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Qin H, Fietze I, Mazzotti DR, Steenbergen N, Kraemer JF, Glos M, Wessel N, Song L, Penzel T, Zhang X. Obstructive sleep apnea heterogeneity and autonomic function: a role for heart rate variability in therapy selection and efficacy monitoring. J Sleep Res 2024; 33:e14020. [PMID: 37709966 DOI: 10.1111/jsr.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023]
Abstract
Obstructive sleep apnea is a highly prevalent sleep-related breathing disorder, resulting in a disturbed breathing pattern, changes in blood gases, abnormal autonomic regulation, metabolic fluctuation, poor neurocognitive performance, and increased cardiovascular risk. With broad inter-individual differences recognised in risk factors, clinical symptoms, gene expression, physiological characteristics, and health outcomes, various obstructive sleep apnea subtypes have been identified. Therapeutic efficacy and its impact on outcomes, particularly for cardiovascular consequences, may also vary depending on these features in obstructive sleep apnea. A number of interventions such as positive airway pressure therapies, oral appliance, surgical treatment, and pharmaceutical options are available in clinical practice. Selecting an effective obstructive sleep apnea treatment and therapy is a challenging medical decision due to obstructive sleep apnea heterogeneity and numerous treatment modalities. Thus, an objective marker for clinical evaluation is warranted to estimate the treatment response in patients with obstructive sleep apnea. Currently, while the Apnea-Hypopnea Index is used for severity assessment of obstructive sleep apnea and still considered a major guide to diagnosis and managements of obstructive sleep apnea, the Apnea-Hypopnea Index is not a robust marker of symptoms, function, or outcome improvement. Abnormal cardiac autonomic modulation can provide additional insight to better understand obstructive sleep apnea phenotyping. Heart rate variability is a reliable neurocardiac tool to assess altered autonomic function and can also provide cardiovascular information in obstructive sleep apnea. Beyond the Apnea-Hypopnea Index, this review aims to discuss the role of heart rate variability as an indicator and predictor of therapeutic efficacy to different modalities in order to optimise tailored treatment for obstructive sleep apnea.
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Affiliation(s)
- Hua Qin
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- The Fourth People's Hospital of Guangyuan, Guangyuan, China
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Jan F Kraemer
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Information Processing and Analytics Group, School of Library and Information Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Medicine, Medical School Berlin, Berlin, Germany
| | - Lijun Song
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Xiaowen Zhang
- Department of Otolaryngology, Head and Neck Surgery, State Key Laboratory of Respiratory Disease, The Key Laboratory of Advanced Interdisciplinary Studies Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Wessel N, Kim JS, Joung BY, Ko YG, Dischl D, Gapelyuk A, Lee YH, Kim KW, Park JW, Landmesser U. Magnetocardiography at rest predicts cardiac death in patients with acute chest pain. Front Cardiovasc Med 2023; 10:1258890. [PMID: 38155993 PMCID: PMC10752986 DOI: 10.3389/fcvm.2023.1258890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Sudden cardiac arrest is a major cause of morbidity and mortality worldwide and remains a major public health problem for which better non-invasive prediction tools are needed. Primary preventive therapies, such as implantable cardioverter defibrillators, are not personalized and not predictive. Most of these devices do not deliver life-saving therapy during their lifetime. The individual relationship between fatal arrhythmias and cardiac function abnormalities in predicting cardiac death risk has rarely been explored. Methods We retrospectively analyzed the measurements at rest for 191 patients with acute chest pain (ACP) magnetocardiographically. Our recently introduced analyses are able to detect inhomogeneities of the depolarization and repolarization. Moreover, electrically silent phenomena-intracellular ionic currents as well as vortex currents-can be measured and quantified. All included ACP patients were recruited in 2009 at Yonsei University Hospital and were followed up until 2022. Results During half of the follow-up period (6.5 years), 11 patients died. Out of all the included nine clinical, eight magnetocardiographical, and nine newly introduced magnetoionographical parameters we tested in this study, three parameters revealed themselves to be outstanding at predicting death: heart rate-corrected QT (QTc) prolongation, depression of repolarization current IKr + IKs, and serum creatinine (all significant in Cox regression, p < 0.05). They clearly predicted cardiac death over the 6.5 years duration (sensitivity 90.9%, specificity 85.6%, negative predictive accuracy 99.4%). Cardiac death risk was more than ninefold higher in patients with low repolarization reserve and QTc prolongation in comparison with the remaining patients with ACP (p < 0.001). The non-parametric Kaplan-Meier statistics estimated significantly lower survival functions from their lifetime data (p < 0.001). Discussion To the best of our knowledge, these are the first data linking magnetocardiographical and magnetoionographical parameters and subsequent significant fatal events in people, suggesting structural and functional components to clinical life-threatening ventricular arrhythmogenesis. The findings support investigation of new prevention strategies and herald those new non-invasive techniques as complementary risk stratification tools.
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Affiliation(s)
- N. Wessel
- Department of Human Medicine, MSB Medical School Berlin GmbH, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - J. S. Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - B. Y. Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y. G. Ko
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D. Dischl
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A. Gapelyuk
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Y. H. Lee
- Center for Biosignals, KRISS Korea Research Institute of Standards and Science, Daejeon, Republic of Korea
| | - K. W. Kim
- Center for Biosignals, KRISS Korea Research Institute of Standards and Science, Daejeon, Republic of Korea
| | - J. W. Park
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - U. Landmesser
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Pille M, Gapelyuk A, Berg K, Bannasch S, Mockler J, Park LS, Park JW, Wessel N. Cardiac magnetic field map topology quantified by Kullback-Leibler entropy identifies patients with clinically suspected myocarditis. Front Cardiovasc Med 2023; 10:1276321. [PMID: 38028437 PMCID: PMC10663336 DOI: 10.3389/fcvm.2023.1276321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Myocarditis is a condition that can have severe adverse outcomes and lead to sudden cardiac death if remaining undetected. This study tested the capability of cardiac magnetic field mapping to detect patients with clinically suspected myocarditis. This could open up the way for rapid, non-invasive, and cost-effective screening of suspected cases before a gold standard assessment via endomyocardial biopsy. Methods Historical cardiac magnetic field maps (n = 97) and data from a state-of-the-art magnetocardiography device (n = 30) were analyzed using the Kullback-Leibler entropy (KLE) for dimensionality reduction and topological quantification. Linear discriminant analysis was used to discern between patients with ongoing myocarditis and healthy controls. Results The STT segment of a magnetocardiogram, i.e., the section between the end of the S wave and the end of the T wave, was best suited to discern both groups. Using a 250-ms excerpt from the onset of the STT segment gave a reliable classification between the myocarditis and control group for both historic data (sensitivity: 0.83, specificity: 0.85, accuracy: 0.84) and recent data (sensitivity: 0.69, specificity: 0.88, accuracy: 0.80) using the KLE to quantify the topology of the cardiac magnetic field map. Conclusion The implementation based on KLE can reliably distinguish between clinically suspected myocarditis patients and healthy controls. We implemented an automatized feature selection based on LDA to replace the observer-dependent manual thresholding in previous studies.
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Affiliation(s)
- M. Pille
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - A. Gapelyuk
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - K. Berg
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - S. Bannasch
- Biomagnetik Park Holding GmbH, Hamburg, Germany
| | - J. Mockler
- Biomagnetik Park Holding GmbH, Hamburg, Germany
| | - L.-S. Park
- Biomagnetik Park Holding GmbH, Hamburg, Germany
| | - J.-W. Park
- Biomagnetik Park Holding GmbH, Hamburg, Germany
- Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
| | - N. Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Human Medicine, MSB Medical School Berlin GmbH, Berlin, Germany
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Sidorenko L, Sidorenko I, Gapelyuk A, Wessel N. Pathological Heart Rate Regulation in Apparently Healthy Individuals. Entropy (Basel) 2023; 25:1023. [PMID: 37509970 PMCID: PMC10378381 DOI: 10.3390/e25071023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
Cardiovascular diseases are the leading cause of morbidity and mortality in adults worldwide. There is one common pathophysiological aspect present in all cardiovascular diseases-dysfunctional heart rhythm regulation. Taking this aspect into consideration for cardiovascular risk predictions opens important research perspectives, allowing for the development of preventive treatment techniques. The aim of this study was to find out whether certain pathologically appearing signs in the heart rate variability (HRV) of an apparently healthy person, even with high HRV, can be defined as biomarkers for a disturbed cardiac regulation and whether this can be treated preventively by a drug-free method. This multi-phase study included 218 healthy subjects of either sex, who consecutively visited the physician at Gesundheit clinic because of arterial hypertension, depression, headache, psycho-emotional stress, extreme weakness, disturbed night sleep, heart palpitations, or chest pain. In study phase A, baseline measurement to identify individuals with cardiovascular risks was done. Therefore, standard HRV, as well as the new cardiorhythmogram (CRG) method, were applied to all subjects. The new CRG analysis used here is based on the recently introduced LF drops and HF counter-regulation. Regarding the mechanisms of why these appear in a steady-state cardiorhythmmogram, they represent non-linear event-based dynamical HRV biomarkers. The next phase of the study, phase B, tested whether the pathologically appearing signs identified via CRG in phase A could be clinically influenced by drug-free treatment. In order to validate the new CRG method, it was supported by non-linear HRV analysis in both phase A and in phase B. Out of 218 subjects, the pathologically appearing signs could be detected in 130 cases (60%), p < 0.01, by the new CRG method, and by the standard HRV analysis in 40 cases (18%), p < 0.05. Thus, the CRG method was able to detect 42% more cases with pathologically appearing cardiac regulation. In addition, the comparative CRG analysis before and after treatment showed that the pathologically appearing signs could be clinically influenced without the use of medication. After treatment, the risk group decreased eight-fold-from 130 people to 16 (p < 0.01). Therefore, progression of the detected pathological signs to structural cardiac pathology or arrhythmia could be prevented in most of the cases. However, in the remaining risk group of 16 apparently healthy subjects, 8 people died due to all-cause mortality. In contrast, no other subject in this study has died so far. The non-linear parameter which is able to quantify the changes in CRGs before versus after treatment is FWRENYI4 (symbolic dynamic feature); it decreased from 2.85 to 2.53 (p < 0.001). In summary, signs of pathological cardiac regulation can be identified by the CRG analysis of apparently healthy subjects in the early stages of development of cardiac pathology. Thus, our method offers a sensitive biomarker for cardiovascular risks. The latter can be influenced by non-drug treatments (acupuncture) to stop the progression into structural cardiac pathologies or arrhythmias in most but not all of the patients. Therefore, this could be a real and easy-to-use supplemental method, contributing to primary prevention in cardiology.
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Affiliation(s)
- Ludmila Sidorenko
- Department of Molecular Biology and Human Genetics, State University of Medicine and Pharmacy, "Nicolae Testemitanu", Stefan cel Mare Str. 165, MD-2004 Chisinau, Moldova
| | - Irina Sidorenko
- Medical Center "Gesundheit", Mihai Kogalniceanu Str. 45/2, MD-2009 Chisinau, Moldova
| | - Andrej Gapelyuk
- Cardiovascular Physics, Humboldt-Universität zu Berlin, D-10099 Berlin, Germany
| | - Niels Wessel
- Cardiovascular Physics, Humboldt-Universität zu Berlin, D-10099 Berlin, Germany
- MSB Medical School Berlin GmbH, D-14197 Berlin, Germany
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Nordine M, Pille M, Kraemer J, Berger C, Brandhorst P, Kaeferstein P, Kopetsch R, Wessel N, Trauzeddel RF, Treskatsch S. Intraoperative Beat-to-Beat Pulse Transit Time (PTT) Monitoring via Non-Invasive Piezoelectric/Piezocapacitive Peripheral Sensors Can Predict Changes in Invasively Acquired Blood Pressure in High-Risk Surgical Patients. Sensors (Basel) 2023; 23:3304. [PMID: 36992016 PMCID: PMC10059272 DOI: 10.3390/s23063304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Non-invasive tracking of beat-to-beat pulse transit time (PTT) via piezoelectric/piezocapacitive sensors (PES/PCS) may expand perioperative hemodynamic monitoring. This study evaluated the ability for PTT via PES/PCS to correlate with systolic, diastolic, and mean invasive blood pressure (SBPIBP, DBPIBP, and MAPIBP, respectively) and to detect SBPIBP fluctuations. METHODS PES/PCS and IBP measurements were performed in 20 patients undergoing abdominal, urological, and cardiac surgery. A Pearson's correlation analysis (r) between 1/PTT and IBP was performed. The predictive ability of 1/PTT with changes in SBPIBP was determined by area under the curve (reported as AUC, sensitivity, specificity). RESULTS Significant correlations between 1/PTT and SBPIBP were found for PES (r = 0.64) and PCS (r = 0.55) (p < 0.01), as well as MAPIBP/DBPIBP for PES (r = 0.6/0.55) and PCS (r = 0.5/0.45) (p < 0.05). A 7% decrease in 1/PTTPES predicted a 30% SBPIBP decrease (0.82, 0.76, 0.76), while a 5.6% increase predicted a 30% SBPIBP increase (0.75, 0.7, 0.68). A 6.6% decrease in 1/PTTPCS detected a 30% SBPIBP decrease (0.81, 0.72, 0.8), while a 4.8% 1/PTTPCS increase detected a 30% SBPIBP increase (0.73, 0.64, 0.68). CONCLUSIONS Non-invasive beat-to-beat PTT via PES/PCS demonstrated significant correlations with IBP and detected significant changes in SBPIBP. Thus, PES/PCS as a novel sensor technology may augment intraoperative hemodynamic monitoring during major surgery.
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Affiliation(s)
- Michael Nordine
- Department of Anesthesiology and Intensive Care Medicine, Hindenburgdamm 30, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 12203 Berlin, Germany; (M.N.)
| | - Marius Pille
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Physics, Humboldt University zu Berlin, 10115 Berlin, Germany
| | - Jan Kraemer
- Department of Physics, Humboldt University zu Berlin, 10115 Berlin, Germany
| | - Christian Berger
- Department of Anesthesiology and Intensive Care Medicine, Hindenburgdamm 30, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 12203 Berlin, Germany; (M.N.)
| | - Philipp Brandhorst
- Department of Anesthesiology and Intensive Care Medicine, Hindenburgdamm 30, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 12203 Berlin, Germany; (M.N.)
| | | | | | - Niels Wessel
- Department of Physics, Humboldt University zu Berlin, 10115 Berlin, Germany
- Department of Human Medicine, MSB Medical School Berlin GmbH, 14197 Berlin, Germany
| | - Ralf Felix Trauzeddel
- Department of Anesthesiology and Intensive Care Medicine, Hindenburgdamm 30, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 12203 Berlin, Germany; (M.N.)
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Hindenburgdamm 30, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 12203 Berlin, Germany; (M.N.)
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O'Connor M, Kolb C, Klein N, Rauwolf T, Kuster S, Kääb S, Tilz RR, Bänsch D, Ince H, Belke R, Hauser T, Rietsch K, Krämer JF, Wessel N, Lennerz C. REACT DX registry: Real world REACTion to atrial high rate episodes detected in implantable cardioverter-defibrillator recipients with a DX lead. Technol Health Care 2023; 31:735-746. [PMID: 36442163 DOI: 10.3233/thc-220432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with significant morbidity and is predicted by atrial high rate events. The early detection of AF is paramount to timely interventions to reduce the morbidity of AF. The DX ICD system combined with Home Monitoring® allows for continuous atrial rhythm monitoring without the need for a dedicated atrial lead. OBJECTIVE To establish the reaction to and timing of reactions to the detection of atrial high rate episodes (AHRE). METHODS A prospective cohort of DX ICD systems was followed up and the response to AHREs was collected and evaluated. RESULTS A total of 234 patients were enrolled; an AHRE ⩾ 6 min was detected in 13.7% of patients (n= 32) within a mean follow-up duration of 16 months. A high rate of oral anticoagulation (OAC) prescription was seen with the detection of AHREs in patients with a not-low risk CHA2DS2-VASc score. There was a delay in this prescription highlighting the potential to improve the timeliness of patient care in this group of patients. CONCLUSIONS The DX ICD system provides rapid and ongoing atrial rhythm monitoring such that physicians are rapidly aware of AHRE without the need for a dedicated atrial lead, but local protocols are needed to improve the response time of anti-coagulation prescription.
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Affiliation(s)
- Matthew O'Connor
- German Heart Center Munich, Department of Electrophysiology, Technical University of Munich, Munich, Germany
- The Royal Brompton and Harefield NHS Trust, Department of Electrophysiology, London, UK
| | - Christof Kolb
- German Heart Center Munich, Department of Electrophysiology, Technical University of Munich, Munich, Germany
| | - Norbert Klein
- Department of Cardiology, Angiology and Internal Intensive-Care Medicine, Klinikum St. Georg gGmbH, Leipzig, Germany
| | - Thomas Rauwolf
- Internal Medicine/Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
| | - Stefan Kuster
- Department of Internal Medicine, Cardiology, DRK Hospital Mölln-Ratzeburg, Ratzeburg, Germany
| | - Stefan Kääb
- Department of Medicine 1, University Hospital, LMU Munich, Munich, Germany
- German Heart Center Munich, Department of Electrophysiology, Technical University of Munich, Munich, Germany
| | - Roland Richard Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein (UKSH), Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Dietmar Bänsch
- Clinic for Electrophysiology, KMG Klinikum, Güstrow, Germany
| | - Hüseyin Ince
- Department of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Roberto Belke
- BIOTRONIK, Berlin, Germany
- German Heart Center Munich, Department of Electrophysiology, Technical University of Munich, Munich, Germany
| | | | | | - Jan F Krämer
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- German Heart Center Munich, Department of Electrophysiology, Technical University of Munich, Munich, Germany
| | - Carsten Lennerz
- German Heart Center Munich, Department of Electrophysiology, Technical University of Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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Vaquerizo-Villar F, Alvarez D, Kraemer JF, Wessel N, Gutierrez-Tobal GC, Calvo E, Del Campo F, Kheirandish-Gozal L, Gozal D, Penzel T, Hornero R. Automatic Sleep Staging in Children with Sleep Apnea using Photoplethysmography and Convolutional Neural Networks. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:216-219. [PMID: 34891275 DOI: 10.1109/embc46164.2021.9629995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Sleep staging is of paramount importance in children with suspicion of pediatric obstructive sleep apnea (OSA). Complexity, cost, and intrusiveness of overnight polysomnography (PSG), the gold standard, have led to the search for alternative tests. In this sense, the photoplethysmography signal (PPG) carries useful information about the autonomous nervous activity associated to sleep stages and can be easily acquired in pediatric sleep apnea home tests with a pulse oximeter. In this study, we use the PPG signal along with convolutional neural networks (CNN), a deep-learning technique, for the automatic identification of the three main levels of sleep: wake (W), rapid eye movement (REM), and non-REM sleep. A database of 366 PPG recordings from pediatric OSA patients is involved in the study. A CNN architecture was trained using 30-s epochs from the PPG signal for three-stage sleep classification. This model showed a promising diagnostic performance in an independent test set, with 78.2% accuracy and 0.57 Cohen's kappa for W/NREM/REM classification. Furthermore, the percentage of time in wake stage obtained for each subject showed no statistically significant differences with the manually scored from PSG. These results were superior to the only state-of-the-art study focused on the analysis of the PPG signal in the automated detection of sleep stages in children suffering from OSA. This suggests that CNN can be used along with PPG recordings for sleep stages scoring in pediatric home sleep apnea tests.
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Wehler D, Jelinek H, Gronau A, Wessel N, Kraemer J, Krones R, Penzel T. Reliability of heart-rate-variability features derived from ultra-short ECG recordings and their validity in the assessment of cardiac autonomic neuropathy. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Qin H, Keenan BT, Mazzotti DR, Vaquerizo-Villar F, Kraemer JF, Wessel N, Tufik S, Bittencourt L, Cistulli PA, de Chazal P, Sutherland K, Singh B, Pack AI, Chen NH, Fietze I, Gislason T, Holfinger S, Magalang UJ, Penzel T. Heart rate variability during wakefulness as a marker of obstructive sleep apnea severity. Sleep 2021; 44:6121869. [PMID: 33506267 DOI: 10.1093/sleep/zsab018] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/15/2021] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVES Patients with obstructive sleep apnea (OSA) exhibit heterogeneous heart rate variability (HRV) during wakefulness and sleep. We investigated the influence of OSA severity on HRV parameters during wakefulness in a large international clinical sample. METHODS 1247 subjects (426 without OSA and 821 patients with OSA) were enrolled from the Sleep Apnea Global Interdisciplinary Consortium. HRV parameters were calculated during a 5-minute wakefulness period with spontaneous breathing prior to the sleep study, using time-domain, frequency-domain and nonlinear methods. Differences in HRV were evaluated among groups using analysis of covariance, controlling for relevant covariates. RESULTS Patients with OSA showed significantly lower time-domain variations and less complexity of heartbeats compared to individuals without OSA. Those with severe OSA had remarkably reduced HRV compared to all other groups. Compared to non-OSA patients, those with severe OSA had lower HRV based on SDNN (adjusted mean: 37.4 vs. 46.2 ms; p < 0.0001), RMSSD (21.5 vs. 27.9 ms; p < 0.0001), ShanEn (1.83 vs. 2.01; p < 0.0001), and Forbword (36.7 vs. 33.0; p = 0.0001). While no differences were found in frequency-domain measures overall, among obese patients there was a shift to sympathetic dominance in severe OSA, with a higher LF/HF ratio compared to obese non-OSA patients (4.2 vs. 2.7; p = 0.009). CONCLUSIONS Time-domain and nonlinear HRV measures during wakefulness are associated with OSA severity, with severe patients having remarkably reduced and less complex HRV. Frequency-domain measures show a shift to sympathetic dominance only in obese OSA patients. Thus, HRV during wakefulness could provide additional information about cardiovascular physiology in OSA patients. CLINICAL TRIAL INFORMATION A Prospective Observational Cohort to Study the Genetics of Obstructive Sleep Apnea and Associated Co-Morbidities (German Clinical Trials Register - DKRS, DRKS00003966) https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003966.
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Affiliation(s)
- Hua Qin
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Jan F Kraemer
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Peter A Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Philip de Chazal
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney Sydney, Australia
| | - Kate Sutherland
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney Sydney, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Allan I Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ning-Hung Chen
- Division of Pulmonary, Critical Care Medicine and Sleep Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thorarinn Gislason
- Department of Sleep Medicine, Landspitali University Hospital, Reykjavik, Iceland.,Medical Faculty, University of Iceland, Reykjavik, Iceland
| | - Steven Holfinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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10
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Qin H, Steenbergen N, Glos M, Wessel N, Kraemer JF, Vaquerizo-Villar F, Penzel T. The Different Facets of Heart Rate Variability in Obstructive Sleep Apnea. Front Psychiatry 2021; 12:642333. [PMID: 34366907 PMCID: PMC8339263 DOI: 10.3389/fpsyt.2021.642333] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA), a heterogeneous and multifactorial sleep related breathing disorder with high prevalence, is a recognized risk factor for cardiovascular morbidity and mortality. Autonomic dysfunction leads to adverse cardiovascular outcomes in diverse pathways. Heart rate is a complex physiological process involving neurovisceral networks and relative regulatory mechanisms such as thermoregulation, renin-angiotensin-aldosterone mechanisms, and metabolic mechanisms. Heart rate variability (HRV) is considered as a reliable and non-invasive measure of autonomic modulation response and adaptation to endogenous and exogenous stimuli. HRV measures may add a new dimension to help understand the interplay between cardiac and nervous system involvement in OSA. The aim of this review is to introduce the various applications of HRV in different aspects of OSA to examine the impaired neuro-cardiac modulation. More specifically, the topics covered include: HRV time windows, sleep staging, arousal, sleepiness, hypoxia, mental illness, and mortality and morbidity. All of these aspects show pathways in the clinical implementation of HRV to screen, diagnose, classify, and predict patients as a reasonable and more convenient alternative to current measures.
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Affiliation(s)
- Hua Qin
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Jan F Kraemer
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group, Universidad de Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red-Bioingeniería, Biomateriales y Nanomedicina, Valladolid, Spain
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Saratov State University, Russian Federation, Saratov, Russia
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11
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Wessel N, Berg K, Kraemer JF, Gapelyuk A, Rietsch K, Hauser T, Kurths J, Wenzel D, Klein N, Kolb C, Belke R, Schirdewan A, Kääb S. Cardiac Autonomic Dysfunction and Incidence of de novo Atrial Fibrillation: Heart Rate Variability vs. Heart Rate Complexity. Front Physiol 2020; 11:596844. [PMID: 33363477 PMCID: PMC7752808 DOI: 10.3389/fphys.2020.596844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The REACT DX registry evaluates standard therapies to episodes of long-lasting atrial tachyarrhythmias and assesses the quality of sensing and stability of the lead and the implantable cardioverter-defibrillator (ICD) (BIOTRONIK Lumax VR-T DX and successors) over at least a 1-year follow-up period. OBJECTIVE To study the association between the risk of de novo device-detected atrial fibrillation (AF), the autonomic perturbations before the onset of paroxysmal AF and a 7-days heart rate variability (7dHRV) 1 month after ICD implantation. METHODS The registry consists of 234 patients implanted with an ICD, including 10 with de novo long-lasting atrial tachyarrhythmias with no prior history of AF. The patients were matched via the propensity-score methodology as well as for properties directly influencing the ECGs recorded using GE CardioMem CM 3000. Heart rate variability (HRV) analysis was performed using standard parameters from time- and frequency-domains, and from non-linear dynamics. RESULTS No linear HRV was associated with an increased risk of AF (p = n.s.). The only significant approach was derived from symbolic dynamics with the parameter "forbidden words" which distinguished both groups on all 7 days of measurements (p < 0.05), thereby quantifying the heart rate complexity (HRC) as drastically lower in the de novo AF group. CONCLUSION Cardiac autonomic dysfunction denoted by low HRC may be associated with higher AF incidence. For patients with mild to moderate heart failure, standard HRV parameters are not appropriate to quantify cardiac autonomic perturbations before the onset of AF. Further studies are needed to determine the individual risk for AF that would enable interventions to restore autonomic balance in the general population.
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Affiliation(s)
- Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Karsten Berg
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jan F. Kraemer
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrej Gapelyuk
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | | | - Jürgen Kurths
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
- Centre for Analysis of Complex Systems, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Dave Wenzel
- Clinic for Cardiology and Angiology, University Hospital Magdeburg, Magdeburg, Germany
| | | | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | | | | | - Stefan Kääb
- Medical Center of Ludwig-Maximilians-University of Munich, Munich, Germany
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12
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Wessel N, Gapelyuk A, Weiß J, Schmidt M, Kraemer JF, Berg K, Malberg H, Stepan H, Kurths J. Instantaneous Cardiac Baroreflex Sensitivity: xBRS Method Quantifies Heart Rate Blood Pressure Variability Ratio at Rest and During Slow Breathing. Front Neurosci 2020; 14:547433. [PMID: 33071732 PMCID: PMC7543095 DOI: 10.3389/fnins.2020.547433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/04/2020] [Indexed: 11/13/2022] Open
Abstract
Spontaneous baroreflex sensitivity (BRS) is a widely used tool for the quantification of the cardiovascular regulation. Numerous groups use the xBRS method, which calculates the cross-correlation between the systolic beat-to-beat blood pressure and the R-R interval (resampled at 1 Hz) in a 10 s sliding window, with 0-5 s delays for the interval. The delay with the highest correlation is selected and, if significant, the quotient of the standard deviations of the R-R intervals and the systolic blood pressures is recorded as the corresponding xBRS value. In this paper we test the hypothesis that the xBRS method quantifies the causal interactions of spontaneous BRS from non-invasive measurements at rest. We use the term spontaneous BRS in the sense of the sensitivity curve is calculated from non-interventional, i.e., spontaneous, baroreceptor activity. This study includes retrospective analysis of 1828 measurements containing ECG as well as continues blood pressure under resting conditions. Our results show a high correlation between the heart rate - systolic blood pressure variability (HRV/BPV) quotient and the xBRS (r = 0.94, p < 0.001). For a deeper understanding we conducted two surrogate analyses by substituting the systolic blood pressure by its reversed time series. These showed that the xBRS method was not able to quantify causal relationships between the two signals. It was not possible to distinguish between random and baroreflex controlled sequences. It appears xBRS rather determines the HRV/BPV quotient. We conclude that the xBRS method has a potentially large bias in characterizing the capacity of the arterial baroreflex under resting conditions. During slow breathing, estimates for xBRS are significantly increased, which clearly shows that measurements at rest only involve limited baroreflex activity, but does neither challenge, nor show the full range of the arterial baroreflex regulatory capacity. We show that xBRS is exclusively dominated by the heart rate to systolic blood pressure ratio (r = 0.965, p < 0.001). Further investigations should focus on additional autonomous testing procedures such as slow breathing or orthostatic testing to provide a basis for a non-invasive evaluation of baroreflex sensitivity.
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Affiliation(s)
- Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrej Gapelyuk
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jonas Weiß
- Institute of Biomedical Engineering, Technische Universität Dresden, Dresden, Germany
| | - Martin Schmidt
- Institute of Biomedical Engineering, Technische Universität Dresden, Dresden, Germany
| | - Jan F Kraemer
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Karsten Berg
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hagen Malberg
- Institute of Biomedical Engineering, Technische Universität Dresden, Dresden, Germany
| | - Holger Stepan
- Division of Obstetrics, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Jürgen Kurths
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany.,Potsdam Institute for Climate Impact Research, Potsdam, Germany.,Department of Human and Animal Physiology, Saratov State University, Saratov, Russia
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13
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Martinez-Alanis M, Bojorges-Valdez E, Wessel N, Lerma C. Prediction of Sudden Cardiac Death Risk with a Support Vector Machine Based on Heart Rate Variability and Heartprint Indices. Sensors (Basel) 2020; 20:s20195483. [PMID: 32992675 PMCID: PMC7582608 DOI: 10.3390/s20195483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022]
Abstract
Most methods for sudden cardiac death (SCD) prediction require long-term (24 h) electrocardiogram recordings to measure heart rate variability (HRV) indices or premature ventricular complex indices (with the heartprint method). This work aimed to identify the best combinations of HRV and heartprint indices for predicting SCD based on short-term recordings (1000 heartbeats) through a support vector machine (SVM). Eleven HRV indices and five heartprint indices were measured in 135 pairs of recordings (one before an SCD episode and another without SCD as control). SVMs (defined with a radial basis function kernel with hyperparameter optimization) were trained with this dataset to identify the 13 best combinations of indices systematically. Through 10-fold cross-validation, the best area under the curve (AUC) value as a function of γ (gamma) and cost was identified. The predictive value of the identified combinations had AUCs between 0.80 and 0.86 and accuracies between 80 and 86%. Further SVM performance tests on a different dataset of 68 recordings (33 before SCD and 35 as control) showed AUC = 0.68 and accuracy = 67% for the best combination. The developed SVM may be useful for preventing imminent SCD through early warning based on electrocardiogram (ECG) or heart rate monitoring.
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Affiliation(s)
- Marisol Martinez-Alanis
- Facultad de Ingeniería, Universidad Anáhuac México, Huixquilucan 52786, Estado de Mexico, Mexico;
| | - Erik Bojorges-Valdez
- Departamento de Estudios en Ingeniería para la Innovación, Universidad Iberoamericana Ciudad de México, Ciudad de México 01219, Mexico;
| | - Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, 10099 Berlin, Germany;
| | - Claudia Lerma
- Departamento de Instrumentación Electromecánica, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México 14089, Mexico
- Correspondence: ; Tel.: +52-55-5573-2911 (ext. 26202)
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14
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Wessel N, Gapelyuk A, Kraemer JF, Berg K, Kurths J. Spontaneous baroreflex sensitivity: sequence method at rest does not quantify causal interactions but rather determines the heart rate to blood pressure variability ratio. Physiol Meas 2020; 41:03LT01. [PMID: 32160607 DOI: 10.1088/1361-6579/ab7edc] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- N Wessel
- Humboldt-Universität zu Berlin, Berlin, Germany
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15
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Thiesse L, Rudzik F, Kraemer JF, Spiegel K, Leproult R, Wessel N, Pieren R, Héritier H, Eze IC, Foraster M, Garbazza C, Vienneau D, Brink M, Wunderli JM, Probst-Hensch N, Röösli M, Cajochen C. Transportation noise impairs cardiovascular function without altering sleep: The importance of autonomic arousals. Environ Res 2020; 182:109086. [PMID: 32069756 DOI: 10.1016/j.envres.2019.109086] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 05/15/2023]
Abstract
AIMS Chronic exposure to nocturnal transportation noise has been linked to cardiovascular disorders with sleep impairment as the main mediator. Here we examined whether nocturnal transportation noise affects the main stress pathways, and whether it relates to changes in the macro and micro structure of sleep. METHODS AND RESULTS Twenty-six young healthy participants (12 women, 24.6 ± 0.7 years, mean ± SE) spent five consecutive 24-h days and one last morning in the laboratory. The first (baseline) and last (recovery) nights comprised a quiet ambient scenario. In-between, four different noise scenarios (low/medium/high intermittent road or rail scenarios with an identical equivalent continuous sound level of 45 dB) were randomly presented during the 8-h nights. Participants felt more annoyed from the transportation noise scenarios compared to the quiet ambient scenario played back during the baseline and recovery nights (F5,117 = 10.2, p < 0.001). Nocturnal transportation noise did not significantly impact polysomnographically assessed sleep macrostructure, blood pressure, nocturnal catecholamine levels and morning cytokine levels. Evening cortisol levels increased after sleeping with highly intermittent road noise compared to baseline (p = 0.002, noise effect: F4,83 = 4.0, p = 0.005), a result related to increased cumulative duration of autonomic arousals during the noise nights (F5,106 = 3.4, p < 0.001; correlation: rpearson = 0.64, p = 0.006). CONCLUSION Under controlled laboratory conditions, highly intermittent nocturnal road noise exposure at 45 dB increased the cumulative duration of autonomic arousals during sleep and next-day evening cortisol levels. Our results indicate that, without impairing sleep macrostructure, nocturnal transportation noise of 45 dB is a physiological stressor that affects the hypothalamic-pituitary-adrenal axis during the following day in healthy young good sleepers.
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Affiliation(s)
- Laurie Thiesse
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Switzerland
| | - Franziska Rudzik
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Switzerland
| | - Jan F Kraemer
- Department of Physics, Humboldt-Universität ZU Berlin, Germany
| | - Karine Spiegel
- WAKING Team, Lyon Neuroscience Research Center (CRNL) - INSERM U1028, CNRS UMR5292, University Claude Bernard Lyon 1, Lyon, France
| | - Rachel Leproult
- Université libre de Bruxelles (ULB), Avenue F.D. Roosevelt 50, Bruxelles, Belgium
| | - Niels Wessel
- Department of Physics, Humboldt-Universität ZU Berlin, Germany
| | - Reto Pieren
- Empa - Swiss Federal Laboratories for Materials Science and Technology, Duebendorf, Switzerland
| | - Harris Héritier
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Ikenna C Eze
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Maria Foraster
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Blanquerna School of Health Science, Universitat Ramon Llull, Barcelona, Spain
| | - Corrado Garbazza
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Switzerland
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Mark Brink
- Swiss Federal Office for the Environment, Bern, Switzerland
| | - Jean Marc Wunderli
- Empa - Swiss Federal Laboratories for Materials Science and Technology, Duebendorf, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Switzerland.
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16
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Reyes-Lagos JJ, Ledesma-Ramírez CI, Hadamitzky M, Peña-Castillo MÁ, Echeverría JC, Lückemann L, Schedlowski M, Berg K, Wessel N, Pacheco-López G. Symbolic analysis of heart rate fluctuations identifies cardiac autonomic modifications during LPS-induced endotoxemia. Auton Neurosci 2019; 221:102577. [PMID: 31445407 DOI: 10.1016/j.autneu.2019.102577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
Abstract
The present study aimed to compare linear and symbolic dynamics (SD) indices for detecting the autonomic cardiac changes produced by endotoxemia in freely-moving rats. In this context, we analyzed ECG-derived R-R time series in freely moving Dark Agouti rats, which received lipopolysaccharide (LPS, n = 9), or vehicle (V, n = 7). Five minutes R-R time series were assessed every hour up to +12 h and + 24 h post-LPS injection. We found that SD indices showed significant differences at +7 h between V vs. LPS groups and at +9 h between basal levels of LPS (-3 h) and post-LPS injection (pre-LPS vs. post-LPS). In general, SD seems more appropriate than linear indices to evaluate the autonomic changes of endotoxemic rats. Overall, the symbolic parameters detected decreased R-R variability and complexity, which indicate a modification of the autonomic regulation during LPS-induced endotoxemia. This modification is probably related to a reduced activity of the cholinergic anti-inflammatory pathway at the long term.
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Affiliation(s)
- José Javier Reyes-Lagos
- Autonomous University of the State of Mexico (UAEMex), Faculty of Medicine, Toluca, 50180, Mexico
| | | | - Martin Hadamitzky
- University of Duisburg-Essen, University Hospital Essen, Institute of Medical Psychology and Behavioral Immunobiology, Essen 45122, Germany
| | - Miguel Ángel Peña-Castillo
- Metropolitan Autonomous University (UAM), Campus Iztapalapa, Basic Sciences and Engineering Division, Mexico City 09340, Mexico
| | - Juan C Echeverría
- Metropolitan Autonomous University (UAM), Campus Iztapalapa, Basic Sciences and Engineering Division, Mexico City 09340, Mexico
| | - Laura Lückemann
- University of Duisburg-Essen, University Hospital Essen, Institute of Medical Psychology and Behavioral Immunobiology, Essen 45122, Germany
| | - Manfred Schedlowski
- University of Duisburg-Essen, University Hospital Essen, Institute of Medical Psychology and Behavioral Immunobiology, Essen 45122, Germany
| | - Karsten Berg
- Cardiovascular Physics, Department of Physics, Humboldt-Universität zu Berlin, Berlin 10115, Germany
| | - Niels Wessel
- Cardiovascular Physics, Department of Physics, Humboldt-Universität zu Berlin, Berlin 10115, Germany
| | - Gustavo Pacheco-López
- Metropolitan Autonomous University (UAM), Campus Lerma, Biological and Health Sciences Division, Lerma 52005, Mexico; Swiss Federal Institute of Technology (ETH) Zurich, Department of Health Sciences, and Technology, Zurich 8092, Switzerland.
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17
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Lyons MM, Kraemer JF, Dhingra R, Keenan BT, Wessel N, Glos M, Penzel T, Gurubhagavatula I. Screening for Obstructive Sleep Apnea in Commercial Drivers Using EKG-Derived Respiratory Power Index. J Clin Sleep Med 2019; 15:23-32. [PMID: 30621825 DOI: 10.5664/jcsm.7562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 08/17/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is common in commercial motor vehicle operators (CMVOs); however, polysomnography (PSG), the gold-standard diagnostic test, is expensive and inconvenient for screening. OSA is associated with changes in heart rate and voltage on electrocardiography (EKG). We evaluated the utility of EKG parameters in identifying CMVOs at greater risk for sleepiness-related crashes (apnea-hypopnea index [AHI] ≥ 30 events/h). METHODS In this prospective study of CMVOs, we performed EKGs with concurrent PSG, and calculated the respiratory power index (RPI) on EKG, a surrogate for AHI calculated from PSG. We evaluated the utility of two-stage predictive models using simple clinical measures (age, body mass index [BMI], neck circumference, Epworth Sleepiness Scale score, and the Multi-Variable Apnea Prediction [MVAP] score) in the first stage, followed by RPI in a subset as the second-stage. We assessed area under the receiver operating characteristic curve (AUC), sensitivity, and negative posttest probability (NPTP) for this two-stage approach and for RPI alone. RESULTS The best-performing model used the MVAP, which combines BMI, age, and sex with three OSA symptoms, in the first stage, followed by RPI in the second. The model yielded an estimated (95% confidence interval) AUC of 0.883 (0.767-0.924), sensitivity of 0.917 (0.706-0.962), and NPTP of 0.034 (0.015-0.133). Predictive characteristics were similar using a model with only BMI as the first-stage screen. CONCLUSIONS A two-stage model that combines BMI or the MVAP score in the first stage, with EKG in the second, had robust discriminatory power to identify severe OSA in CMVOs.
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Affiliation(s)
- M Melani Lyons
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jan F Kraemer
- Department of Physics, Humboldt-Universitat zu Berlin, Berlin, Germany
| | - Radha Dhingra
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Brendan T Keenan
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Niels Wessel
- Department of Physics, Humboldt-Universitat zu Berlin, Berlin, Germany
| | - Martin Glos
- The Centre of Sleep Medicine, Department of Cardiology, Charité Universitätsmedizin, Berlin, Berlin, Germany
| | - Thomas Penzel
- The Centre of Sleep Medicine, Department of Cardiology, Charité Universitätsmedizin, Berlin, Berlin, Germany
| | - Indira Gurubhagavatula
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Sleep Disorders Clinic at the Philadelphia CMC VA Medical Center, Philadelphia, Pennsylvania
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18
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Järve A, Todiras M, Kny M, Fischer FI, Kraemer JF, Wessel N, Plehm R, Fielitz J, Alenina N, Bader M. Angiotensin-(1-7) Receptor Mas in Hemodynamic and Thermoregulatory Dysfunction After High-Level Spinal Cord Injury in Mice: A Pilot Study. Front Physiol 2019; 9:1930. [PMID: 30687131 PMCID: PMC6336833 DOI: 10.3389/fphys.2018.01930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/21/2018] [Indexed: 01/12/2023] Open
Abstract
Spinal cord injury (SCI) above mid-thoracic levels leads to autonomic dysfunction affecting both the cardiovascular system and thermoregulation. The renin-angiotensin system (RAS) which is a potent regulator of blood pressure, including its novel beneficial arm with the receptor Mas could be an interesting target in post-SCI hemodynamics. To test the hypothesis that hemodynamics, activity and diurnal patterns of those are more affected in the Mas deficient mice post-SCI we used a mouse model of SCI with complete transection of spinal cord at thoracic level 4 (T4-Tx) and performed telemetric monitoring of blood pressure (BP) and heart rate (HR). Our data revealed that hypothermia deteriorated physiological BP and HR control. Preserving normothermia by keeping mice at 30°C prevented severe hypotension and bradycardia post-SCI. Moreover, it facilitated rapid return of diurnal regulation of BP, HR and activity in wild type (WT) mice. In contrast, although Mas deficient mice had comparable reacquisition of diurnal HR rhythm, they showed delayed recovery of diurnal rhythmicity in BP and significantly lower nocturnal activity. Exposing mice with T4-Tx (kept in temperature-controlled cages) to 23°C room temperature for one hour at different time-points post-SCI, demonstrated their inability to maintain core body temperature, Mas deficient mice being significantly more impaired than WT littermates. We conclude that Mas deficient mice were more resistant to acute hypotension, delayed nocturnal recovery, lower activity and more severely impaired thermoregulation. The ambient temperature had significant effect on hemodynamics and, thus it should be taken into account when assessing cardiovascular parameters post-SCI in mice.
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Affiliation(s)
- Anne Järve
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research, Berlin, Germany
| | - Mihail Todiras
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Melanie Kny
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Falk I Fischer
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan F Kraemer
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ralph Plehm
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Jens Fielitz
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Partner Site Greifswald, German Centre for Cardiovascular Research, Greifswald, Germany.,Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Natalia Alenina
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research, Berlin, Germany
| | - Michael Bader
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Institute of Biology, University of Lübeck, Lübeck, Germany
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Granitza P, Kraemer JF, Schoebel C, Penzel T, Kurths J, Wessel N. Is dynamic desaturation better than a static index to quantify the mortality risk in heart failure patients with Cheyne-Stokes respiration? Chaos 2018; 28:106312. [PMID: 30384661 DOI: 10.1063/1.5039601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/23/2018] [Indexed: 06/08/2023]
Abstract
Cheyne-Stokes respiration (CSR) is a periodic, highly dynamic, respiratory pattern and a known comorbidity in congestive heart failure (CHF) patients. It is generally seen as an indicator for a negative prognosis, even if no distinction in degree is known or understood. This paper aims to improve on existing attempts by creating a quantification of the behavior of the dynamic desaturation process of oxygen in the blood. We performed this work on a cohort of 11 subjects with CHF, reduced left ventricular ejection fraction, and CSR. The dynamic desaturation process was evaluated according to changes to peripheral capillary oxygenation S p O 2 resulting from highly nonlinear relationships in the ventilatory system perturbed by periodic breathing. Hypoxaemic burden expressed as a static index T 90 was compared to a novel relative desaturation index R D I , developed in this paper. While T 90 represents a single value calculated using a static cut-off value of 90 % S p O 2 , the R D I is more sensitive to dynamic influences as it uses the specific maximum change in saturation for each CSR episode. The threshold of T 90 = 22 min per night as suggested by Oldenburg et al. could not be confirmed to predict survival, but all central apneas resulting in a relative desaturation of S p O 2 above a cut-off value of 8 % were a 100 % positive predictor of mortality. The R D I proved sufficiently stable in intraindividual measurements across CSR epochs. Across the cohort, it showed a bimodal distribution for the deceased group, indicative of a possible aetiological difference. Hence, it is our conclusion that a dynamic approach to analyse desaturation of oxygen during Cheyne-Stokes respiration is to be strongly favoured over a static approach to analysis.
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Affiliation(s)
- Philine Granitza
- Department of Physics, Cardiovascular Physics, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Jan F Kraemer
- Department of Physics, Cardiovascular Physics, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Christoph Schoebel
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Thomas Penzel
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Jürgen Kurths
- Department of Physics, Cardiovascular Physics, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Niels Wessel
- Department of Physics, Cardiovascular Physics, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
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Krämer J, Liebers U, Drozdek M, Kurths J, Wessel N, Witt C. Hitze-induzierte Exazerbation der COPD – kardiorespiratorische Reaktion stationärer Patienten auf Hitzestress. Pneumologie 2018. [DOI: 10.1055/s-0037-1619364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J Krämer
- Institut für Kardiovaskuläre Physik, Humboldt-Universität, Berlin
| | - U Liebers
- Arbeitsbereich Pneumologie CCM; Charité-Universitätsmedizin Berlin
| | - M Drozdek
- Arbeitsbereich Pneumologie CCM; Charité-Universitätsmedizin Berlin
| | - J Kurths
- Institut für Kardiovaskuläre Physik, Humboldt-Universität, Berlin
| | - N Wessel
- Institut für Kardiovaskuläre Physik, Humboldt-Universität, Berlin
| | - C Witt
- Arbeitsbereich Pneumologie CCM; Charité-Universitätsmedizin Berlin
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Baumert M, Baier V, Haueisen J, Wessel N, Meyerfeldt U, Schirdewan A, Voss A. Forecasting of Life Threatening Arrhythmias Using the Compression Entropy of Heart Rate. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1633859] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Objectives:
Ventricular tachycardia (VT) provoking sudden cardiac death (SCD) are a major cause of mortality in the developed countries. The most efficient therapy for SCD prevention are implantable cardioverter defibrillators (ICD). In this study heart rate variability (HRV) measures were analyzed for short-term forecasting of VT in order to improve VT sensing and to enable a patient warning of forthcoming shocks.
Methods:
The last 1000 normal beat-to-beat intervals before 50 VT episodes stored by the ICD were analyzed and compared to individually acquired control time series (CON). HRV analysis was performed with standard parameters of time and frequency domain as suggested by the HRV Task Force and furthermore with a newly developed and optimized nonlinear parameter that assesses the compression entropy of heart rate (Hc).
Results:
Except of meanNN (p = 0.02) we found no significant differences in standard HRV parameters. In contrast, Hc revealed highly significant (p = 0.007) alterations in VT compared with CON suggesting a decreased complexity before the onset of VT.
Conclusion:
Compression entropy might be a suitable parameter for short-term forecasting of life-threatening tachycardia in ICD.
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Helland VC, Gapelyuk A, Suhrbier A, Riedl M, Penzel T, Kurths J, Wessel N. Investigation of an Automatic Sleep Stage Classification by Means of Multiscorer Hypnogram. Methods Inf Med 2018; 49:467-72. [DOI: 10.3414/me09-02-0052] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 02/23/2010] [Indexed: 11/09/2022]
Abstract
Summary
Objectives: Scoring sleep visually based on polysomnography is an important but time-consuming element of sleep medicine. Whereas computer software assists human experts in the assignment of sleep stages to polysomnogram epochs, their performance is usually insufficient. This study evaluates the possibility to fully automatize sleep staging considering the reliability of the sleep stages available from human expert sleep scorers.
Methods: We obtain features from EEG, ECG and respiratory signals of polysomnograms from ten healthy subjects. Using the sleep stages provided by three human experts, we evaluate the performance of linear discriminant analysis on the entire polysomnogram and only on epochs where the three experts agree in their sleep stage scoring.
Results: We show that in polysomnogram intervals, to which all three scorers assign the same sleep stage, our algorithm achieves 90% accuracy. This high rate of agreement with the human experts is accomplished with only a small set of three frequency features from the EEG. We increase the performance to 93% by including ECG and respiration features. In contrast, on intervals of ambiguous sleep stage, the sleep stage classification obtained from our algorithm, agrees with the human consensus scorer in approximately 61%.
Conclusions: These findings suggest that machine classification is highly consistent with human sleep staging and that error in the algorithm’s assignments is rather a problem of lack of well-defined criteria for human experts to judge certain polysomnogram epochs than an insufficiency of computational procedures.
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Wessel N, Sidorenko L, Kraemer JF, Schoebel C, Baumann G. Assessing cardiac autonomic function via heart rate variability analysis requires monitoring respiration. Europace 2017; 18:1280. [PMID: 27496953 DOI: 10.1093/europace/euv460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Wessel
- Humboldt-Universität zu Berlin, Berlin, Germany
| | - L Sidorenko
- Humboldt-Universität zu Berlin, Berlin, Germany
| | - J F Kraemer
- Humboldt-Universität zu Berlin, Berlin, Germany
| | - C Schoebel
- Humboldt-Universität zu Berlin, Berlin, Germany
| | - G Baumann
- Humboldt-Universität zu Berlin, Berlin, Germany
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Krause H, Kraemer JF, Penzel T, Kurths J, Wessel N. On the difference of cardiorespiratory synchronisation and coordination. Chaos 2017; 27:093933. [PMID: 28964129 DOI: 10.1063/1.4999352] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/18/2017] [Indexed: 06/07/2023]
Abstract
Cardiorespiratory phase synchronisation (CRS) is a type of cardiorespiratory coupling that manifests through a prediliction for heart beats to occur at specific points relative to the phase of the respiratory cycle. It has been under investigation for nearly 20 years, and while it seems to be mostly occurring in relaxed states such as deep sleep and anesthesia, no clear clinical implications have been established. Cardiorespiratory coordination (CRC) is a recent development in this field where the relationship between the respiratory onset and heart beat is analysed in the time domain and the possible relationship of each heart beat is considered for both the previous and the next respiratory onset. This ostensibly closely related effect must not only show relevant information content but also do so independent of CRS in order to be relevant for future studies. In this paper, we investigate CRC and its relation to CRS mainly using graphical and statistical methods on two exemplary datasets: measurements from a pregnant woman participating in a preeclampsia study and those from a man suffering from sleep apnea. We show fundamental differences between the results of both approaches and are able to show a formerly unknown dependency between the heart activity and respiratory rate, potentially indicating heartbeat-initiated inspiration. Despite their differences, methods developed for the quantification of CRS can be adapted to CRC. Completing the comparison is an investigation into the relationship between CRC and respiratory sinus arrhythmia. Similar to previous results for CRS, the two effects are found to be orthogonal, meaning that they can be observed independently or in conjunction.
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Affiliation(s)
- Harald Krause
- AG NLD - Cardiovascular Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jan F Kraemer
- AG NLD - Cardiovascular Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Penzel
- AG NLD - Cardiovascular Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jürgen Kurths
- AG NLD - Cardiovascular Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Niels Wessel
- AG NLD - Cardiovascular Physics, Humboldt-Universität zu Berlin, Berlin, Germany
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Affiliation(s)
- Thomas Penzel
- Sleep Medicine Center, Charité-Universitätsmedizin, Berlin, Germany. International Clinical Research Center, St. Annes University Hospital Brno, Brno, Czechia
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Miyabara R, Berg K, Kraemer JF, Baltatu OC, Wessel N, Campos LA. Quantifying Effects of Pharmacological Blockers of Cardiac Autonomous Control Using Variability Parameters. Front Physiol 2017; 8:10. [PMID: 28167918 PMCID: PMC5253391 DOI: 10.3389/fphys.2017.00010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/06/2017] [Indexed: 01/11/2023] Open
Abstract
Objective: The aim of this study was to identify the most sensitive heart rate and blood pressure variability (HRV and BPV) parameters from a given set of well-known methods for the quantification of cardiovascular autonomic function after several autonomic blockades. Methods: Cardiovascular sympathetic and parasympathetic functions were studied in freely moving rats following peripheral muscarinic (methylatropine), β1-adrenergic (metoprolol), muscarinic + β1-adrenergic, α1-adrenergic (prazosin), and ganglionic (hexamethonium) blockades. Time domain, frequency domain and symbolic dynamics measures for each of HRV and BPV were classified through paired Wilcoxon test for all autonomic drugs separately. In order to select those variables that have a high relevance to, and stable influence on our target measurements (HRV, BPV) we used Fisher's Method to combine the p-value of multiple tests. Results: This analysis led to the following best set of cardiovascular variability parameters: The mean normal beat-to-beat-interval/value (HRV/BPV: meanNN), the coefficient of variation (cvNN = standard deviation over meanNN) and the root mean square differences of successive (RMSSD) of the time domain analysis. In frequency domain analysis the very-low-frequency (VLF) component was selected. From symbolic dynamics Shannon entropy of the word distribution (FWSHANNON) as well as POLVAR3, the non-linear parameter to detect intermittently decreased variability, showed the best ability to discriminate between the different autonomic blockades. Conclusion: Throughout a complex comparative analysis of HRV and BPV measures altered by a set of autonomic drugs, we identified the most sensitive set of informative cardiovascular variability indexes able to pick up the modifications imposed by the autonomic challenges. These indexes may help to increase our understanding of cardiovascular sympathetic and parasympathetic functions in translational studies of experimental diseases.
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Affiliation(s)
- Renata Miyabara
- Center of Innovation, Technology and Education (CITE), Anhembi Morumbi University - Laureate International UniversitiesSao Jose dos Campos, Brazil; Center of Innovation, Technology and Education (CITE), Camilo Castelo Branco UniversitySao Jose dos Campos, Brazil
| | - Karsten Berg
- Institut für Physik, Humboldt-Universität zu Berlin Berlin, Germany
| | - Jan F Kraemer
- Institut für Physik, Humboldt-Universität zu Berlin Berlin, Germany
| | - Ovidiu C Baltatu
- Center of Innovation, Technology and Education (CITE), Anhembi Morumbi University - Laureate International UniversitiesSao Jose dos Campos, Brazil; Center of Innovation, Technology and Education (CITE), Camilo Castelo Branco UniversitySao Jose dos Campos, Brazil
| | - Niels Wessel
- Institut für Physik, Humboldt-Universität zu Berlin Berlin, Germany
| | - Luciana A Campos
- Center of Innovation, Technology and Education (CITE), Anhembi Morumbi University - Laureate International UniversitiesSao Jose dos Campos, Brazil; Center of Innovation, Technology and Education (CITE), Camilo Castelo Branco UniversitySao Jose dos Campos, Brazil
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Penzel T, Kantelhardt JW, Bartsch RP, Riedl M, Kraemer JF, Wessel N, Garcia C, Glos M, Fietze I, Schöbel C. Modulations of Heart Rate, ECG, and Cardio-Respiratory Coupling Observed in Polysomnography. Front Physiol 2016; 7:460. [PMID: 27826247 PMCID: PMC5078504 DOI: 10.3389/fphys.2016.00460] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/23/2016] [Indexed: 11/13/2022] Open
Abstract
The cardiac component of cardio-respiratory polysomnography is covered by ECG and heart rate recordings. However, their evaluation is often underrepresented in summarizing reports. As complements to EEG, EOG, and EMG, these signals provide diagnostic information for autonomic nervous activity during sleep. This review presents major methodological developments in sleep research regarding heart rate, ECG, and cardio-respiratory couplings in a chronological (historical) sequence. It presents physiological and pathophysiological insights related to sleep medicine obtained by new technical developments. Recorded nocturnal ECG facilitates conventional heart rate variability (HRV) analysis, studies of cyclical variations of heart rate, and analysis of ECG waveform. In healthy adults, the autonomous nervous system is regulated in totally different ways during wakefulness, slow-wave sleep, and REM sleep. Analysis of beat-to-beat heart-rate variations with statistical methods enables us to estimate sleep stages based on the differences in autonomic nervous system regulation. Furthermore, up to some degree, it is possible to track transitions from wakefulness to sleep by analysis of heart-rate variations. ECG and heart rate analysis allow assessment of selected sleep disorders as well. Sleep disordered breathing can be detected reliably by studying cyclical variation of heart rate combined with respiration-modulated changes in ECG morphology (amplitude of R wave and T wave).
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Affiliation(s)
- Thomas Penzel
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin BerlinBerlin, Germany; International Clinical Research Center, St. Anne's University Hospital BrnoBrno, Czech Republic
| | - Jan W Kantelhardt
- Naturwissenschaftliche Fakultät II - Chemie, Physik und Mathematik, Institut für Physik, Martin-Luther Universität Halle-WittenbergHalle, Germany; Kardiovaskuläre Physik, Arbeitsgruppe Nichtlineare Dynamik, Fachbereich Physik, Humboldt-Universität BerlinBerlin, Germany
| | | | - Maik Riedl
- Kardiovaskuläre Physik, Arbeitsgruppe Nichtlineare Dynamik, Fachbereich Physik, Humboldt-Universität Berlin Berlin, Germany
| | - Jan F Kraemer
- Kardiovaskuläre Physik, Arbeitsgruppe Nichtlineare Dynamik, Fachbereich Physik, Humboldt-Universität Berlin Berlin, Germany
| | - Niels Wessel
- Kardiovaskuläre Physik, Arbeitsgruppe Nichtlineare Dynamik, Fachbereich Physik, Humboldt-Universität Berlin Berlin, Germany
| | - Carmen Garcia
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin Berlin Berlin, Germany
| | - Martin Glos
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin Berlin Berlin, Germany
| | - Ingo Fietze
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin Berlin Berlin, Germany
| | - Christoph Schöbel
- Interdisziplinäres Schlafmedizinisches Zentrum, Charité - Universitätsmedizin Berlin Berlin, Germany
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Sidorenko L, Kraemer JF, Wessel N. Standard heart rate variability spectral analysis: does it purely assess cardiac autonomic function? Europace 2016; 18:1085. [PMID: 27174902 DOI: 10.1093/europace/euw078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Sidorenko
- State University of Medicine and Pharmacy "Nicolae Testemitanu", Chişinău, Republic of Moldova Humboldt-Universität zu Berlin, Berlin, Germany
| | - J F Kraemer
- Humboldt-Universität zu Berlin, Berlin, Germany
| | - N Wessel
- Humboldt-Universität zu Berlin, Berlin, Germany
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Schwabedal JTC, Riedl M, Penzel T, Wessel N. Alpha-wave frequency characteristics in health and insomnia during sleep. J Sleep Res 2016; 25:278-86. [PMID: 26781046 DOI: 10.1111/jsr.12372] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/27/2015] [Indexed: 11/30/2022]
Abstract
Appearances of alpha waves in the sleep electrencephalogram indicate physiological, brief states of awakening that lie in between wakefulness and sleep. These microstates may also cause the loss in sleep quality experienced by individuals suffering from insomnia. To distinguish such pathological awakenings from physiological ones, differences in alpha-wave characteristics between transient awakening and wakefulness observed before the onset of sleep were studied. In polysomnographic datasets of sleep-healthy participants (n = 18) and patients with insomnia (n = 10), alpha waves were extracted from the relaxed, wake state before sleep onset, wake after sleep-onset periods and arousals of sleep. In these, alpha frequency and variability were determined as the median and standard deviation of inverse peak-to-peak intervals. Before sleep onset, patients with insomnia showed a decreased alpha variability compared with healthy participants (P < 0.05). After sleep onset, both groups showed patterns of decreased alpha frequency that was lower for wake after sleep-onset periods of shorter duration. For patients with insomnia, alpha variability increased for short wake after sleep-onset periods. Major differences between the two groups were encountered during arousal. In particular, the alpha frequency in patients with insomnia rebounded to wake levels, while the frequency in healthy participants remained at the reduced level of short wake after sleep-onset periods. Reductions in alpha frequency during wake after sleep-onset periods may be related to the microstate between sleep and wakefulness that was described for such brief awakenings. Reduced alpha variability before sleep may indicate a dysfunction of the alpha generation mechanism in insomnia. Alpha characteristics may also prove valuable in the study of other sleep and attention disorders.
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Affiliation(s)
| | - Maik Riedl
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité Berlin, Berlin, Germany
| | - Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
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Chaparro-Vargas R, Ahmed B, Wessel N, Penzel T, Cvetkovic D. Insomnia Characterization: From Hypnogram to Graph Spectral Theory. IEEE Trans Biomed Eng 2016; 63:2211-9. [PMID: 26742123 DOI: 10.1109/tbme.2016.2515261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To quantify and differentiate control and insomnia sleep onset patterns through biomedical signal processing of overnight polysomnograms. METHODS The approach consisted of three tandem modules: 1) biosignal processing module, which used state-space time-varying autoregressive moving average (TVARMA) processes with recursive particle filter, 2) hypnogram generation module that implemented a fuzzy inference system (FIS), and 3) insomnia characterization module that discriminated between control and subjects with insomnia using a logistic regression model trained with a set of similarity measures ( d1, d2 , d3, d4). The study employed sleep onset periods from 16 control and 16 subjects with insomnia. RESULTS State-spaced TVARMA processes with recursive particle filtering provided resilience to nonlinear, nonstationary, and non-Gaussian conditions of biosignals. FIS managed automated sleep scoring robust to intersubjects' and interraters' variability. The similarity distances quantified in a scalar measure the transitions amongst sleep onset stages, computed from expert and automated hypnograms. A statistical set of unpaired two-tailed t -tests suggested that distances d1 , d2, and d3 had larger statistical significance ( ) to characterize sleeping patterns. The logistic regression model classified control and subjects with insomnia with sensitivity 87 % , specificity 75 %, and accuracy 81 %. CONCLUSION Our approach can perform a supportive role in either biosignal processing, sleep staging, insomnia characterization, or all the previous, coping with time-consuming procedures and massive data volumes of standard protocols. SIGNIFICANCE The introduction of graph spectral theory and logistic regression for the diagnosis of insomnia represents a novel concept, attempting to describe complex sleep dynamics throughout transitions networks and scalar measures.
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Wessel N, Riedl M, Kramer J, Muller A, Penzel T, Kurths J. Synchronisation and coupling analysis: applied cardiovascular physics in sleep medicine. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2013:6567-70. [PMID: 24111247 DOI: 10.1109/embc.2013.6611060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sleep is a physiological process with an internal program of a number of well defined sleep stages and intermediate wakefulness periods. The sleep stages modulate the autonomous nervous system and thereby the sleep stages are accompanied by different regulation regimes for the cardiovascular and respiratory system. The differences in regulation can be distinguished by new techniques of cardiovascular physics. The number of patients suffering from sleep disorders increases unproportionally with the increase of the human population and aging, leading to very high expenses in the public health system. Therefore, the challenge of cardiovascular physics is to develop highly-sophisticated methods which are able to, on the one hand, supplement and replace expensive medical devices and, on the other hand, improve the medical diagnostics with decreasing the patient's risk. Methods of cardiovascular physics are used to analyze heart rate, blood pressure and respiration to detect changes of the autonomous nervous system in different diseases. Data driven modeling analysis, synchronization and coupling analysis and their applications to biosignals in healthy subjects and patients with different sleep disorders are presented. Newly derived methods of cardiovascular physics can help to find indicators for these health risks.
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Cysarz D, Porta A, Montano N, Van Leeuwen P, Kurths J, Wessel N. Different approaches of symbolic dynamics to quantify heart rate complexity. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2013:5041-4. [PMID: 24110868 DOI: 10.1109/embc.2013.6610681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The analysis of symbolic dynamics applied to physiological time series is able to retrieve information about dynamical properties of the underlying system that cannot be gained with standard methods like e.g. spectral analysis. Different approaches for the transformation of the original time series to the symbolic time series have been proposed. Yet the differences between the approaches are unknown. In this study three different transformation methods are investigated: (1) symbolization according to the deviation from the average time series, (2) symbolization according to several equidistant levels between the minimum and maximum of the time series, (3) binary symbolization of the first derivative of the time series. Each method was applied to the cardiac interbeat interval series RR(i) and its difference ΔRR(I) of 17 healthy subjects obtained during head-up tilt testing. The symbolic dynamics of each method is analyzed by means of the occurrence of short sequences ('words') of length 3. The occurrence of words is grouped according to words without variations of the symbols (0V%), words with one variation (1V%), two like variations (2LV%) and two unlike variations (2UV%). Linear regression analysis showed that for method 1 0V%, 1V%, 2LV% and 2UV% changed with increasing tilt angle. For method 2 0V%, 2LV% and 2UV% changed with increasing tilt angle and method 3 showed changes for 0V% and 1V%. In conclusion, all methods are capable of reflecting changes of the cardiac autonomic nervous system during head-up tilt. All methods show that even the analysis of very short symbolic sequences is capable of tracking changes of the cardiac autonomic regulation during head-up tilt testing.
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Runge J, Riedl M, Müller A, Stepan H, Kurths J, Wessel N. Quantifying the causal strength of multivariate cardiovascular couplings with momentary information transfer. Physiol Meas 2015; 36:813-25. [PMID: 25799083 DOI: 10.1088/0967-3334/36/4/813] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This article studies a recently introduced information-theoretic approach to detect and quantify the causal couplings in a complex cardiovascular system. In the first step a causal algorithm detects the coupling delays and in the second step the causal strength of each coupling mechanism is quantified using the recently introduced momentary information transfer. As an example, the method is applied to time series of respiration, systolic and diastolic blood pressure, and heart rate of pregnant healthy women and women suffering from pre-eclampsia. A possible explanation for the influence of heart rate on systolic blood pressure is found and some differences between healthy women and patients are discussed.
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Affiliation(s)
- Jakob Runge
- Department of Physics, Humbolt University Berlin, Berlin, Germany. Potsdam Institute for Climate Impact Research, Potsdam, Germany
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Porta A, Baumert M, Cysarz D, Wessel N. Enhancing dynamical signatures of complex systems through symbolic computation. Philos Trans A Math Phys Eng Sci 2015; 373:rsta.2014.0099. [PMID: 25548265 PMCID: PMC4281870 DOI: 10.1098/rsta.2014.0099] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, University of Adelaide, Adelaide, South Australia, Australia
| | - Dirk Cysarz
- Integrated Curriculum for Anthroposophic Medicine, University of Witten/Herdecke, Witten, Germany Institute of Integrative Medicine, University of Witten/Herdecke, Witten, Germany
| | - Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
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Schlemmer A, Parlitz U, Luther S, Wessel N, Penzel T. Changes of sleep-stage transitions due to ageing and sleep disorder. Philos Trans A Math Phys Eng Sci 2015; 373:rsta.2014.0093. [PMID: 25548271 DOI: 10.1098/rsta.2014.0093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Transition patterns between different sleep stages are analysed in terms of probability distributions of symbolic sequences for young and old subjects with and without sleep disorder. Changes of these patterns due to ageing are compared with variations of transition probabilities due to sleep disorder.
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Affiliation(s)
- A Schlemmer
- Max Planck Institute for Dynamics and Self-Organization, Am Faßberg 17, Göttingen 37077, Germany Institute for Nonlinear Dynamics, Georg-August-Universität Göttingen, Am Faßberg 17, Göttingen 37077, Germany
| | - U Parlitz
- Max Planck Institute for Dynamics and Self-Organization, Am Faßberg 17, Göttingen 37077, Germany Institute for Nonlinear Dynamics, Georg-August-Universität Göttingen, Am Faßberg 17, Göttingen 37077, Germany
| | - S Luther
- Max Planck Institute for Dynamics and Self-Organization, Am Faßberg 17, Göttingen 37077, Germany Institute for Nonlinear Dynamics, Georg-August-Universität Göttingen, Am Faßberg 17, Göttingen 37077, Germany
| | - N Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Robert-Koch-Platz 4, Berlin 10115, Germany
| | - T Penzel
- Department of Physics, Humboldt-Universität zu Berlin, Robert-Koch-Platz 4, Berlin 10115, Germany Sleep Medicine Center, Charité Universitätsmedizin Berlin, Chariteplatz 1, Berlin 10117, Germany
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Abstract
In the present study, we aimed at investigating a heart rate variability (HRV) biomarker that could be associated with the severity of the apnea-hypopnea index (AHI), which could be used for an early diagnosis of obstructive sleep apnea (OSA). This was a cross-sectional observational study on 47 patients (age 36 ± 9.2 standard deviation) diagnosed with mild (23.4%), moderate (34%), or severe (42.6%) OSA. HRV was studied by linear measures of fast Fourier transform, nonlinear Poincaré analysis, and detrended fluctuation analysis (DFA)—DFA α1 characterizes short-term fluctuations, DFA α2 characterizes long-term fluctuations. Associations between polysomnography indexes (AHI, arousal index [AI], and oxygen desaturation index [ODI]) and HRV indexes were studied. Patients with different grades of AHI had similar sympathovagal balance levels as indicated by the frequency-domain and Poincaré HRV indexes. The DFA α2 index was significantly positive correlated with AHI, AI, and ODI (Pearson r: 0.55, 0.59, and 0.59, respectively, with P < 0.0001). The ROC analysis revealed that DFA α2 index predicted moderate and severe OSA with a sensitivity/specificity/area under the curve of 0.86/0.64/0.8 (P = 0.005) and 0.6/0.89/0.76 (P = 0.003), respectively. Our data indicate that the DFA α2 index may be used as a reliable index for the detection of OSA severity.
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Affiliation(s)
- Eduardo Luiz Pereira da Silva
- From the Center of Innovation, Technology, and Education-CITE (ELPS, VLP, LAC, OCB), Camilo Castelo Branco University (UNICASTELO), Sao Jose dos Campos Technology Park, Sao Jose dos Campos; University Iguaçu Campus-V (ELPS), Itaperuna, Rio de Janeiro; Department of Biological Sciences (RP), State University of Southwest Bahia-UESB, Jequie, Bahia; Sleep Institute of Itaperuna (LNR), Rio de Janeiro, Brazil; and Humboldt-Universität zu Berlin (NW), Berlin, Germany
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Andreotti F, Riedl M, Himmelsbach T, Wedekind D, Wessel N, Stepan H, Schmieder C, Jank A, Malberg H, Zaunseder S. Robust fetal ECG extraction and detection from abdominal leads. Physiol Meas 2014; 35:1551-67. [DOI: 10.1088/0967-3334/35/8/1551] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ravelo-García AG, Saavedra-Santana P, Juliá-Serdá G, Navarro-Mesa JL, Navarro-Esteva J, Álvarez-López X, Gapelyuk A, Penzel T, Wessel N. Symbolic dynamics marker of heart rate variability combined with clinical variables enhance obstructive sleep apnea screening. Chaos 2014; 24:024404. [PMID: 24985458 DOI: 10.1063/1.4869825] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Many sleep centres try to perform a reduced portable test in order to decrease the number of overnight polysomnographies that are expensive, time-consuming, and disturbing. With some limitations, heart rate variability (HRV) has been useful in this task. The aim of this investigation was to evaluate if inclusion of symbolic dynamics variables to a logistic regression model integrating clinical and physical variables, can improve the detection of subjects for further polysomnographies. To our knowledge, this is the first contribution that innovates in that strategy. A group of 133 patients has been referred to the sleep center for suspected sleep apnea. Clinical assessment of the patients consisted of a sleep related questionnaire and a physical examination. The clinical variables related to apnea and selected in the statistical model were age (p < 10(-3)), neck circumference (p < 10(-3)), score on a questionnaire scale intended to quantify daytime sleepiness (p < 10(-3)), and intensity of snoring (p < 10(-3)). The validation of this model demonstrated an increase in classification performance when a variable based on non-linear dynamics of HRV (p < 0.01) was used additionally to the other variables. For diagnostic rule based only on clinical and physical variables, the corresponding area under the receiver operating characteristic (ROC) curve was 0.907 (95% confidence interval (CI) = 0.848, 0.967), (sensitivity 87.10% and specificity 80%). For the model including the average of a symbolic dynamic variable, the area under the ROC curve was increased to 0.941 (95% = 0.897, 0.985), (sensitivity 88.71% and specificity 82.86%). In conclusion, symbolic dynamics, coupled with significant clinical and physical variables can help to prioritize polysomnographies in patients with a high probability of apnea. In addition, the processing of the HRV is a well established low cost and robust technique.
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Affiliation(s)
- A G Ravelo-García
- Institute for Technological Development and Innovation in Communications (IDeTIC), Universidad de Las Palmas de Gran Canaria, Las Palmas de G.C. 35017, Spain
| | - P Saavedra-Santana
- Department of Mathematics. Universidad de Las Palmas de Gran Canaria, Las Palmas de G.C. 35017, Spain
| | - G Juliá-Serdá
- Pulmonary Medicine Department. Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de G.C. 35010, Spain
| | - J L Navarro-Mesa
- Institute for Technological Development and Innovation in Communications (IDeTIC), Universidad de Las Palmas de Gran Canaria, Las Palmas de G.C. 35017, Spain
| | - J Navarro-Esteva
- Pulmonary Medicine Department. Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de G.C. 35010, Spain
| | - X Álvarez-López
- Pulmonary Medicine Department. Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de G.C. 35010, Spain
| | - A Gapelyuk
- Department of Physics, Humboldt-Universität zu Berlin, Berlin 10115, Germany
| | - T Penzel
- Sleep Center, Charité Universitätsmedizin, Berlin 10117, Germany
| | - N Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin 10115, Germany
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Fischer R, Konkel A, Mehling H, Blossey K, Gapelyuk A, Wessel N, von Schacky C, Dechend R, Muller DN, Rothe M, Luft FC, Weylandt K, Schunck WH. Dietary omega-3 fatty acids modulate the eicosanoid profile in man primarily via the CYP-epoxygenase pathway. J Lipid Res 2014; 55:1150-64. [PMID: 24634501 DOI: 10.1194/jlr.m047357] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Indexed: 12/20/2022] Open
Abstract
Cytochrome P450 (CYP)-dependent metabolites of arachidonic acid (AA) contribute to the regulation of cardiovascular function. CYP enzymes also accept EPA and DHA to yield more potent vasodilatory and potentially anti-arrhythmic metabolites, suggesting that the endogenous CYP-eicosanoid profile can be favorably shifted by dietary omega-3 fatty acids. To test this hypothesis, 20 healthy volunteers were treated with an EPA/DHA supplement and analyzed for concomitant changes in the circulatory and urinary levels of AA-, EPA-, and DHA-derived metabolites produced by the cyclooxygenase-, lipoxygenase (LOX)-, and CYP-dependent pathways. Raising the Omega-3 Index from about four to eight primarily resulted in a large increase of EPA-derived CYP-dependent epoxy-metabolites followed by increases of EPA- and DHA-derived LOX-dependent monohydroxy-metabolites including the precursors of the resolvin E and D families; resolvins themselves were not detected. The metabolite/precursor fatty acid ratios indicated that CYP epoxygenases metabolized EPA with an 8.6-fold higher efficiency and DHA with a 2.2-fold higher efficiency than AA. Effects on leukotriene, prostaglandin E, prostacyclin, and thromboxane formation remained rather weak. We propose that CYP-dependent epoxy-metabolites of EPA and DHA may function as mediators of the vasodilatory and cardioprotective effects of omega-3 fatty acids and could serve as biomarkers in clinical studies investigating the cardiovascular effects of EPA/DHA supplementation.
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Affiliation(s)
- Robert Fischer
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany Experimental and Clinical Research Center (ECRC), Berlin, Germany
| | - Anne Konkel
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Heidrun Mehling
- Experimental and Clinical Research Center (ECRC), Berlin, Germany
| | - Katrin Blossey
- Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | | | | | | | - Ralf Dechend
- Experimental and Clinical Research Center (ECRC), Berlin, Germany HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Dominik N Muller
- Experimental and Clinical Research Center (ECRC), Berlin, Germany
| | | | - Friedrich C Luft
- Experimental and Clinical Research Center (ECRC), Berlin, Germany
| | - Karsten Weylandt
- Experimental and Clinical Research Center (ECRC), Berlin, Germany
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Walther T, Voss A, Baumert M, Truebner S, Till H, Stepan H, Wessel N, Faber R. Cardiovascular variability before and after delivery: recovery from arterial stiffness in women with preeclampsia 4 days post partum. Hypertens Pregnancy 2013; 33:1-14. [PMID: 24328785 DOI: 10.3109/10641955.2013.821481] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We studied the short-term response of autonomic control to delivery in normal pregnancies and pregnancies with preeclampsia (PE). METHODS Fourteen healthy pregnant women and 13 women with PE were monitored within four days before and four days after delivery and compared to values of 14 non-pregnant women as controls using high-resolution electrocardiogram and noninvasive continuous blood pressure monitoring. RESULTS In PE, blood pressure remained elevated four days postpartum, but markers for arterial stiffness normalized. In contrast, none of heart rate variability and baroreflex sensitivity parameters, altered due to either pregnancy or disease, were normalized 96 h after delivery. CONCLUSION Four days after delivery, the maternal cardiovascular system is still strongly affected by pregnancy independent of the health status.
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Affiliation(s)
- Thomas Walther
- Department of Pharmacology and Therapeutics, University College Cork , Cork , Ireland
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Müller A, Riedl M, Penzel T, Bonnemeier H, Kurths J, Wessel N. Coupling analysis of transient cardiovascular dynamics. ACTA ACUST UNITED AC 2013; 58:131-9. [PMID: 23446924 DOI: 10.1515/bmt-2012-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 01/28/2013] [Indexed: 11/15/2022]
Abstract
The analysis of effects from coupling in and between systems is important in data-driven investigations as practiced in many scientific fields. It allows deeper insights into the mechanisms of interaction emerging among individual smaller systems when forming complex systems as in the human circulatory system. For systems featuring various regimes, usually only the epochs before and after a transition between different regimes are analyzed, although relevant information might be hidden within these transitions. Transient behavior of cardiovascular variables may emerge, on the one hand, from the recovery of the system after a severe disturbance or, on the other hand, from adaptive behavior throughout changes of states. It contains important information about the processes involved and the relations between state variables such as heart rate, blood pressure, and respiration. Therefore, we apply an ensemble approach to extend the method of symbolic coupling traces to time-variant coupling analysis. These new ensemble symbolic coupling traces are capable of determining coupling direction, strength, and time offset τ from transient dynamics in multivariate cardiovascular data. We use this method to analyze data recorded during an orthostatic test to reveal a transient structure that cannot be detected by classic methods.
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Affiliation(s)
- Andreas Müller
- Cardiovascular Physics, Department of Physics, Humboldt-Universit a t zu Berlin, Robert-Koch-Platz 4, 10115 Berlin, Germany.
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Ramírez Ávila GM, Gapelyuk A, Marwan N, Stepan H, Kurths J, Walther T, Wessel N. Classifying healthy women and preeclamptic patients from cardiovascular data using recurrence and complex network methods. Auton Neurosci 2013; 178:103-10. [PMID: 23727132 DOI: 10.1016/j.autneu.2013.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 04/24/2013] [Accepted: 05/02/2013] [Indexed: 11/17/2022]
Affiliation(s)
- G M Ramírez Ávila
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany; Potsdam Institute for Climate Impact Research, Potsdam, Germany; Instituto de Investigaciones Físicas, Universidad Mayor de San Andrés, La Paz, Bolivia
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Marwan N, Zou Y, Wessel N, Riedl M, Kurths J. Estimating coupling directions in the cardiorespiratory system using recurrence properties. Philos Trans A Math Phys Eng Sci 2013; 371:20110624. [PMID: 23858487 DOI: 10.1098/rsta.2011.0624] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The asymmetry of coupling between complex systems can be studied by conditional probabilities of recurrence, which can be estimated by joint recurrence plots. This approach is applied for the first time on experimental data: time series of the human cardiorespiratory system in order to investigate the couplings between heart rate, mean arterial blood pressure and respiration. We find that the respiratory system couples towards the heart rate, and the heart rate towards the mean arterial blood pressure. However, our analysis could not detect a clear coupling direction between the mean arterial blood pressure and respiration.
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Affiliation(s)
- Norbert Marwan
- Potsdam Institute for Climate Impact Research, 14412 Potsdam, Germany.
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Ramírez Ávila GM, Gapelyuk A, Marwan N, Walther T, Stepan H, Kurths J, Wessel N. Classification of cardiovascular time series based on different coupling structures using recurrence networks analysis. Philos Trans A Math Phys Eng Sci 2013; 371:20110623. [PMID: 23858486 DOI: 10.1098/rsta.2011.0623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We analyse cardiovascular time series with the aim of performing early prediction of preeclampsia (PE), a pregnancy-specific disorder causing maternal and foetal morbidity and mortality. The analysis is made using a novel approach, namely the ε-recurrence networks applied to a phase space constructed by means of the time series of the variabilities of the heart rate and the blood pressure (systolic and diastolic). All the possible coupling structures among these variables are considered for the analysis. Network measures such as average path length, mean coreness, global clustering coefficient and scale-local transitivity dimension are computed and constitute the parameters for the subsequent quadratic discriminant analysis. This allows us to predict PE with a sensitivity of 91.7 per cent and a specificity of 68.1 per cent, thus validating the use of this method for classifying healthy and preeclamptic patients.
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Alvarez D, Hornero R, Marcos JV, Wessel N, Penzel T, Glos M, Del Campo F. Assessment of feature selection and classification approaches to enhance information from overnight oximetry in the context of apnea diagnosis. Int J Neural Syst 2013; 23:1350020. [PMID: 23924411 DOI: 10.1142/s0129065713500202] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study is aimed at assessing the usefulness of different feature selection and classification methodologies in the context of sleep apnea hypopnea syndrome (SAHS) detection. Feature extraction, selection and classification stages were applied to analyze blood oxygen saturation (SaO2) recordings in order to simplify polysomnography (PSG), the gold standard diagnostic methodology for SAHS. Statistical, spectral and nonlinear measures were computed to compose the initial feature set. Principal component analysis (PCA), forward stepwise feature selection (FSFS) and genetic algorithms (GAs) were applied to select feature subsets. Fisher's linear discriminant (FLD), logistic regression (LR) and support vector machines (SVMs) were applied in the classification stage. Optimum classification algorithms from each combination of these feature selection and classification approaches were prospectively validated on datasets from two independent sleep units. FSFS + LR achieved the highest diagnostic performance using a small feature subset (4 features), reaching 83.2% accuracy in the validation set and 88.7% accuracy in the test set. Similarly, GAs + SVM also achieved high generalization capability using a small number of input features (7 features), with 84.2% accuracy on the validation set and 84.5% accuracy in the test set. Our results suggest that reduced subsets of complementary features (25% to 50% of total features) and classifiers with high generalization ability could provide high-performance screening tools in the context of SAHS.
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Affiliation(s)
- Daniel Alvarez
- Biomedical Engineering Group (GIB), University of Valladolid, Paseo Belén 15, 47011, Valladolid, Spain.
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Camargo S, Riedl M, Anteneodo C, Kurths J, Wessel N. Diminished heart beat non-stationarities in congestive heart failure. Front Physiol 2013; 4:107. [PMID: 23720631 PMCID: PMC3654225 DOI: 10.3389/fphys.2013.00107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/26/2013] [Indexed: 11/13/2022] Open
Abstract
Studies on heart rate variability (HRV) have become popular and the possibility of diagnosis based on non-invasive techniques compels us to overcome the difficulties originated on the environmental changes that can affect the signal. We perform a non-parametric segmentation which consists of locating the points where the signal can be split into stationary segments. By finding stationary segments we are able to analyze the size of these segments and evaluate how the signal changes from one segment to another, looking at the statistical moments given in each patch, for example, mean and variance. We analyze HRV data for 15 patients with congestive heart failure (CHF; 11 males, 4 females, age 56±11 years), 18 elderly healthy subjects (EH; 11 males, 7 females, age 50±7 years), and 15 young healthy subjects (YH; 11 females, 4 males, age 31±6 years). Our results confirm higher variance for YH, and EH, while CHF displays diminished variance with p-values <0.01, when compared to the healthy groups, presenting higher HRV in healthy subjects. Moreover, it is possible to distinguish between YH and EH with p < 0.05 through the segmentation outcomes. We found high correlations between the results of segmentation and standard measures of HRV analysis and a connection to results of detrended fluctuation analysis (DFA). The segmentation applied to HRV studies detects aging and pathological conditions effects on the non-stationary behavior of the analyzed groups, promising to contribute in complexity analysis and providing risk stratification measures.
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Affiliation(s)
- Sabrina Camargo
- Department of Physics, Humboldt-Universität zu Berlin Berlin, Germany ; Department of Physics, PUC-Rio Rio de Janeiro, Brazil
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Kraemer JF, Bönke A, Wessel N. Steps towards evaluating cardio-respiratory synchronicity in protective ventilation. J Crit Care 2013. [DOI: 10.1016/j.jcrc.2012.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Mueller A, Riedl M, Penzel T, Kurths J, Wessel N. Steps to a coupling analysis of transient cardiovascular dynamics. J Crit Care 2013. [DOI: 10.1016/j.jcrc.2012.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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