disease progression based on the presence or absence of SDB during NREM and REM sleep using a cut-point of 5 events/h. Explanatory variables such as age, race, body mass index (BMI), change in BMI, and baseline REM-AHI were considered. Proportional hazards regression was then used to establish whether the development of SDB during NREM sleep was associated with incident cardiovascular disease.Results: The majority of the 1,908 participants included in the study did not develop SDB during NREM sleep. The likelihood of progression of SDB into NREM sleep did increase with higher baseline REM-AHI. BMI and an increase in BMI predicted progression of SDB in both NREM and REM sleep in men but not in women. There was a strong interdependence between developing a NREM-AHI of ≥5 events/h and worsening REM-AHI at follow-up with odds ratios of 6.01 and 4.47, in women and men, respectively. Moreover, the relative risk for incident cardiovascular events among those who developed a NREM-AHI of ≥5 events/h at the follow-up visit was elevated only in women with REM-related SDB at baseline.Conclusions: SDB during REM sleep is a relatively stable condition and does not progress in the majority of individuals. Progression of SDB into NREM sleep is associated with sex, weight, and age. SDB during REM and NREM sleep tends to develop concurrently. Finally, the development of SDB during NREM sleep is associated with incident cardiovascular events, but only in women with REM-related SDB at baseline.
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Chung YM, Hu CS, Lo YL, Wu HT. A Persistent Homology Approach to Heart Rate Variability Analysis With an Application to Sleep-Wake Classification. Front Physiol 2021; 12:637684. [PMID: 33732168 PMCID: PMC7959762 DOI: 10.3389/fphys.2021.637684] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/05/2021] [Indexed: 01/08/2023] Open
Abstract
Persistent homology is a recently developed theory in the field of algebraic topology to study shapes of datasets. It is an effective data analysis tool that is robust to noise and has been widely applied. We demonstrate a general pipeline to apply persistent homology to study time series, particularly the instantaneous heart rate time series for the heart rate variability (HRV) analysis. The first step is capturing the shapes of time series from two different aspects—the persistent homologies and hence persistence diagrams of its sub-level set and Taken's lag map. Second, we propose a systematic and computationally efficient approach to summarize persistence diagrams, which we coined persistence statistics. To demonstrate our proposed method, we apply these tools to the HRV analysis and the sleep-wake, REM-NREM (rapid eyeball movement and non rapid eyeball movement) and sleep-REM-NREM classification problems. The proposed algorithm is evaluated on three different datasets via the cross-database validation scheme. The performance of our approach is better than the state-of-the-art algorithms, and the result is consistent throughout different datasets.
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Affiliation(s)
- Yu-Min Chung
- Department of Mathematics and Statistics, University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Chuan-Shen Hu
- Department of Mathematics, National Taiwan Normal University, Taipei, Taiwan
| | - Yu-Lun Lo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan
| | - Hau-Tieng Wu
- Department of Mathematics and Department of Statistical Science, Duke University, Durham, NC, United States.,Mathematics Division, National Center for Theoretical Sciences, Taipei, Taiwan
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40
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George UZ, Moon KS, Lee SQ. Extraction and Analysis of Respiratory Motion Using a Comprehensive Wearable Health Monitoring System. SENSORS (BASEL, SWITZERLAND) 2021; 21:1393. [PMID: 33671202 PMCID: PMC7923104 DOI: 10.3390/s21041393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/22/2022]
Abstract
Respiratory activity is an important vital sign of life that can indicate health status. Diseases such as bronchitis, emphysema, pneumonia and coronavirus cause respiratory disorders that affect the respiratory systems. Typically, the diagnosis of these diseases is facilitated by pulmonary auscultation using a stethoscope. We present a new attempt to develop a lightweight, comprehensive wearable sensor system to monitor respiration using a multi-sensor approach. We employed new wearable sensor technology using a novel integration of acoustics and biopotentials to monitor various vital signs on two volunteers. In this study, a new method to monitor lung function, such as respiration rate and tidal volume, is presented using the multi-sensor approach. Using the new sensor, we obtained lung sound, electrocardiogram (ECG), and electromyogram (EMG) measurements at the external intercostal muscles (EIM) and at the diaphragm during breathing cycles with 500 mL, 625 mL, 750 mL, 875 mL, and 1000 mL tidal volume. The tidal volumes were controlled with a spirometer. The duration of each breathing cycle was 8 s and was timed using a metronome. For each of the different tidal volumes, the EMG data was plotted against time and the area under the curve (AUC) was calculated. The AUC calculated from EMG data obtained at the diaphragm and EIM represent the expansion of the diaphragm and EIM respectively. AUC obtained from EMG data collected at the diaphragm had a lower variance between samples per tidal volume compared to those monitored at the EIM. Using cubic spline interpolation, we built a model for computing tidal volume from EMG data at the diaphragm. Our findings show that the new sensor can be used to measure respiration rate and variations thereof and holds potential to estimate tidal lung volume from EMG measurements obtained from the diaphragm.
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Affiliation(s)
- Uduak Z. George
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA 92182, USA;
| | - Kee S. Moon
- Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, USA
| | - Sung Q. Lee
- Electronics and Telecommunications Research Institute, Daejeon 34129, Korea;
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Soliński M, Kuklik P, Gierałtowski J, Baranowski R, Graff B, Żebrowski J. Reply to comment on 'The effect of persistent U-shaped patterns in RR night-time series on the heart rate variability complexity in healthy humans'. Physiol Meas 2021; 42:018003. [PMID: 33554876 DOI: 10.1088/1361-6579/abd98e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mateusz Soliński
- Faculty of Physics, Warsaw University of Technology, Koszykowa 75 St. Warsaw 00-662, Poland
| | - Paweł Kuklik
- Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
| | - Jan Gierałtowski
- Faculty of Physics, Warsaw University of Technology, Koszykowa 75 St. Warsaw 00-662, Poland
| | - Rafał Baranowski
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Alpejska 42, Warsaw 04-628, Poland
| | - Beata Graff
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Dębinki 7, Gdańsk 80-211, Poland
| | - Jan Żebrowski
- Faculty of Physics, Warsaw University of Technology, Koszykowa 75 St. Warsaw 00-662, Poland
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42
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Morales J, Borzée P, Testelmans D, Buyse B, Van Huffel S, Varon C. Linear and Non-linear Quantification of the Respiratory Sinus Arrhythmia Using Support Vector Machines. Front Physiol 2021; 12:623781. [PMID: 33633586 PMCID: PMC7901929 DOI: 10.3389/fphys.2021.623781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
Respiratory sinus arrhythmia (RSA) is a form of cardiorespiratory coupling. It is observed as changes in the heart rate in synchrony with the respiration. RSA has been hypothesized to be due to a combination of linear and nonlinear effects. The quantification of the latter, in turn, has been suggested as a biomarker to improve the assessment of several conditions and diseases. In this study, a framework to quantify RSA using support vector machines is presented. The methods are based on multivariate autoregressive models, in which the present samples of the heart rate variability are predicted as combinations of past samples of the respiration. The selection and tuning of a kernel in these models allows to solve the regression problem taking into account only the linear components, or both the linear and the nonlinear ones. The methods are tested in simulated data as well as in a dataset of polysomnographic studies taken from 110 obstructive sleep apnea patients. In the simulation, the methods were able to capture the nonlinear components when a weak cardiorespiratory coupling occurs. When the coupling increases, the nonlinear part of the coupling is not detected and the interaction is found to be of linear nature. The trends observed in the application in real data show that, in the studied dataset, the proposed methods captured a more prominent linear interaction than the nonlinear one.
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Affiliation(s)
- John Morales
- STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
- Leuven.AI - KU Leuven Institute for AI, KU Leuven, Leuven, Belgium
| | - Pascal Borzée
- Department of Pneumology, UZ Leuven, Leuven, Belgium
| | | | - Bertien Buyse
- Department of Pneumology, UZ Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
- Leuven.AI - KU Leuven Institute for AI, KU Leuven, Leuven, Belgium
| | - Carolina Varon
- STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
- e-Media Research Lab, Department of Electrical Engineering, KU Leuven, Leuven, Belgium
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43
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Rajesh KNVPS, Dhuli R, Kumar TS. Obstructive sleep apnea detection using discrete wavelet transform-based statistical features. Comput Biol Med 2020; 130:104199. [PMID: 33422885 DOI: 10.1016/j.compbiomed.2020.104199] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/19/2020] [Accepted: 12/19/2020] [Indexed: 11/29/2022]
Abstract
MOTIVATION AND OBJECTIVE Obstructive sleep apnea (OSA) is a sleep disorder identified in nearly 10% of middle-aged people, which deteriorates the normal functioning of human organs, notably that of the heart. Furthermore, untreated OSA is associated with increased hypertension, diabetes, stroke, and cardiovascular diseases, thereby increasing the mortality risk. Therefore, early identification of sleep apnea is of significant interest. METHOD In this paper, an automated approach for OSA diagnosis using a single-lead electrocardiogram (ECG) has been reported. Three sets of features, namely moments of power spectrum density (PSD), waveform complexity measures, and higher-order moments, are extracted from the 1-min segmented ECG subbands obtained from discrete wavelet transform (DWT). Later, correlation-based feature selection with particle swarm optimization (PSO) search strategy is employed for getting an optimum feature vector. This process retained 18 significant features from initially computed 32 features. Finally, the acquired feature set is fed to different classifiers including, linear discriminant analysis, nearest neighbors, support vector machine, and random forest to perform per segment classification. RESULTS Experiments on the publicly available physionet single-lead ECG dataset show that the proposed approach using the random forest classifier effectively discriminates normal and OSA ECG signals. Specifically, our method achieved an accuracy of 89% and 90%, with 50-50 hold-out validation and 10-fold cross-validation, respectively. Besides, in both these validation scenarios, our method obtained 96% of the area under ROC. Importantly, our proposed approach provided better performance results than most of the existing methodologies.
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Affiliation(s)
- Kandala N V P S Rajesh
- Department of ECE, Gayatri Vidya Parishad College of Engineering, Visakhapatnam, 530048, India.
| | - Ravindra Dhuli
- School of Electronics Engineering, VIT- AP University, Amaravathi, 522237, India.
| | - T Sunil Kumar
- Department of Engineering Cybernetics, NTNU, Norway.
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44
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Porta A, Fantinato A, Bari V, Gelpi F, Cairo B, De Maria B, Bertoldo EG, Fiolo V, Callus E, De Vincentiis C, Volpe M, Molfetta R, Ranucci M. Evaluation of the impact of surgical aortic valve replacement on short-term cardiovascular and cerebrovascular controls through spontaneous variability analysis. PLoS One 2020; 15:e0243869. [PMID: 33301491 PMCID: PMC7728248 DOI: 10.1371/journal.pone.0243869] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/30/2020] [Indexed: 11/25/2022] Open
Abstract
We assessed the effect of surgical aortic valve replacement (SAVR) on cardiovascular and cerebrovascular controls via spontaneous variability analyses of heart period, approximated as the temporal distance between two consecutive R-wave peaks on the electrocardiogram (RR), systolic, diastolic and mean arterial pressure (SAP, DAP and MAP) and mean cerebral blood flow (MCBF). Powers in specific frequency bands, complexity, presence of nonlinear dynamics and markers of cardiac baroreflex and cerebral autoregulation were calculated. Variability series were acquired before (PRE) and after (POST) SAVR in 11 patients (age: 76±5 yrs, 7 males) at supine resting and during active standing. Parametric spectral analysis was performed based on the autoregressive model. Complexity was assessed via a local nonlinear prediction approach exploiting the k-nearest-neighbor strategy. The presence of nonlinear dynamics was checked by comparing the complexity marker computed over the original series with the distribution of the same index assessed over a set of surrogates preserving distribution and power spectral density of the original series. Cardiac baroreflex and cerebral autoregulation were estimated by assessing the transfer function from SAP to RR and from MAP to MCBF and squared coherence function via the bivariate autoregressive approach. We found that: i) orthostatic challenge had no effect on cardiovascular and cerebrovascular control markers in PRE; ii) RR variance was significantly reduced in POST; iii) complexity of SAP, DAP and MAP variabilities increased in POST with a greater likelihood of observing nonlinear dynamics over SAP compared to PRE at supine resting; iv) the amplitude of MCBF variations and MCBF complexity in POST remained similar to PRE; v) cardiac baroreflex sensitivity decreased in POST, while cerebrovascular autoregulation was preserved. SAVR induces important changes of cardiac and vascular autonomic controls and baroreflex regulation in patients exhibiting poor reactivity of cardiovascular regulatory mechanisms, while cerebrovascular autoregulation seems to be less affected.
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Affiliation(s)
- Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
- * E-mail:
| | - Angela Fantinato
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesca Gelpi
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | - Valentina Fiolo
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy
| | - Edward Callus
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Marianna Volpe
- Department of Cardiac Rehabilitation, IRCCS Policlinico San Donato, Milan, Italy
| | - Raffaella Molfetta
- Department of Cardiac Rehabilitation, IRCCS Policlinico San Donato, Milan, Italy
| | - Marco Ranucci
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
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Mlynczak M. Temporal orders and causal vector for physiological data analysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:750-753. [PMID: 33018095 DOI: 10.1109/embc44109.2020.9176842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In addition to the global parameter- and time-series-based approaches, physiological analyses should constitute a local temporal one, particularly when analyzing data within protocol segments. Hence, we introduce the R package implementing the estimation of temporal orders with a causal vector (CV). It may use linear modeling or time series distance. The algorithm was tested on cardiorespiratory data comprising tidal volume and tachogram curves, obtained from elite athletes (supine and standing, in static conditions) and a control group (different rates and depths of breathing, while supine). We checked the relation between CV and body position or breathing style. The rate of breathing had a greater impact on the CV than does the depth. The tachogram curve preceded the tidal volume relatively more when breathing was slower.
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46
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Leube J, Zschocke J, Kluge M, Pelikan L, Graf A, Glos M, Müller A, Bartsch RP, Penzel T, Kantelhardt JW. Reconstruction of the respiratory signal through ECG and wrist accelerometer data. Sci Rep 2020; 10:14530. [PMID: 32884062 PMCID: PMC7471298 DOI: 10.1038/s41598-020-71539-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/10/2020] [Indexed: 11/08/2022] Open
Abstract
Respiratory rate and changes in respiratory activity provide important markers of health and fitness. Assessing the breathing signal without direct respiratory sensors can be very helpful in large cohort studies and for screening purposes. In this paper, we demonstrate that long-term nocturnal acceleration measurements from the wrist yield significantly better respiration proxies than four standard approaches of ECG (electrocardiogram) derived respiration. We validate our approach by comparison with flow-derived respiration as standard reference signal, studying the full-night data of 223 subjects in a clinical sleep laboratory. Specifically, we find that phase synchronization indices between respiration proxies and the flow signal are large for five suggested acceleration-derived proxies with [Formula: see text] for males and [Formula: see text] for females (means ± standard deviations), while ECG-derived proxies yield only [Formula: see text] for males and [Formula: see text] for females. Similarly, respiratory rates can be determined more precisely by wrist-worn acceleration devices compared with a derivation from the ECG. As limitation we must mention that acceleration-derived respiration proxies are only available during episodes of non-physical activity (especially during sleep).
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Affiliation(s)
- Julian Leube
- Institute of Physics, Martin-Luther-University Halle-Wittenberg, 06099, Halle, Germany
| | - Johannes Zschocke
- Institute of Physics, Martin-Luther-University Halle-Wittenberg, 06099, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics and Informatics, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, 06099, Halle, Germany
| | - Maria Kluge
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Luise Pelikan
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Antonia Graf
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Martin Glos
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Alexander Müller
- Klinik und Poliklinik für Innere Medizin I, Technische Universität München, 81675, Munich, Germany
| | - Ronny P Bartsch
- Department of Physics, Bar-Ilan University, Ramat Gan, 5290002, Israel
| | - Thomas Penzel
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
- Saratov State University, Saratov, Russia
| | - Jan W Kantelhardt
- Institute of Physics, Martin-Luther-University Halle-Wittenberg, 06099, Halle, Germany.
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Lucchini M, Pini N, Burtchen N, Signorini MG, Fifer WP. Transfer Entropy Modeling of Newborn Cardiorespiratory Regulation. Front Physiol 2020; 11:1095. [PMID: 32973570 PMCID: PMC7481456 DOI: 10.3389/fphys.2020.01095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/07/2020] [Indexed: 01/26/2023] Open
Abstract
This study investigates the complex interplay between the cardiac and respiratory systems in 268 healthy neonates born between 35 and 40 weeks of gestation. The aim is to provide a comprehensive description of the developing cardiorespiratory information transfer mechanisms as a function of gestational age (GA). This report proposes an extension of the traditional Transfer Entropy measure (TE), which employs multiple lagged versions of the time series of the intervals between two successive R waves of the QRS signal on the electrocardiogram (RR series) and respiration time series (RESP). The method aims to quantify the instantaneous and delayed effects between the two processes within a fine-grained time scale. Firstly, lagged TE was validated on a simulated dataset. Subsequently, lagged TE was employed on newborn cardiorespiratory data. Results indicate a progressive increase in information transfer as a function of gestational age, as well as significant differences in terms of instantaneous and delayed interactions between the cardiac and the respiratory system when comparing the two TE directionalities (RR→RESP vs. RESP→RR). The proposed investigation addresses the role of the different autonomic nervous system (ANS) branches involved in the cardiorespiratory system, since the sympathetic and parasympathetic branches operate at different time scales. Our results allow to infer that the two TE directionalities are uniquely and differently modulated by both branches of the ANS. TE adds an original quantitative tool to understanding cardiorespiratory imbalance in early infancy.
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Affiliation(s)
- Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - Nicolò Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States.,Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Milan, Italy
| | - Nina Burtchen
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
| | - Maria G Signorini
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Milan, Italy
| | - William P Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States.,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States
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48
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Rapid Eye Movement-related Sleep-disordered Breathing and Cardiovascular Risk: Additional Clarity or More Questions? Ann Am Thorac Soc 2020; 17:559-560. [PMID: 32356692 PMCID: PMC7193808 DOI: 10.1513/annalsats.202002-128ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Kinnunen H, Rantanen A, Kenttä T, Koskimäki H. Feasible assessment of recovery and cardiovascular health: accuracy of nocturnal HR and HRV assessed via ring PPG in comparison to medical grade ECG. Physiol Meas 2020; 41:04NT01. [PMID: 32217820 DOI: 10.1088/1361-6579/ab840a] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To validate the accuracy of the Oura ring in the quantification of resting heart rate (HR) and heart rate variability (HRV). BACKGROUND Wearable devices have become comfortable, lightweight, and technologically advanced for assessing health behavior. As an example, the novel Oura ring integrates daily physical activity and nocturnal cardiovascular measurements. Ring users can follow their autonomic nervous system responses to their daily behavior based on nightly changes in HR and HRV, and adjust their behavior accordingly after self-reflection. As wearable photoplethysmogram (PPG) can be disrupted by several confounding influences, it is crucial to demonstrate the accuracy of ring measurements. APPROACH Nocturnal HR and HRV were assessed in 49 adults with simultaneous measurements from the Oura ring and the gold standard ECG measurement. Female and male participants with a wide age range (15-72 years) and physical activity status were included. Regression analysis between ECG and the ring outcomes was performed. MAIN RESULTS Very high agreement between the ring and ECG was observed for nightly average HR and HRV (r2 = 0.996 and 0.980, respectively) with a mean bias of -0.63 bpm and -1.2 ms. High agreement was also observed across 5 min segments within individual nights in (r2 = 0.869 ± 0.098 and 0.765 ± 0.178 in HR and HRV, respectively). SIGNIFICANCE Present findings indicate high validity of the Oura ring in the assessment of nocturnal HR and HRV in healthy adults. The results show the utility of this miniaturised device as a lifestyle management tool in long-term settings. High quality PPG signal results prompt future studies utilizing ring PPG towards clinically relevant health outcomes.
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Affiliation(s)
- Hannu Kinnunen
- Optoelectronics and Measurement Techniques Research Group, University of Oulu, Oulu, Finland. Oura Health Ltd, Oulu, Finland
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50
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Goodwin AJ, Eytan D, Greer RW, Mazwi M, Thommandram A, Goodfellow SD, Assadi A, Jegatheeswaran A, Laussen PC. A practical approach to storage and retrieval of high-frequency physiological signals. Physiol Meas 2020; 41:035008. [PMID: 32131060 DOI: 10.1088/1361-6579/ab7cb5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Storage of physiological waveform data for retrospective analysis presents significant challenges. Resultant data can be very large, and therefore becomes expensive to store and complicated to manage. Traditional database approaches are not appropriate for large scale storage of physiological waveforms. Our goal was to apply modern time series compression and indexing techniques to the problem of physiological waveform storage and retrieval. APPROACH We deployed a vendor-agnostic data collection system and developed domain-specific compression approaches that allowed long term storage of physiological waveform data and other associated clinical and medical device data. The database (called AtriumDB) also facilitates rapid retrieval of retrospective data for high-performance computing and machine learning applications. MAIN RESULTS A prototype system has been recording data in a 42-bed pediatric critical care unit at The Hospital for Sick Children in Toronto, Ontario since February 2016. As of December 2019, the database contains over 720,000 patient-hours of data collected from over 5300 patients, all with complete waveform capture. One year of full resolution physiological waveform storage from this 42-bed unit can be losslessly compressed and stored in less than 300 GB of disk space. Retrospective data can be delivered to analytical applications at a rate of up to 50 million time-value pairs per second. SIGNIFICANCE Stored data are not pre-processed or filtered. Having access to a large retrospective dataset with realistic artefacts lends itself to the process of anomaly discovery and understanding. Retrospective data can be replayed to simulate a realistic streaming data environment where analytical tools can be rapidly tested at scale.
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Affiliation(s)
- Andrew J Goodwin
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. School of Biomedical Engineering, University of Sydney, Sydney, New South Wales, Australia
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