Characterization of sleep stages by correlations in the magnitude and sign of heartbeat increments

Future of Sleep Medicine: Novel Insights on Sleep Regulation from Network Physiology (Part II)

The authors review recent progress in understanding fundamental aspects of physiologic regulation during wake and sleep based on modern data-driven, analytic, and computational approaches with focus on the complex dynamics of physiologic systems interactions, their coexisting and transient forms of coupling, and the role of network integration among physiologic systems in generating states and functions at the organism level. They underscore the importance of novel network-based integrative approaches and the network physiology framework to investigate the structure and dynamics of physiologic networks and to quantify emergent global states and behaviors in health and disease.

Future of Sleep Medicine: Novel Approaches and Measures Derived from Physiologic Systems Dynamics (Part I)

We review recent progress in understanding fundamental aspects of physiologic regulation during wake and sleep based on modern data-driven, analytical, and computational approaches with a focus on the complex dynamics of individual physiologic systems. The presented empirical findings indicate that sleep-wake and circadian cycles do not simply modulate basic physiologic functions but influence physiologic systems dynamics simultaneously over a broad range of time scales. The reviewed empirical approaches and derived measures represent novel mechanistic aspects of sleep and wake regulation, and lay the foundation for a new class of diagnostic and prognostic biomarkers in clinical sleep medicine.

Roles of eyestalk in salinity acclimatization of mud crab (Scylla paramamosain) by transcriptomic analysis

Salinity acclimatization refers to the physiological and behavioral adjustments made by crustaceans to adapt to varying salinity environments. The eyestalk, a neuroendocrine organ in crustaceans, plays a crucial role in salinity acclimatization. To elucidate the molecular mechanisms underlying eyestalk involvement in mud crab (Scylla paramamosain) acclimatization, we employed RNA-seq technology to analyze transcriptomic changes in the eyestalk under low (5 ppt) and standard (23 ppt) salinity conditions. This analysis revealed 5431 differentially expressed genes (DEGs), with 2372 upregulated and 3059 downregulated. Notably, these DEGs were enriched in crucial biological pathways like metabolism, osmoregulation, and signal transduction. To validate the RNA-seq data, we further analyzed 15 DEGs of interest using qRT-PCR. Our results suggest a multifaceted role for the eyestalk: maintaining energy homeostasis, regulating hormone synthesis and release, PKA activity, and downstream signaling, and ensuring proper ion and osmotic balance. Furthermore, our findings indicate that the crustacean hyperglycemic hormone (CHH) may function as a key regulator, modulating carbonic anhydrase expression through the activation of the PKA signaling pathway, thereby influencing cellular osmoregulation, and associated metabolic processes. Overall, our study provides valuable insights into unraveling the molecular mechanisms of mud crab acclimatization to low salinity environments.

Automatic sleep-stage classification of heart rate and actigraphy data using deep and transfer learning approaches

Manual sleep-stage scoring based on full-night polysomnography data recorded in a sleep lab has been the gold standard of clinical sleep medicine. This costly and time-consuming approach is unfit for long-term studies as well as assessment of sleep on a population level. With the vast amount of physiological data becoming available from wrist-worn devices, deep learning techniques provide an opportunity for fast and reliable automatic sleep-stage classification tasks. However, training a deep neural network requires large annotated sleep databases, which are not available for long-term epidemiological studies. In this paper, we introduce an end-to-end temporal convolutional neural network able to automatically score sleep stages from raw heartbeat RR interval (RRI) and wrist actigraphy data. Moreover, a transfer learning approach enables the training of the network on a large public database (Sleep Heart Health Study, SHHS) and its subsequent application to a much smaller database recorded by a wristband device. The transfer learning significantly shortens training time and improves sleep-scoring accuracy from 68.9% to 73.8% and inter-rater reliability (Cohen's kappa) from 0.51 to 0.59. We also found that for the SHHS database, automatic sleep-scoring accuracy using deep learning shows a logarithmic relationship with the training size. Although deep learning approaches for automatic sleep scoring are not yet comparable to the inter-rater reliability among sleep technicians, performance is expected to significantly improve in the near future when more large public databases become available. We anticipate those deep learning techniques, when combined with our transfer learning approach, will leverage automatic sleep scoring of physiological data from wearable devices and enable the investigation of sleep in large cohort studies.

Network Physiology of Exercise: Beyond Molecular and Omics Perspectives

Molecular Exercise Physiology and Omics approaches represent an important step toward synthesis and integration, the original essence of Physiology. Despite the significant progress they have introduced in Exercise Physiology (EP), some of their theoretical and methodological assumptions are still limiting the understanding of the complexity of sport-related phenomena. Based on general principles of biological evolution and supported by complex network science, this paper aims to contrast theoretical and methodological aspects of molecular and network-based approaches to EP. After explaining the main EP challenges and why sport-related phenomena cannot be understood if reduced to the molecular level, the paper proposes some methodological research advances related to the type of studied variables and measures, the data acquisition techniques, the type of data analysis and the assumed relations among physiological levels. Inspired by Network Physiology, Network Physiology of Exercise provides a new paradigm and formalism to quantify cross-communication among diverse systems across levels and time scales to improve our understanding of exercise-related phenomena and opens new horizons for exercise testing in health and disease.

Ensemble of coupling forms and networks among brain rhythms as function of states and cognition

The current paradigm in brain research focuses on individual brain rhythms, their spatiotemporal organization, and specific pairwise interactions in association with physiological states, cognitive functions, and pathological conditions. Here we propose a conceptually different approach to understanding physiologic function as emerging behavior from communications among distinct brain rhythms. We hypothesize that all brain rhythms coordinate as a network to generate states and facilitate functions. We analyze healthy subjects during rest, exercise, and cognitive tasks and show that synchronous modulation in the micro-architecture of brain rhythms mediates their cross-communications. We discover that brain rhythms interact through an ensemble of coupling forms, universally observed across cortical areas, uniquely defining each physiological state. We demonstrate that a dynamic network regulates the collective behavior of brain rhythms and that network topology and links strength hierarchically reorganize with transitions across states, indicating that brain-rhythm interactions play an essential role in generating physiological states and cognition.

Synchronization of the Processes of Autonomic Control of Blood Circulation in Humans Is Different in the Awake State and in Sleep Stages

The influence of higher nervous activity on the processes of autonomic control of the cardiovascular system and baroreflex regulation is of considerable interest, both for understanding the fundamental laws of the functioning of the human body and for developing methods for diagnostics and treatment of pathologies. The complexity of the analyzed systems limits the possibilities of research in this area and requires the development of new tools. Earlier we propose a method for studying the collective dynamics of the processes of autonomic control of blood circulation in the awake state and in different stages of sleep. The method is based on estimating a quantitative measure representing the total percentage of phase synchronization between the low-frequency oscillations in heart rate and blood pressure. Analysis of electrocardiogram and invasive blood pressure signals in apnea patients in the awake state and in different sleep stages showed a high sensitivity of the proposed measure. It is shown that in slow-wave sleep the degree of synchronization of the studied rhythms is higher than in the awake state and lower than in sleep with rapid eye movement. The results reflect the modulation of the processes of autonomic control of blood circulation by higher nervous activity and can be used for the quantitative assessment of this modulation.

Directional couplings between the respiration and parasympathetic control of the heart rate during sleep and wakefulness in healthy subjects at different ages

Cardiorespiratory interactions are important, both for understanding the fundamental processes of functioning of the human body and for development of methods for diagnostics of various pathologies. The properties of cardiorespiratory interaction are determined by the processes of autonomic control of blood circulation, which are modulated by the higher nervous activity. We study the directional couplings between the respiration and the process of parasympathetic control of the heart rate in the awake state and different stages of sleep in 96 healthy subjects from different age groups. The detection of directional couplings is carried out using the method of phase dynamics modeling applied to experimental RR-intervals and the signal of respiration. We reveal the presence of bidirectional couplings between the studied processes in all age groups. Our results show that the coupling from respiration to the process of parasympathetic control of the heart rate is stronger than the coupling in the opposite direction. The difference in the strength of bidirectional couplings between the considered processes is most pronounced in deep sleep.

Assessment of autonomic function by long-term heart rate variability: beyond the classical framework of LF and HF measurements

In the assessment of autonomic function by heart rate variability (HRV), the framework that the power of high-frequency component or its surrogate indices reflects parasympathetic activity, while the power of low-frequency component or LF/HF reflects sympathetic activity has been used as the theoretical basis for the interpretation of HRV. Although this classical framework has contributed greatly to the widespread use of HRV for the assessment of autonomic function, it was obtained from studies of short-term HRV (typically 5‑10 min) under tightly controlled conditions. If it is applied to long-term HRV (typically 24 h) under free-running conditions in daily life, erroneous conclusions could be drawn. Also, long-term HRV could contain untapped useful information that is not revealed in the classical framework. In this review, we discuss the limitations of the classical framework and present studies that extracted autonomic function indicators and other useful biomedical information from long-term HRV using novel approaches beyond the classical framework. Those methods include non-Gaussianity index, HRV sleep index, heart rate turbulence, and the frequency and amplitude of cyclic variation of heart rate.

Benchmarking Transfer Entropy Methods for the Study of Linear and Nonlinear Cardio-Respiratory Interactions

Transfer entropy (TE) has been used to identify and quantify interactions between physiological systems. Different methods exist to estimate TE, but there is no consensus about which one performs best in specific applications. In this study, five methods (linear, k-nearest neighbors, fixed-binning with ranking, kernel density estimation and adaptive partitioning) were compared. The comparison was made on three simulation models (linear, nonlinear and linear + nonlinear dynamics). From the simulations, it was found that the best method to quantify the different interactions was adaptive partitioning. This method was then applied on data from a polysomnography study, specifically on the ECG and the respiratory signals (nasal airflow and respiratory effort around the thorax). The hypothesis that the linear and nonlinear components of cardio-respiratory interactions during light and deep sleep change with the sleep stage, was tested. Significant differences, after performing surrogate analysis, indicate an increased TE during deep sleep. However, these differences were found to be dependent on the type of respiratory signal and sampling frequency. These results highlight the importance of selecting the appropriate signals, estimation method and surrogate analysis for the study of linear and nonlinear cardio-respiratory interactions.

Simulating Dynamics of Circulation in the Awake State and Different Stages of Sleep Using Non-autonomous Mathematical Model With Time Delay

We propose a mathematical model of the human cardiovascular system. The model allows one to simulate the main heart rate, its variability under the influence of the autonomic nervous system, breathing process, and oscillations of blood pressure. For the first time, the model takes into account the activity of the cerebral cortex structures that modulate the autonomic control loops of blood circulation in the awake state and in various stages of sleep. The adequacy of the model is demonstrated by comparing its time series with experimental records of healthy subjects in the SIESTA database. The proposed model can become a useful tool for studying the characteristics of the cardiovascular system dynamics during sleep.

Network Physiology of Exercise: Vision and Perspectives

The basic theoretical assumptions of Exercise Physiology and its research directions, strongly influenced by reductionism, may hamper the full potential of basic science investigations, and various practical applications to sports performance and exercise as medicine. The aim of this perspective and programmatic article is to: (i) revise the current paradigm of Exercise Physiology and related research on the basis of principles and empirical findings in the new emerging field of Network Physiology and Complex Systems Science; (ii) initiate a new area in Exercise and Sport Science, Network Physiology of Exercise (NPE), with focus on basic laws of interactions and principles of coordination and integration among diverse physiological systems across spatio-temporal scales (from the sub-cellular level to the entire organism), to understand how physiological states and functions emerge, and to improve the efficacy of exercise in health and sport performance; and (iii) to create a forum for developing new research methodologies applicable to the new NPE field, to infer and quantify nonlinear dynamic forms of coupling among diverse systems and establish basic principles of coordination and network organization of physiological systems. Here, we present a programmatic approach for future research directions and potential practical applications. By focusing on research efforts to improve the knowledge about nested dynamics of vertical network interactions, and particularly, the horizontal integration of key organ systems during exercise, NPE may enrich Basic Physiology and diverse fields like Exercise and Sports Physiology, Sports Medicine, Sports Rehabilitation, Sport Science or Training Science and improve the understanding of diverse exercise-related phenomena such as sports performance, fatigue, overtraining, or sport injuries.

Entropy Analysis of RR-Time Series From Stress Tests

The RR-interval time series or tachograms obtained from electrocardiograms have been widely studied since they reflect the cardiac variability, and this is an indicative of the health status of a person. The tachogram can be seen as a highly non-linear and complex time series, and therefore, should be analyzed with non-linear techniques. In this work, several entropy measures, Sample Entropy (SampEn), Approximate Entropy (ApEn), and Fuzzy Entropy (FuzzyEn) are used as a measure of heart rate variability (HRV). Tachograms belonging to thirty-nine subjects were obtained from a cardiac stress test consisting of a rest period followed by a period of moderate physical activity. Subjects are grouped according to their physical activity using the IPAQ sedentary and active questionnaire, we work with youth and middle-aged adults. The entropy measures for each group show that for the sedentary subjects the values are high at rest and decrease appreciably with moderate physical activity, This happens for both young and middle-aged adults. These results are highly reproducible. In the case of the subjects that exercise regularly, an increase in entropy is observed or they tend to retain the entropy value that they had at rest. It seems that there is a possible correlation between the physical condition of a person with the increase or decrease in entropy during moderate physical activity with respect to the entropy at rest. It was also observed that entropy during longer physical activity tests tends to decrease as fatigue accumulates, but this decrease is small compared to the change that occurs when going from rest to physical activity.

Can the Detrended Fluctuation Analysis Reveal Nonlinear Components of Heart Rate Variabilityƒ

The Detrended Fluctuation Analysis (DFA) is widely employed to quantify the fractal dynamics of R-R intervals (RRI). This is usually done by estimating a short- and a long-term coefficient, but it is still unclear how much the information provided by such a bi-scale DFA is independent of that of traditional spectral indices. However, more sophisticated DFA approaches have been recently proposed, including the multifractal-multiscale DFA and the DFA for magnitude and sign of RRI changes. The aim of our work is to investigate whether novel DFA approaches allow extracting the information on the nonlinear RRI dynamics that traditional spectral methods cannot retrieve.We selected 4-hour segments of beat-by-beat RRI series from a 24-hour Holter recording, one during daytime (wake), one at night (sleep) in a healthy volunteer. From the wake segment, we generated 100 surrogate series shuffling the phases but preserving the power spectrum, and then from each of the resulting RRI series, we generated the series of the sign and the series of the magnitude of successive RRI changes. We generated similar series from the sleep recording. Thus, we finally obtained 6 original beat-to-beat series to be compared with 600 surrogate series, each of 4-hour duration.The comparison between original and surrogate series showed that for this experimental setting, the traditional monofractal DFA provides the same information retrievable by the power spectrum. However, specific components of the multifractal DFA reveal information not detectable by the power spectrum, particularly in the sleep condition. Furthermore, the DFA of the magnitude of RRI changes reflects important nonlinear components. Therefore, these more sophisticated DFA approaches might effectively improve the clinical value of RRI variability analysis.

Non-REM Sleep Marker for Wearable Monitoring: Power Concentration of Respiratory Heart Rate Fluctuation

A variety of heart rate variability (HRV) indices have been reported to estimate sleep stages, but the associations are modest and lacking solid physiological basis. Non-REM (NREM) sleep is associated with increased regularity of respiratory frequency, which results in the concentration of high frequency (HF) HRV power into a narrow frequency range. Using this physiological feature, we developed a new HRV sleep index named Hsi to quantify the degree of HF power concentration. We analyzed 11,636 consecutive 5-min segments of electrocardiographic (ECG) signal of polysomnographic data in 141 subjects and calculated Hsi and conventional HRV indices for each segment. Hsi was greater during NREM (mean [SD], 75.1 [8.3]%) than wake (61.0 [10.3]%) and REM (62.0 [8.4]%) stages. Receiver-operating characteristic curve analysis revealed that Hsi discriminated NREM from wake and REM segments with an area under the curve of 0.86, which was greater than those of heart rate (0.642), peak HF power (0.75), low-to-high frequency ratio (0.77), and scaling exponent α (0.77). With a cutoff >70%, Hsi detected NREM segments with 77% sensitivity, 80% specificity, and a Cohen’s kappa coefficient of 0.57. Hsi may provide an accurate NREM sleep maker for ECG and pulse wave signals obtained from wearable sensors.

The avalanche-like behaviour of large-scale haemodynamic activity from wakefulness to deep sleep

Increasing evidence suggests that responsiveness is associated with critical or near-critical cortical dynamics, which exhibit scale-free cascades of spatio-temporal activity. These cascades, or 'avalanches', have been detected at multiple scales, from in vitro and in vivo microcircuits to voltage imaging and brain-wide functional magnetic resonance imaging (fMRI) recordings. Criticality endows the cortex with certain information-processing capacities postulated as necessary for conscious wakefulness, yet it remains unknown how unresponsiveness impacts on the avalanche-like behaviour of large-scale human haemodynamic activity. We observed a scale-free hierarchy of co-activated connected clusters by applying a point-process transformation to fMRI data recorded during wakefulness and non-rapid eye movement (NREM) sleep. Maximum-likelihood estimates revealed a significant effect of sleep stage on the scaling parameters of the cluster size power-law distributions. Post hoc statistical tests showed that differences were maximal between wakefulness and N2 sleep. These results were robust against spatial coarse graining, fitting alternative statistical models and different point-process thresholds, and disappeared upon phase shuffling the fMRI time series. Evoked neural bistabilities preventing arousals during N2 sleep do not suffice to explain these differences, which point towards changes in the intrinsic dynamics of the brain that could be necessary to consolidate a state of deep unresponsiveness.

Decomposing the complexity of heart-rate variability by the multifractal-multiscale approach to detrended fluctuation analysis: an application to low-level spinal cord injury

OBJECTIVE

While several studies have assessed autonomic cardiovascular control after a spinal cord lesion using heart-rate variability (HRV) indices in the frequency and time domains, complexity measures have rarely been used, even if detrended fluctuation analysis (DFA) appeared promising. Recent developments in DFA decompose the multifractal contributions using temporal scales. Our aim is to evaluate the potential of these new DFA tools, considering as an example application the decomposition of HRV complexity in individuals with spinal cord injury (SCI) at a low lesion level, for whom alterations in traditional indices are not expected.

APPROACH

We enrolled 14 subjects with SCI with a lesion below the eleventh thoracic vertebra and 34 able-bodied (AB) controls. We recorded the R-R intervals (RRI) for 10 min in supine and sitting postures. We applied the multifractal-multiscale (MFMS) DFA to derive scale coefficients, α(q,τ), with function of the multifractal order q and scale τ, and evaluated a scale-coefficient dispersion index, α _SD(τ), as the standard deviation of α(q,τ) over q. We calculated the RRI increments, their magnitude and sign, estimating the MFMS DFA coefficients for the series of magnitude α _m(q,τ) and sign α _s(q,τ).

MAIN RESULTS

While sitting, differences between SCI and AB groups depended on q for coefficients 16  <  τ  <  32 s, so that α _SD(τ) was lower in individuals with SCI at τ  =  25 s. In the supine condition, short-term scales were greater in individuals with SCI for all q, and α _SD(τ) did not differ between groups. Group differences were found in α _s(q,τ) and not in α _m(q,τ) or in traditional HRV indices. The surrogate analysis showed AB-SCI differences in linear HRV components at scales τ  <  16 s and nonlinear components at larger scales.

SIGNIFICANCE

Complexity decomposition by DFA describes autonomic alterations in HRV in low-level paraplegia better than traditional indices, probably pointing out a loss of system complexity in the sitting posture and an impaired sympatho/vagal modulation in the supine position.

Coupling Between Leg Muscle Activation and EEG During Normal Walking, Intentional Stops, and Freezing of Gait in Parkinson's Disease

In this paper, we apply novel techniques for characterizing leg muscle activation patterns via electromyograms (EMGs) and for relating them to changes in electroencephalogram (EEG) activity during gait experiments. Specifically, we investigate changes of leg-muscle EMG amplitudes and EMG frequencies during walking, intentional stops, and unintended freezing-of-gait (FOG) episodes. FOG is a frequent paroxysmal gait disturbance occurring in many patients suffering from Parkinson's disease (PD). We find that EMG amplitudes and frequencies do not change significantly during FOG episodes with respect to walking, while drastic changes occur during intentional stops. Phase synchronization between EMG signals is most pronounced during walking in controls and reduced in PD patients. By analyzing cross-correlations between changes in EMG patterns and brain-wave amplitudes (from EEGs), we find an increase in EEG-EMG coupling at the beginning of stop and FOG episodes. Our results may help to better understand the enigmatic pathophysiology of FOG, to differentiate between FOG events and other gait disturbances, and ultimately to improve diagnostic procedures for patients suffering from PD.

Multifractal Spectrum Curvature of RR Tachograms of Healthy People and Patients with Congestive Heart Failure, a New Tool to Assess Health Conditions

We calculate the multifractal spectra of heartbeat RR-interval time series (tachograms) of healthy subjects and patients with congestive heart failure (CHF). From these time series, we obtained new subseries of 6 h durations when healthy persons and patients were asleep and awake respectively. For each time series and subseries, we worked out the multifractal spectra with the Chhabra and Jensen method and found that their graphs have different shapes for CHF patients and healthy persons. We suggest to measure two parameters: the curvature around the maximum and the symmetry for all these multifractal spectra graphs, because these parameters were different for healthy and CHF subjects. Multifractal spectra of healthy subjects tend to be right skewed especially when the subjects are asleep and the curvature around the maximum is small compared with the curvature around the maximum of the CHF multifractal spectra; that is, the spectra of patients tend to be more pointed around the maximum. In CHF patients, we also have encountered differences in the curvature of the multifractal spectra depending on their respective New York Heart Association (NYHA) index.

Differences in nonlinear heart dynamics during rest and exercise and for different training

OBJECTIVE

In this work we want to analyze differences in nonlinear properties between rest and exercise and also to study the permanent effects of physical exercise on heart rate dynamics.

APPROACH

It has been shown that physical exercise alters heart dynamics by increasing heart rate and decreasing variability, modifying spectral power and linear correlations, etc. We hypothesize that physical exercise should also reduce nonlinearity in the heartbeat time series. To quantify nonlinearity in the heartbeat time series, we use an index of nonlinearity recently proposed by Bernaola et al based on correlations of the magnitude time series.

MAIN RESULTS

Our results confirm our initial hypothesis of loss of nonlinearity during physical exercise. Moreover, regarding the permanent effects of physical exercise on heart rate dynamics, we also obtain that aerobic physical training tends to increase nonlinearity in heart dynamics during rest.

SIGNIFICANCE

It is well-known that heart dynamics are controlled by complex interactions between the sympathetic and parasympathetic branches of the autonomic nervous system. Moreover, these two branches act in a competing way, resulting in a clear parasympathetic withdrawal and sympathetic activation during physical exercise. We associate these interactions during physical exercise with a drastic loss of nonlinear properties in the heartbeat time series, revealing the importance of nonlinearity measures in the study of complex systems.

Assessment of ECG and respiration recordings from simulated emergency landings of ultra light aircraft

Pilots of ultra light aircraft have limited training resources, but with the use of low cost simulators it might be possible to train and test some parts of their training on the ground. The purpose of this paper is to examine possibility of stress inducement on a low cost flight simulator. Stress is assessed from electrocardiogram and respiration. Engine failure during flight served as a stress inducement stimuli. For one flight, pilots had access to an emergency navigation system. There were recorded some statistically significant changes in parameters regarding breathing frequency. Although no significant change was observed in ECG parameters, there appears to be an effect on respiration parameters. Physiological signals processed with analysis of variance suggest, that the moment of engine failure and approach for landing affected average breathing frequency. Presence of navigation interface does not appear to have a significant effect on pilots.

Transitions in physiological coupling between heartbeat and pulse across sleep stages

OBJECTIVE

The aim of this study is to investigate the coupling behavior between heartbeat and pulse of blood flow at different sleep stages, and to explore the feasibility of using this coupling strength for automatic sleep staging.

APPROACH

The electrocardiogram and photoplethysmography signals are recorded during sleep, and R-wave-to-R-wave intervals (RRI) and pulse-to-pulse intervals (PPI) are extracted respectively. The detrended cross-correlation analysis (DCCA) is applied to quantify long-range cross correlations between the RRIs and PPIs across sleep stages. The DCCA scaling exponents are used as the indicator of coupling strength between heartbeat and pulse, and are compared with detrended fluctuation analysis (DFA) scaling exponents of RRIs and PPIs in the application of sleep stage discrimination.

MAIN RESULTS

We find the DCCA scaling exponents between RRIs and PPIs decrease monotonously from wake, REM sleep to light and deep sleep, indicating that the coupling strength between heartbeat and pulse are reduced gradually when entering deep sleep. Statistical analysis shows that the DCCA scaling exponents possess better discrimination ability between wake/REM sleep and light/deep sleep, compared with DFA scaling exponents of RRIs and PPIs.

SIGNIFICANCE

Our study reveals the coupling strength between heartbeat and pulse changes regularly across sleep stages, which may help understand the regulation mechanism underlying the cardiovascular system. The DCCA scaling exponents between RRIs and PPIs can be used as an indicator for measuring vigilance level and automatic sleep staging.

Heart Rate Fragmentation: A Symbolic Dynamical Approach

Background: We recently introduced the concept of heart rate fragmentation along with a set of metrics for its quantification. The term was coined to refer to an increase in the percentage of changes in heart rate acceleration sign, a dynamical marker of a type of anomalous variability. The effort was motivated by the observation that fragmentation, which is consistent with the breakdown of the neuroautonomic-electrophysiologic control system of the sino-atrial node, could confound traditional short-term analysis of heart rate variability.

Objective: The objectives of this study were to: (1) introduce a symbolic dynamical approach to the problem of quantifying heart rate fragmentation; (2) evaluate how the distribution of the different dynamical patterns (“words”) varied with the participants' age in a group of healthy subjects and patients with coronary artery disease (CAD); and (3) quantify the differences in the fragmentation patterns between the two sample populations.

Methods: The symbolic dynamical method employed here was based on a ternary map of the increment NN interval time series and on the analysis of the relative frequency of symbolic sequences (words) with a pre-defined set of features. We analyzed annotated, open-access Holter databases of healthy subjects and patients with CAD, provided by the University of Rochester Telemetric and Holter ECG Warehouse (THEW).

Results: The degree of fragmentation was significantly higher in older individuals than in their younger counterparts. However, the fragmentation patterns were different in the two sample populations. In healthy subjects, older age was significantly associated with a higher percentage of transitions from acceleration/deceleration to zero acceleration and vice versa (termed “soft” inflection points). In patients with CAD, older age was also significantly associated with higher percentages of frank reversals in heart rate acceleration (transitions from acceleration to deceleration and vice versa, termed “hard” inflection points). Compared to healthy subjects, patients with CAD had significantly higher percentages of soft and hard inflection points, an increased percentage of words with a high degree of fragmentation and a decreased percentage of words with a lower degree of fragmentation.

Conclusion: The symbolic dynamical method employed here was useful to probe the newly recognized property of heart rate fragmentation. The findings from these cross-sectional studies confirm that CAD and older age are associated with higher levels of heart rate fragmentation. Furthermore, fragmentation with healthy aging appears to be phenotypically different from fragmentation in the context of CAD.

Optimized automatic sleep stage classification using the normalized mutual information feature selection (NMIFS) method

Sleep is a very important physiological phenomenon for recovery of physical and mental fatigue. Recently, there has been a lot of interest in the quality of sleep and the research is actively under way. In particular, it is important to have a repetitive and regular sleep cycle for good sleep. However, it takes a lot of time to determine sleep stages using physiological signals by experts. In this study, we constructed an optimized classifier based on normalized mutual information feature selection (NMIFS) and kernel based extreme learning machine (K-ELM), and total 4 sleep stages (Awake, weak sleep (stage1+stage2), deep sleep(stage3+stage4) and rapid eye movement (REM)) were automatically classified. As a results, the average of the accuracy obtained by proposed method (NMIFS+K-ELM) is 2~3% higher than that of simple method (K-ELM).

Spurious Results of Fluctuation Analysis Techniques in Magnitude and Sign Correlations

Fluctuation Analysis (FA) and specially Detrended Fluctuation Analysis (DFA) are techniques commonly used to quantify correlations and scaling properties of complex time series such as the observable outputs of great variety of dynamical systems, from Economics to Physiology. Often, such correlated time series are analyzed using the magnitude and sign decomposition, i.e., by using FA or DFA to study separately the sign and the magnitude series obtained from the original signal. This approach allows for distinguishing between systems with the same linear correlations but different dynamical properties. However, here we present analytical and numerical evidence showing that FA and DFA can lead to spurious results when applied to sign and magnitude series obtained from power-law correlated time series of fractional Gaussian noise (fGn) type. Specifically, we show that: (i) the autocorrelation functions of the sign and magnitude series obtained from fGns are always power-laws; However, (ii) when the sign series presents power-law anticorrelations, FA and DFA wrongly interpret the sign series as purely uncorrelated; Similarly, (iii) when analyzing power-law correlated magnitude (or volatility) series, FA and DFA fail to retrieve the real scaling properties, and identify the magnitude series as purely uncorrelated noise; Finally, (iv) using the relationship between FA and DFA and the autocorrelation function of the time series, we explain analytically the reason for the FA and DFA spurious results, which turns out to be an intrinsic property of both techniques when applied to sign and magnitude series.

Entropy measures, entropy estimators, and their performance in quantifying complex dynamics: Effects of artifacts, nonstationarity, and long-range correlations

Entropy measures are widely applied to quantify the complexity of dynamical systems in diverse fields. However, the practical application of entropy methods is challenging, due to the variety of entropy measures and estimators and the complexity of real-world time series, including nonstationarities and long-range correlations (LRC). We conduct a systematic study on the performance, bias, and limitations of three basic measures (entropy, conditional entropy, information storage) and three traditionally used estimators (linear, kernel, nearest neighbor). We investigate the dependence of entropy measures on estimator- and process-specific parameters, and we show the effects of three types of nonstationarities due to artifacts (trends, spikes, local variance change) in simulations of stochastic autoregressive processes. We also analyze the impact of LRC on the theoretical and estimated values of entropy measures. Finally, we apply entropy methods on heart rate variability data from subjects in different physiological states and clinical conditions. We find that entropy measures can only differentiate changes of specific types in cardiac dynamics and that appropriate preprocessing is vital for correct estimation and interpretation. Demonstrating the limitations of entropy methods and shedding light on how to mitigate bias and provide correct interpretations of results, this work can serve as a comprehensive reference for the application of entropy methods and the evaluation of existing studies.

Predictability of arousal in mouse slow wave sleep by accelerometer data

Arousals can be roughly characterized by punctual intrusions of wakefulness into sleep. In a standard perspective, using human electroencephalography (EEG) data, arousals are associated to slow-wave rhythms and K-complex brain activity. The physiological mechanisms that give rise to arousals during sleep are not yet fully understood. Moreover, subtle body movement patterns, which may characterize arousals both in human and in animals, are usually not detectable by eye perception and are not in general present in sleep studies. In this paper, we focus attention on accelerometer records (AR) to characterize and predict arousal during slow wave sleep (SWS) stage of mice. Furthermore, we recorded the local field potentials (LFP) from the CA1 region in the hippocampus and paired with accelerometer data. The hippocampus signal was also used here to identify the SWS stage. We analyzed the AR dynamics of consecutive arousals using recurrence technique and the determinism (DET) quantifier. Recurrence is a fundamental property of dynamical systems, which can be exploited to characterize time series properties. The DET index evaluates how similar are the evolution of close trajectories: in this sense, it computes how accurate are predictions based on past trajectories. For all analyzed mice in this work, we observed, for the first time, the occurrence of a universal dynamic pattern a few seconds that precedes the arousals during SWS sleep stage based only on the AR signal. The predictability success of an arousal using DET from AR is nearly 90%, while similar analysis using LFP of hippocampus brain region reveal 88% of success. Noteworthy, our findings suggest an unique dynamical behavior pattern preceding an arousal of AR data during sleep. Thus, the employment of this technique applied to AR data may provide useful information about the dynamics of neuronal activities that control sleep-waking switch during SWS sleep period. We argue that the predictability of arousals observed through DET(AR) can be functionally explained by a respiratory-driven modification of neural states. Finally, we believe that the method associating AR data with other physiologic events such as neural rhythms can become an accurate, convenient and non-invasive way of studying the physiology and physiopathology of movement and respiratory processes during sleep.

Multifractality in individual honeybee behavior hints at colony-specific social cascades: Reanalysis of radio-frequency identification data from five different colonies

Honeybees (Apis mellifera) exhibit complex coordination and interaction across multiple behaviors such as swarming. This coordination among honeybees in the same colony is remarkably similar to the concept of informational cascades. The multifractal geometry of cascades suggests that multifractal measures of individual honeybee activity might carry signatures of these colony-wide coordinations. The present work reanalyzes time stamps of entrances to and exits from the hive captured by radio-frequency identification (RFID) sensors reading RFID tags on individual bees. Indeed, both multifractal spectrum width for individual bees' inter-reading interval series and differences of those widths from surrogates significantly predicted not just whether the individual bee's hive had a mesh enclosure but also predicted the specific membership of individual bees in one of five colonies. The significant effects of multifractality in matching honeybee activity to type of colony and, further, matching individual honeybees to their exact home colony suggests that multifractality quantifies key features of the colony-wide interactions across many scales. This relevance of multifractality to predicting colony type or colony membership adds additional credence to the cascade metaphor for colony organization. Perhaps, multifractality provides a new tool for exploring the relationship between individual organisms and larger, more complex social behaviors.

Modulations of Heart Rate, ECG, and Cardio-Respiratory Coupling Observed in Polysomnography

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).

Delay-correlation landscape reveals characteristic time delays of brain rhythms and heart interactions

Within the framework of 'Network Physiology', we ask a fundamental question of how modulations in cardiac dynamics emerge from networked brain-heart interactions. We propose a generalized time-delay approach to identify and quantify dynamical interactions between physiologically relevant brain rhythms and the heart rate. We perform empirical analysis of synchronized continuous EEG and ECG recordings from 34 healthy subjects during night-time sleep. For each pair of brain rhythm and heart interaction, we construct a delay-correlation landscape (DCL) that characterizes how individual brain rhythms are coupled to the heart rate, and how modulations in brain and cardiac dynamics are coordinated in time. We uncover characteristic time delays and an ensemble of specific profiles for the probability distribution of time delays that underly brain-heart interactions. These profiles are consistently observed in all subjects, indicating a universal pattern. Tracking the evolution of DCL across different sleep stages, we find that the ensemble of time-delay profiles changes from one physiologic state to another, indicating a strong association with physiologic state and function. The reported observations provide new insights on neurophysiological regulation of cardiac dynamics, with potential for broad clinical applications. The presented approach allows one to simultaneously capture key elements of dynamic interactions, including characteristic time delays and their time evolution, and can be applied to a range of coupled dynamical systems.

Modeling heart rate variability including the effect of sleep stages

We propose a model for heart rate variability (HRV) of a healthy individual during sleep with the assumption that the heart rate variability is predominantly a random process. Autonomic nervous system activity has different properties during different sleep stages, and this affects many physiological systems including the cardiovascular system. Different properties of HRV can be observed during each particular sleep stage. We believe that taking into account the sleep architecture is crucial for modeling the human nighttime HRV. The stochastic model of HRV introduced by Kantelhardt et al. was used as the initial starting point. We studied the statistical properties of sleep in healthy adults, analyzing 30 polysomnographic recordings, which provided realistic information about sleep architecture. Next, we generated synthetic hypnograms and included them in the modeling of nighttime RR interval series. The results of standard HRV linear analysis and of nonlinear analysis (Shannon entropy, Poincaré plots, and multiscale multifractal analysis) show that-in comparison with real data-the HRV signals obtained from our model have very similar properties, in particular including the multifractal characteristics at different time scales. The model described in this paper is discussed in the context of normal sleep. However, its construction is such that it should allow to model heart rate variability in sleep disorders. This possibility is briefly discussed.

Network Physiology: How Organ Systems Dynamically Interact

We systematically study how diverse physiologic systems in the human organism dynamically interact and collectively behave to produce distinct physiologic states and functions. This is a fundamental question in the new interdisciplinary field of Network Physiology, and has not been previously explored. Introducing the novel concept of Time Delay Stability (TDS), we develop a computational approach to identify and quantify networks of physiologic interactions from long-term continuous, multi-channel physiological recordings. We also develop a physiologically-motivated visualization framework to map networks of dynamical organ interactions to graphical objects encoded with information about the coupling strength of network links quantified using the TDS measure. Applying a system-wide integrative approach, we identify distinct patterns in the network structure of organ interactions, as well as the frequency bands through which these interactions are mediated. We establish first maps representing physiologic organ network interactions and discover basic rules underlying the complex hierarchical reorganization in physiologic networks with transitions across physiologic states. Our findings demonstrate a direct association between network topology and physiologic function, and provide new insights into understanding how health and distinct physiologic states emerge from networked interactions among nonlinear multi-component complex systems. The presented here investigations are initial steps in building a first atlas of dynamic interactions among organ systems.

Plasticity of brain wave network interactions and evolution across physiologic states

Neural plasticity transcends a range of spatio-temporal scales and serves as the basis of various brain activities and physiologic functions. At the microscopic level, it enables the emergence of brain waves with complex temporal dynamics. At the macroscopic level, presence and dominance of specific brain waves is associated with important brain functions. The role of neural plasticity at different levels in generating distinct brain rhythms and how brain rhythms communicate with each other across brain areas to generate physiologic states and functions remains not understood. Here we perform an empirical exploration of neural plasticity at the level of brain wave network interactions representing dynamical communications within and between different brain areas in the frequency domain. We introduce the concept of time delay stability (TDS) to quantify coordinated bursts in the activity of brain waves, and we employ a system-wide Network Physiology integrative approach to probe the network of coordinated brain wave activations and its evolution across physiologic states. We find an association between network structure and physiologic states. We uncover a hierarchical reorganization in the brain wave networks in response to changes in physiologic state, indicating new aspects of neural plasticity at the integrated level. Globally, we find that the entire brain network undergoes a pronounced transition from low connectivity in Deep Sleep and REM to high connectivity in Light Sleep and Wake. In contrast, we find that locally, different brain areas exhibit different network dynamics of brain wave interactions to achieve differentiation in function during different sleep stages. Moreover, our analyses indicate that plasticity also emerges in frequency-specific networks, which represent interactions across brain locations mediated through a specific frequency band. Comparing frequency-specific networks within the same physiologic state we find very different degree of network connectivity and link strength, while at the same time each frequency-specific network is characterized by a different signature pattern of sleep-stage stratification, reflecting a remarkable flexibility in response to change in physiologic state. These new aspects of neural plasticity demonstrate that in addition to dominant brain waves, the network of brain wave interactions is a previously unrecognized hallmark of physiologic state and function.

Major component analysis of dynamic networks of physiologic organ interactions

The human organism is a complex network of interconnected organ systems, where the behavior of one system affects the dynamics of other systems. Identifying and quantifying dynamical networks of diverse physiologic systems under varied conditions is a challenge due to the complexity in the output dynamics of the individual systems and the transient and non-linear characteristics of their coupling. We introduce a novel computational method based on the concept of time delay stability and major component analysis to investigate how organ systems interact as a network to coordinate their functions. We analyze a large database of continuously recorded multi-channel physiologic signals from healthy young subjects during night-time sleep. We identify a network of dynamic interactions between key physiologic systems in the human organism. Further, we find that each physiologic state is characterized by a distinct network structure with different relative contribution from individual organ systems to the global network dynamics. Specifically, we observe a gradual decrease in the strength of coupling of heart and respiration to the rest of the network with transition from wake to deep sleep, and in contrast, an increased relative contribution to network dynamics from chin and leg muscle tone and eye movement, demonstrating a robust association between network topology and physiologic function.

Analysis of Gait Rhythm Fluctuations for Neurodegenerative Diseases by Phase Synchronization and Conditional Entropy

Previous studies have revealed that gait rhythm fluctuations convey important information, which is useful for understanding certain types of neurodegenerative diseases such as Amyotrophic Lateral Sclerosis (ALS), Huntington's disease (HD) and Parkinson's disease (PD). However, previous investigations only focused on the locomotor patterns of each individual foot rather than the relations between both feet. Therefore, in our study, phase synchronization (the index ρ) and conditional entropy (Hc) were applied to the five types of time series pairs of gait rhythms (stride time, swing time, stance time, % swing time and % stance time). The results revealed that compared with the patients with ALS, HD and PD, gait rhythms of normal subjects have the strongest phase synchronization property and minimum conditional entropy value. In addition, the indices ρ and Hc cannot only significantly differentiate among the four groups of subjects (ALS, HD, PD and control) but also have the ability to discriminate between any two of these subject groups. Finally, three representative classifiers were utilized in order to evaluate the possible capabilities of the indices ρ and Hc to distinguish the patients with neurodegenerative diseases from the healthy subjects, and achieved maximum area under the curve (AUC) values of 0.959, 0.928 and 0.824 for HD, PD and ALS detection, respectively. In summary, our study provides insight into the relational analysis between gait rhythms measured from both feet, and suggests that it should be considered seriously in the future studies investigating the impact of neurodegenerative disease and potential therapeutic intervention.

Different approaches of symbolic dynamics to quantify heart rate complexity

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.

Symbolic transformations of heart rate variability preserve information about cardiac autonomic control

Traditional measures of heart rate variability (HRV) in the time or frequency domain (e.g. standard deviation of normal-to-normal intervals, SDNN, or the high frequency component of spectral analysis, HF) may be used to track vagal and sympathetic modulation directed to the sinus node. In this study, we assess the ability of symbolic analysis to monitor cardiac autonomic regulation during two autonomic challenges (phenylephrine and nitroprusside; low and high dose of atropine). To assess the effect of the coarse graining procedure, symbolic series obtained from four different transformations over the original series and the series of successive differences of the original values. The analysis focused on patterns of length 3 and exploited a redundancy reduction strategy to group patterns into a small number of families. It turns out that each symbolic series created by the four transformations still contained sufficient dynamical features to quantify differences of cardiovascular changes during the pharmacological challenges. The symbolic series created by transformations of the beat-to-beat interview, i.e RR interval series, showed that patterns without variations (0V) appear more often during a high dose of atropine compared to rest or to a low dose of atropine. Furthermore, patterns with two unlike variations (2UV) appear more often during a low dose of atropine and less often during a high dose of atropine. Differences of nitroprusside and phenylephrine could also be assessed by patterns with these variations. In conclusion, the changes of cardiovascular regulation during pharmacological challenges can be assessed by the analysis of symbolic dynamics derived from the RR interval series independently of the specific symbolic transformation.

Strategies of symbolization in cardiovascular time series to test individual gestational development in the fetus

The analysis of symbolic dynamics applied to physiological time series retrieves dynamical properties of the underlying regulation which are robust against the symbolic transformation. In this study, three different transformations to produce a symbolic series were applied to fetal RR interval series to test whether they reflect individual changes of fetal heart rate variability in the course of pregnancy. Each transformation was applied to 215 heartbeat datasets obtained from 11 fetuses during the second and the third trimester of pregnancy (at least 10 datasets per fetus, median 17). In the symbolic series, the occurrence of symbolic sequences of length 3 was categorized according to the amount of variations in the sequence: no variation of the symbols, one variation, two variations. Linear regression with respect to gestational age showed that the individual course during pregnancy performed best using a binary transformation reflecting whether the RR interval differences are below or above a threshold. The median goodness of fit of the individual regression lines was 0.73 and also the variability among the individual slopes was low. Other transformations to symbolic dynamics performed worse but were still able to reflect the individual progress of fetal cardiovascular regulation.

Mouse activity across time scales: fractal scenarios

In this work we devise a classification of mouse activity patterns based on accelerometer data using Detrended Fluctuation Analysis. We use two characteristic mouse behavioural states as benchmarks in this study: waking in free activity and slow-wave sleep (SWS). In both situations we find roughly the same pattern: for short time intervals we observe high correlation in activity - a typical 1/f complex pattern - while for large time intervals there is anti-correlation. High correlation of short intervals ( to : waking state and to : SWS) is related to highly coordinated muscle activity. In the waking state we associate high correlation both to muscle activity and to mouse stereotyped movements (grooming, waking, etc.). On the other side, the observed anti-correlation over large time scales ( to : waking state and to : SWS) during SWS appears related to a feedback autonomic response. The transition from correlated regime at short scales to an anti-correlated regime at large scales during SWS is given by the respiratory cycle interval, while during the waking state this transition occurs at the time scale corresponding to the duration of the stereotyped mouse movements. Furthermore, we find that the waking state is characterized by longer time scales than SWS and by a softer transition from correlation to anti-correlation. Moreover, this soft transition in the waking state encompass a behavioural time scale window that gives rise to a multifractal pattern. We believe that the observed multifractality in mouse activity is formed by the integration of several stereotyped movements each one with a characteristic time correlation. Finally, we compare scaling properties of body acceleration fluctuation time series during sleep and wake periods for healthy mice. Interestingly, differences between sleep and wake in the scaling exponents are comparable to previous works regarding human heartbeat. Complementarily, the nature of these sleep-wake dynamics could lead to a better understanding of neuroautonomic regulation mechanisms.

A Review of Theoretical Perspectives in Cognitive Science on the Presence of 1/f Scaling in Coordinated Physiological and Cognitive Processes

Time series of human performances present fluctuations around a mean value. These fluctuations are typically considered as insignificant, and attributable to random noise. Over recent decades, it became clear that temporal fluctuations possess interesting properties, however, one of which the property of fractal 1/f scaling. 1/f scaling indicates that a measured process extends over a wide range of timescales, suggesting an assembly over multiple scales simultaneously. This paper reviews neurological, physiological, and cognitive studies that corroborate the claim that 1/f scaling is most clearly present in healthy, well-coordinated activities. Prominent hypotheses about the origins of 1/f scaling are confronted with these reviewed studies. It is concluded that 1/f scaling in living systems appears to reflect their genuine complex nature, rather than constituting a coincidental side-effect. The consequences of fractal dynamics extending from the small spatial and temporal scales (e.g., neurons) to the larger scales of human behavior and cognition, are vast, and impact the way in which relevant research questions may be approached. Rather than focusing on specialized isolable subsystems, using additive linear methodologies, nonlinear dynamics, more elegantly so, imply a complex systems methodology, thereby exploiting, rather than rejecting, mathematical concepts that enable describing large sets of natural phenomena.

Complexity analysis of sleep and alterations with insomnia based on non-invasive techniques

For the first time, fractal analysis techniques are implemented to study the correlations present in sleep actigraphy for individuals suffering from acute insomnia with comparisons made against healthy subjects. Analysis was carried out for 21 healthy individuals with no diagnosed sleep disorders and 26 subjects diagnosed with acute insomnia during night-time hours. Detrended fluctuation analysis was applied in order to look for 1/f-fluctuations indicative of high complexity. The aim is to investigate whether complexity analysis can differentiate between people who sleep normally and people who suffer from acute insomnia. We hypothesize that the complexity will be higher in subjects who suffer from acute insomnia owing to increased night-time arousals. This hypothesis, although contrary to much of the literature surrounding complexity in physiology, was found to be correct-for our study. The complexity results for nearly all of the subjects fell within a 1/f-range, indicating the presence of underlying control mechanisms. The subjects with acute insomnia displayed significantly higher correlations, confirmed by significance testing-possibly a result of too much activity in the underlying regulatory systems. Moreover, we found a linear relationship between complexity and variability, both of which increased with the onset of insomnia. Complexity analysis is very promising and could prove to be a useful non-invasive identifier for people who suffer from sleep disorders such as insomnia.

Combining hidden Markov models for comparing the dynamics of multiple sleep electroencephalograms

In this manuscript, we consider methods for the analysis of populations of electroencephalogram signals during sleep for the study of sleep disorders using hidden Markov models (HMMs). Notably, we propose an easily implemented method for simultaneously modeling multiple time series that involve large amounts of data. We apply these methods to study sleep-disordered breathing (SDB) in the Sleep Heart Health Study (SHHS), a landmark study of SDB and cardiovascular consequences. We use the entire, longitudinally collected, SHHS cohort to develop HMM population parameters, which we then apply to obtain subject-specific Markovian predictions. From these predictions, we create several indices of interest, such as transition frequencies between latent states. Our HMM analysis of electroencephalogram signals uncovers interesting findings regarding differences in brain activity during sleep between those with and without SDB. These findings include stability of the percent time spent in HMM latent states across matched diseased and non-diseased groups and differences in the rate of transitioning.

The role of the circadian system in fractal neurophysiological control

Many neurophysiological variables such as heart rate, motor activity, and neural activity are known to exhibit intrinsic fractal fluctuations - similar temporal fluctuation patterns at different time scales. These fractal patterns contain information about health, as many pathological conditions are accompanied by their alteration or absence. In physical systems, such fluctuations are characteristic of critical states on the border between randomness and order, frequently arising from nonlinear feedback interactions between mechanisms operating on multiple scales. Thus, the existence of fractal fluctuations in physiology challenges traditional conceptions of health and disease, suggesting that high levels of integrity and adaptability are marked by complex variability, not constancy, and are properties of a neurophysiological network, not individual components. Despite the subject's theoretical and clinical interest, the neurophysiological mechanisms underlying fractal regulation remain largely unknown. The recent discovery that the circadian pacemaker (suprachiasmatic nucleus) plays a crucial role in generating fractal patterns in motor activity and heart rate sheds an entirely new light on both fractal control networks and the function of this master circadian clock, and builds a bridge between the fields of circadian biology and fractal physiology. In this review, we sketch the emerging picture of the developing interdisciplinary field of fractal neurophysiology by examining the circadian system's role in fractal regulation.

Ischemic risk stratification by means of multivariate analysis of the heart rate variability

In this work, a univariate and multivariate statistical analysis of indexes derived from heart rate variability (HRV) was conducted to stratify patients with ischemic dilated cardiomyopathy (IDC) in cardiac risk groups. Indexes conditional entropy, refined multiscale entropy (RMSE), detrended fluctuation analysis, time and frequency analysis, were applied to the RR interval series (beat-to-beat series), for single and multiscale complexity analysis of the HRV in IDC patients. Also, clinical parameters were considered. Two different end-points after a follow-up of three years were considered: (i) analysis A, with 151 survivor patients as a low risk group and 13 patients that suffered sudden cardiac death as a high risk group; (ii) analysis B, with 192 survivor patients as a low risk group and 30 patients that suffered cardiac mortality as a high risk group. A univariate and multivariate linear discriminant analysis was used as a statistical technique for classifying patients in risk groups. Sensitivity (Sen) and specificity (Spe) were calculated as diagnostic criteria in order to evaluate the performance of the indexes and their linear combinations. Sen and Spe values of 80.0% and 72.9%, respectively, were obtained during daytime by combining one clinical parameter and one index from RMSE, and during nighttime Sen = 80% and Spe = 73.4% were attained by combining one clinical factor and two indexes from RMSE. In particular, relatively long time scales were more relevant for classifying patients into risk groups during nighttime, while during daytime shorter scales performed better. The results suggest that the left atrial size, indexed to body surface and RMSE indexes are those that allow enhanced classification of ischemic patients in their respective risk groups, confirming that a single measurement is not enough to fully characterize ischemic risk patients and the clinical relevance of HRV complexity measures.

Evaluation of scale invariance in physiological signals by means of balanced estimation of diffusion entropy

By means of the concept of the balanced estimation of diffusion entropy, we evaluate the reliable scale invariance embedded in different sleep stages and stride records. Segments corresponding to waking, light sleep, rapid eye movement (REM) sleep, and deep sleep stages are extracted from long-term electroencephalogram signals. For each stage the scaling exponent value is distributed over a considerably wide range, which tell us that the scaling behavior is subject and sleep cycle dependent. The average of the scaling exponent values for waking segments is almost the same as that for REM segments (∼0.8). The waking and REM stages have a significantly higher value of the average scaling exponent than that for light sleep stages (∼0.7). For the stride series, the original diffusion entropy (DE) and the balanced estimation of diffusion entropy (BEDE) give almost the same results for detrended series. The evolutions of local scaling invariance show that the physiological states change abruptly, although in the experiments great efforts have been made to keep conditions unchanged. The global behavior of a single physiological signal may lose rich information on physiological states. Methodologically, the BEDE can evaluate with considerable precision the scale invariance in very short time series (∼10^{2}), while the original DE method sometimes may underestimate scale-invariance exponents or even fail in detecting scale-invariant behavior. The BEDE method is sensitive to trends in time series. The existence of trends may lead to an unreasonably high value of the scaling exponent and consequent mistaken conclusions.