Five minute recordings of heart rate variability for population studies: repeatability and age-sex characteristics

Reproducibility of autonomic cardiovascular function and hemodynamics at rest and during recovery from exercise

Smartwatches and home-based blood pressure (BP) devices have permitted easy use of heart rate variability (HRV) and BP to identify the recovery status of users after acute exercise training. The reproducibility of HRV and BP after exercise in healthy young participants is not well known. Eighteen participants (age 27 ± 6 years, female n = 8) performed test and retest aerobic exercises (cycling, 30 min, 60% of peak workload, W) and a control session in randomized order. RMSSD, high and low-frequency power of RR intervals, and BP were measured at rest and 30-60 min after interventions. The relative reproducibility was assessed by the intraclass correlation coefficient (ICC) and 95% confidence interval (95% CI). The absolute reproducibility was evaluated using the coefficient of variation (CV%). HRV indices revealed moderate-to-excellent reproducibility at rest (ICC 0.81-0.86; 95% CI 0.53-0.95) but not after exercise (ICC -0.06 to 0.60; 95% CI -1.85 to 0.85). Systolic BP had a good-to-excellent reproducibility before (ICC 0.93; 95% CI 0.81-0.98, CV% 4.2) and after exercise (ICC 0.93; 95% CI 0.81-0.97, CV% 4.2). The reproducibility of HRV indices is poor after exercise in young participants. However, the reproducibility of BP is excellent at rest and after aerobic exercise.

Peaks, sources, and immediate health impacts of PM2.5 and PM1 exposure in Indonesia and Taiwan with microsensors

BACKGROUND

Microsensors have been used for the high-resolution particulate matter (PM) monitoring.

OBJECTIVES

This study applies PM and health microsensors with the objective of assessing the peak exposure, sources, and immediate health impacts of PM2.5 and PM1 in two Asian countries.

METHODS

Exposure assessment and health evaluation were carried out for 50 subjects in 2018 and 2019 in Bandung, Indonesia and for 55 subjects in 2019 and 2020 in Kaohsiung, Taiwan. Calibrated AS-LUNG sets and medical-certified RootiRx® sensors were used to assess PM and heart-rate variability (HRV), respectively.

RESULTS

Overall, the 5-min mean exposure of PM2.5 and PM1 was 30.4 ± 20.0 and 27.0 ± 15.7 µg/m3 in Indonesia and 14.9 ± 11.2 and 13.9 ± 9.8 µg/m3 in Taiwan, respectively. The maximum 5-min peak PM2.5 and PM1 exposures were 473.6 and 154.0 µg/m3 in Indonesia and 467.4 and 217.7 µg/m3 in Taiwan, respectively. Community factories and mosquito coil burning are the two most important exposure sources, resulting in, on average, 4.73 and 5.82 µg/m3 higher PM2.5 exposure increments for Indonesian subjects and 10.1 and 9.82 µg/m3 higher PM2.5 exposure for Taiwanese subjects compared to non-exposure periods, respectively. Moreover, agricultural waste burning and incense burning were another two important exposure sources, but only in Taiwan. Furthermore, 5-min PM2.5 and PM1 exposure had statistically significantly immediate impacts on the HRV indices and heart rates of all subjects in Taiwan and the scooter subjects in Indonesia with generalized additive mixed models. The HRV change for a 10 µg/m3 increase in PM2.5 and PM1 ranged from -0.9% to -2.5% except for ratio of low-high frequency, with greater impacts associated with PM1 than PM2.5 in both countries.

IMPACT STATEMENT

This work highlights the ability of microsensors to capture high peaks of PM2.5 and PM1, to identify exposure sources through the integration of activity records, and to assess immediate changes in heart rate variability for a panel of approximately 50 subjects in Indonesia and Taiwan. This study stands out as one of the few to demonstrate the immediate health impacts of peak PM, complementing to the short-term (days or weeks) or long-term effects (months or longer) assessed in most epidemiological studies. The technology/methodology employed offer great potential for researchers in the resource-limited countries with high PM2.5 and PM1 levels.

Normative values of short-term heart rate variability in a cross-sectional study of a Danish population. The DanFunD study

AIMS

The autonomic nervous system includes parasympathetic and sympathetic components that monitor and regulate most of the bodily functions and play a central role in the physiology and homeostasis of the human body. Heart rate variability is a non-invasive tool for quantification of rhythmic fluctuations in heart rate that reflects the function of the autonomic nervous system. The study aims to describe the heart rate variability distribution in the general population, stratified in sex and age groups, which is currently insufficiently described.

METHODS

A cross-sectional population-based study recruited participants in 10 municipalities in the western part of the greater Copenhagen area in Denmark, including 6891 men and women aged 18-72 years (participation rate was 29.5%). Short-term heart rate variability measures were obtained and related to age and gender.

RESULTS

Both time and frequency domain measures showed a huge variation in the different sex and age groups. Women had a higher median heart rate than men, and the association with age was U-shaped. Measures indicating a predominance of the parasympathetic component in relation to the sympathetic component were more frequent in women and younger age groups.

CONCLUSIONS

Both sex and age influence the heart rate variability in this adult Danish population. Therefore, our age- and sex-related reference values of heart rate variability in the time and frequency domain should be used in further epidemiological and clinical research.

Long-term stability of respiratory sinus arrhythmia among adults with and without a history of depression

Respiratory sinus arrhythmia (RSA) is an index of parasympathetic nervous system activity reflecting respiratory influences on heart rate. This influence is typically measured as high frequency heart rate variability (HF-HRV) or root mean square of successive differences (RMSSD) of adjacent inter-beat intervals. Examining the long-term stability of its measurement is important as levels of resting RSA have been conceptualized as a marker of individual differences; in particular, of an individual's autonomic regulation and affect-related processes, including emotion regulation. At present, it is not known if resting RSA levels reflect stable differences over a long-term period (i.e., >1 year). Even less is known about how RSA stability differs as a function of depression history and whether it relates to depression risk trajectories. In the present study, we examined the 1.5-year test-retest reliability of resting RSA using the intraclass correlation coefficient (ICC) in 82 adults: n = 41 with a history of depression (ever-depressed); n = 41 controls with no depression history (never-depressed). HF-HRV was fairly stable in both groups (ever-depressed ICC = 0.55, never-depressed ICC = 0.54). RMSSD was also fairly stable in ever-depressed adults (ICC = 0.57) and never-depressed controls (ICC = 0.40). ICC values for both indices did not differ between groups per overlapping 95% confidence intervals. Therefore, RSA stability as assessed by both frequency (HF-HRV) and time domain (RMSSD) measures was not attenuated by a depression history. Implications and the need for future research are discussed.

Reliability of five-minute vs. one-hour heart rate variability metrics in individuals with spinal cord injury

Background

A previous study showed low reliability of 1-h HRV outcomes in participants with spinal cord injury (SCI), but it was not certain whether the low reliability was due to the unrestricted activity of participants. We aimed to investigate test-retest reliability of HRV metrics in individuals with SCI using a 1-h measurement in a supine position.

Methods

Individuals with SCI underwent two sessions of 1-h recording of the time between consecutive R waves (RR-intervals) in a supine position. HRV outcomes were obtained from a single 5-min data segment and for the full 1-h recording. HRV parameters of interest were: standard deviation of all normal-to-normal R-R intervals (SDNN) and square root of the mean of the squared differences between successive R-R intervals (RMSSD) (time domain); and high frequency power (HF), low frequency power (LF), very low frequency power (VLF), ultra-low frequency power (ULF) and total power (TP) (frequency domain). Relative reliability was assessed by intraclass correlation coefficient (ICC). Absolute reliability was assessed by coefficient of variation (CV) and Bland-Altman limits of agreement (LoA).

Results

Data from 37 individuals (14 with tetraplegia and 23 with paraplegia) were included. Relative reliability was higher for the 1-h (ICCs ranged from 0.13-0.71) than for the 5-min duration (ICCs ranged from 0.06-0.50) in the overall SCI group for all HRV metrics. Participants with tetraplegia had lower relative reliability compared to participants with paraplegia in all HRV metrics for the 5-min duration (ICCs ranged from -0.01-0.34 vs. 0.21-0.57). For the 1-h duration, participants with paraplegia showed higher relative reliability than participants with tetraplegia in all HRV metrics (ICCs ranged from 0.18-0.79 vs. 0.07-0.54) except TP (ICC 0.69 vs. 0.82). In terms of absolute reliability, the CVs and LoAs for the 1-h duration were better than for the 5-min duration. In general, time domain metrics showed better reliability than frequency domain metrics for both durations in participants with tetraplegia and paraplegia. The lowest CV and narrowest 95% LoA were found for SDNN in 5-min and 1-h durations overall and in both lesion levels.

Conclusions

The supine position did not provide better reliability compared to unrestricted activity in participants with SCI. HRV analysis using a 5-min duration is of limited value in SCI due to poor reliability. For the 1-h analysis duration, interpretation of the reliability of HRV varies according to lesion level: it is recommended to take lesion level into account when interpreting reliability measures.

Heart Rate Variability in Concussed College Athletes: Follow-Up Study and Biological Sex Differences

Finding reliable biomarkers to assess concussions could play a pivotal role in diagnosis, monitoring, and predicting associated risks. The present study aimed to explore the use of heart rate variability (HRV) in the follow-up of concussions among college athletes and to investigate the relationships between biological sex, symptomatology, and HRV values at baseline and after a concussion. Correlations between measures were also analyzed. A total of 169 (55 females) athletes aged 16 to 22 years old completed baseline testing, and 30 (8 females) concussion cases were followed. Baseline assessment (T1) included psychosocial and psychological questionnaires, symptoms report, and four minutes of HRV recording. In the event of a concussion, athletes underwent re-testing within 72 h (T2) and before returning to play (T3). Baseline findings revealed that girls had higher %VLF while sitting than boys, and a small negligible correlation was identified between %HF and total symptoms score as well as %HF and affective sx. Post-concussion analyses demonstrated a significant effect of time × position × biological sex for %HF, where girls exhibited higher %HF at T3. These findings suggest disruptions in HRV following a concussion and underscore biological sex as an important factor in the analysis of HRV variation in concussion recovery trajectory.

Test-retest reliability of short- and long-term heart rate variability in individuals with spinal cord injury

STUDY DESIGN

Cross-sectional.

OBJECTIVES

To investigate test-retest reliability of heart rate variability (HRV) metrics in SCI without restriction of activity over long (24-h) and shorter durations (5-min, 10-min, 1-h, 3-h and 6-h).

SETTINGS

University hospital in Khon Kaen, Thailand.

METHODS

Forty-five participants (11 with tetraplegia and 34 with paraplegia) underwent two 24-h recordings of RR-intervals to derive time and frequency HRV metrics. Relative reliability was assessed by intraclass correlation coefficient (ICC) and absolute reliability by coefficient of variation (CV) and Bland-Altman limits of agreement (LoA).

RESULTS

For 5- and 10-min durations, eight of eleven HRV metrics had moderate to excellent reliability (ICC 0.40-0.76); the remaining three were poor (ICC < 0.4). HRV values from 1-h and 3-h durations showed moderate to excellent reliability (ICC of 0.46-0.81), except for 1-h reliability of ULF and TP (ICC of 0.06 and 0.30, respectively). Relative reliability was excellent (ICC of 0.77-0.92) for 6-h and 24-h durations in all HRV metrics. Absolute reliability improved as recording duration increased (lower CVs and narrower LoAs). Participants with high AD risk (SCI level at or above T6) showed lower test-retest reliability of HF and LF values than participants with low AD risk.

CONCLUSION

Relative reliability of HRV was excellent for 6-h and 24-h. The best absolute reliability values were for 24-h duration. Time-domain outcomes were more reliable than frequency domain outcomes. Participants with high risk of AD, particularly those with tetraplegia, showed lower reliability, especially for HF and LF.

Electrodermal activity and heart rate variability for detection of peripheral abnormalities in type 2 diabetes: A review

Modern medicine exhibits an upward trend towards non-invasive methods for early detection of disease and long-term monitoring of patients' health. Diabetes mellitus and its complications are a promising area for implementation of new medical diagnostic devices. One of the most serious complications of diabetes is diabetic foot ulcer. The main causes responsible for diabetic foot ulcer are ischemia caused by peripheral artery disease and diabetic neuropathy caused by polyol pathway-induced oxidative stress. Autonomic neuropathy impairs function of sweat glands, which can be measured by electrodermal activity. On the other hand, autonomic neuropathy leads to changes in heart rate variability, which is used to assess autonomic regulation of the sinoatrial node. Both methods are enough sensitive to detect pathological changes caused by autonomic neuropathy and are promising screening methods for early diagnosis of diabetic neuropathy, which could prevent the onset of diabetic ulcer.

The autonomic and nociceptive response to acute experimental stress is impaired in people with knee osteoarthritis: A preliminary study

Objective

Alterations in autonomic function are evident in some chronic pain conditions but have not been thoroughly examined in people with osteoarthritis (OA). The study aimed to examine resting autonomic nervous system (ANS) function in people with knee OA, and the response of the autonomic and nociceptive systems to acute stress.

Methods

A preliminary cross-sectional study was undertaken involving people with knee OA (n = 14), fibromyalgia (n = 13), and pain-free controls (n = 15). The sympathetic and parasympathetic components of the ANS were assessed through measures of pre-ejection period (PEP), skin conductance level (SCL), and high frequency heart rate variability (HF HRV). The nociceptive system was assessed through pain ratings associated with a tonic heat pain stimulus. In separate sessions, ANS and heat pain measures were assessed at rest and in response to nociceptive and mental arithmetic stressors.

Results

The knee OA group showed reduced HF HRV at rest and reduced modulation in response to stress. Resting PEP and SCL were normal in the knee OA group but PEP modulation was impaired in both chronic pain groups during nociceptive stress. The expected reduction in tonic heat pain ratings in response to stress was lacking in the knee OA and FM groups.

Conclusion

Preliminary evidence shows impaired parasympathetic nervous system function at rest and in response to nociceptive and mental stress in people with knee OA, with some evidence of altered sympathetic nervous system function. Impaired ANS function could contribute to ongoing pain experienced, and interventions that target ANS function could be beneficial.

Impact of high intensity interval exercise with and without heat stress on cardiovascular and aerobic performance: a pilot study

BACKGROUND

Heat stress during aerobic exercise training may offer an additional stimulus to improve cardiovascular function and performance in a cool-temperate environment. However, there is a paucity of information on the additive effects of high-intensity interval exercise (HIIE) and acute heat stress. We aimed to determine the effects of HIIE in combination with acute heat stress on cardiovascular function and exercise performance.

METHODS

Twelve active (peak O₂ consumption [VO_2peak]: 47 ± 8 ml·O₂/min/kg) young adults were counterbalanced to six sessions of HIIE in hot (HIIE-H, 30 ± 1 °C, 50 ± 5% relative humidity [RH]) or temperate conditions (HIIE-T, 20 ± 2 °C, 15 ± 10% RH). Resting heart rate (HR), HR variability (HRV), central (cBP) and peripheral blood pressure (pBP), peripheral mean arterial pressure (pMAP), pulse wave velocity (PWV), VO_2peak, and 5-km treadmill time-trial were measured pre- and post-training.

RESULTS

Resting HR and HRV were not significantly different between groups. However, expressed as percent change from baseline, cSBP (HIIE-T: + 0.9 ± 3.6 and HIIE-H: -6.6 ± 3.0%, p = 0.03) and pSBP (HIIE-T: -2.0 ± 4.6 and HIIE-H: -8.4 ± 4.7%, p = 0.04) were lower in the heat group. Post-training PWV was also significantly lower in the heat group (HIIE-T: + 0.4% and HIIE-H: -6.3%, p = 0.03). Time-trial performance improved with training when data from both groups were pooled, and estimated VO_2peak was not significantly different between groups (HIIE-T: 0.7% and HIIE-H: 6.0%, p = 0.10, Cohen's d = 1.4).

CONCLUSIONS

The addition of acute heat stress to HIIE elicited additive adaptations in only cardiovascular function compared to HIIE alone in active young adults in temperate conditions, thus providing evidence for its effectiveness as a strategy to amplify exercise-induced cardiovascular adaptations.

Standard Heart Rate Variability Parameters-Their Within-Session Stability, Reliability, and Sample Size Required to Detect the Minimal Clinically Important Effect

Many intervention studies assume the stability of heart rate variability (HRV) parameters, and their sample sizes are often small, which can significantly affect their conclusions. The aim of this study is to assess the stability and reliability of standard HRV parameters within a single resting session, and to estimate the sample size required to detect the minimal clinically important effect of an intervention. Heart rate was recorded in 50 adult healthy subjects for 50 min in a seated position. Eight standard HRV parameters were calculated from five evenly spaced 5 min intervals. Stability was assessed by comparing the mean values of HRV parameters between the consecutive five test-retest measurements. Absolute reliability was determined by standard error of measurement, and relative reliability by intraclass correlation coefficient. The sample size required to detect a mean difference of ≥30% of between-subject standard deviation was estimated. As expected, almost all HRV parameters had poor absolute reliability but most HRV parameters had substantial to excellent relative reliability. We found statistically significant differences in almost all HRV parameters between the first 20 min and the last 30 min of the session. The estimated sample size ranged from 19 to 300 subjects for the first 20 min and from 36 to 194 subjects for the last 30 min of the session, depending on the selected HRV parameter. We concluded that optimal HRV measurement protocols in a resting seated position should be performed within the first 20 min or between 20 and 50 min after assuming a resting seated position. Future interventional HRV studies should include a sufficient number of subjects and consider the Bonferroni correction according to the number of selected HRV parameters to achieve an appropriate level of study power and precision.

Trial-level bias score versus mean bias score: Comparison of the reliability and external validity using dot-probe task among daily smokers

INTRODUCTION

Attentional bias (AB) is an individual difference risk factor that represents the extent to which cigarette cues capture one's attention. AB is typically indexed by mean bias score (MBS), theoretically assuming that AB is static. However, poor reliability of MBS has threatened valid interpretation of the results on AB. Based on observed trial-by-trial temporal fluctuation and variability of attentional allocation, trial-level bias score (TLBS) has been introduced as an alternative index with evidence of better psychometric properties in various populations, as compared to MBS. However, such evidence is limited among daily smokers. The current study aimed to replicate and extend extant findings in a sample of daily smokers by hypothesizing that TLBS, as compared to MBS, would demonstrate superior reliability and external validity.

METHODS

Forty-eight daily smokers completed self-reports, ad-libitum smoking, and a dot-probe task three times, which was comprised of 36 pairs of pictorial stimuli of cigarette and neutral cues, yielding 144 total trials.

RESULTS

The TLBS demonstrated superior internal (range intra class correlation [ICC] = 0.79-0.95) and test-retest reliability (range ICC = 0.64-0.88) compared to MBS (range ICC = 0.31-0.40 and 0.06-0.16, respectively). However, few significant relations between either the MBS or TLBS and measures of biobehavioral and self-report indices of smoking reinforcement were observed.

CONCLUSIONS

The current findings demonstrate that TLBS, as compared to MBS, is a more reliable measure of AB among daily smokers, while evidence of its external validity is limited.

Autonomic tone in children and adults: Pupillary, electrodermal and cardiac activity at rest

Considering the suspected involvement of the autonomic nervous system (ANS) in several neurodevelopmental disorders, a description of its tonus in typical populations and of its maturation between childhood and adulthood is necessary. We aimed to arrive at a better understanding of the maturation of the sympathetic (SNS) and parasympathetic (PNS) tonus by comparing children and adults at rest, via recordings of multiple ANS indices. We recorded simultaneously pupil diameter, electrodermal activity (EDA) and cardiac activity (RR interval and HRV: heart rate variability) in 29 children (6-12 years old) and 30 adults (20-42 years old) during a 5-min rest period. Children exhibited lower RR intervals, higher LF peak frequencies, and lower LF/HF (low frequency/high frequency) ratios compared to adults. Children also produced more spontaneous EDA peaks, reflected in a larger EDA AUC (area under the curve), in comparison with adults. Finally, children displayed a larger median pupil diameter and a higher pupillary hippus frequency than adults. Our results converged towards higher SNS and PNS tones in children compared to adults. Childhood would thus be characterized by a high autonomic tone, possibly reflecting a physiological state compatible with developmental acquisitions.

Metabolism regulator adiponectin prevents cardiac remodeling and ventricular arrhythmias via sympathetic modulation in a myocardial infarction model

The stellate ganglia play an important role in cardiac remodeling after myocardial infarction (MI). This study aimed to investigate whether adiponectin (APN), an adipokine mainly secreted by adipose tissue, could modulate the left stellate ganglion (LSG) and exert cardioprotective effects through the sympathetic nervous system (SNS) in a canine model of MI. APN microinjection and APN overexpression with recombinant adeno-associated virus vector in the LSG were performed in acute and chronic MI models, respectively. The results showed that acute APN microinjection decreased LSG function and neural activity, and suppressed ischemia-induced ventricular arrhythmia. Chronic MI led to a decrease in the effective refractory period and action potential duration at 90% and deterioration in echocardiography performance, all of which was blunted by APN overexpression. Moreover, APN gene transfer resulted in favorable heart rate variability alteration, and decreased cardiac SNS activity, serum noradrenaline and neuropeptide Y, which were augmented after MI. APN overexpression also decreased the expression of nerve growth factor and growth associated protein 43 in the LSG and peri-infarct myocardium, respectively. Furthermore, RNA sequencing of LSG indicated that 4-week MI up-regulated the mRNA levels of macrophage/microglia activation marker Iba1, chemokine ligands (CXCL10, CCL20), chemokine receptor CCR5 and pro-inflammatory cytokine IL6, and downregulated IL1RN and IL10 mRNA, which were reversed by APN overexpression. Our results reveal that APN inhibits cardiac sympathetic remodeling and mitigates cardiac remodeling after MI. APN-mediated gene therapy may provide a potential therapeutic strategy for the treatment of MI.

Interpreting resting heart rate variability in complex populations: the role of autonomic reflexes and comorbidities

PURPOSE

Resting heart rate variability (HRV) is an important biomarker linking mental health to cardiovascular outcomes. However, resting HRV is also impaired in autonomic neuropathy, a common and underdiagnosed complication of common medical conditions which is detected by testing autonomic reflexes. We sought to describe the relationship between autonomic reflex abnormalities and resting HRV, taking into consideration medical comorbidities and demographic variables.

METHODS

Participants (n = 209) underwent a standardized autonomic reflex screen which was summarized as the Composite Autonomic Severity Score (CASS) and included measures of reflexive HRV, e.g., heart rate with deep breathing (HRDB). Resting HRV measures were: pNN50 (percentage of NN intervals that differ by > 50 ms) and cvRMSSD (adjusted root mean square of successive differences).

RESULTS

In univariate analyses, lower resting HRV was associated with: older age, higher CASS, neuropathy on examination, hypertension, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, and psychiatric disease. Adaptive regression spline analysis revealed that HRDB explained 27% of the variability in resting HRV for participants with values of HRDB in the normal range. Outside this range, there was no linear relationship because: (1) when HRDB was low (indicating autonomic neuropathy), resting HRV was also low with low variance; and (2) when HRDB was high, the variance in resting HRV was high. In multivariate models, only HRDB was significantly independently associated with cvRMSSD and pNN50.

CONCLUSION

Subclinical autonomic neuropathy, as evidenced by low HRDB and other autonomic reflexes, should be considered as a potential confounder of resting HRV in research involving medically and demographically diverse populations.

Reliability of Heart Rate Variability During Stable and Disrupted Polysomnographic Sleep

Heart rate variability (HRV) is commonly used within sleep and cardiovascular research, yet HRV reliability across various sleep stages remains equivocal. The present study examined the reliability of frequency- and time-domain HRV within stage II (N2), slow wave (SWS), and rapid eye movement (REM) sleep during both stable and disrupted sleep. We hypothesized that high-frequency (HF) HRV would be reliable in all three sleep stages, low-frequency (LF) HRV would be reliable during N2 and SWS, and that disrupted sleep via spontaneous cortical arousals would decrease HRV reliability. Twenty-seven participants (11 male, 16 female, 26±1 years) were equipped with laboratory polysomnography for one night. Both frequency- and time-domain HRV were analyzed in two 5-10 minute blocks during multiple stable and disrupted sleep cycles across N2, SWS and REM sleep. HF HRV was highly correlated across stable N2 (r=0.839, p<0.001), SWS (r=0.765, p<0.001) and REM (r=0.881, p<0.001). LF HRV was moderate-to-highly correlated during stable cycles of N2 sleep (r=0.694, p < 0.001), SWS, (r=0.765, p < 0.001), and REM (r=0.699, p<0.001) sleep. When stable sleep was compared with disrupted sleep, both time- and frequency-domain HRV were reliable (α>0.90, p<0.05) in N2, SWS, and REM, with the exception of LF HRV during SWS (α=0.62, p=0.089). In conclusion, time- and frequency-domain HRV demonstrated reliability across stable N2, SWS and REM sleep, and remained reliable during disrupted sleep. These findings support the use of HRV during sleep as a tool for assessing cardiovascular health and risk stratification.

Self-Compassion and Its Association With Ruminative Tendencies and Vagally Mediated Heart Rate Variability in Recurrent Major Depression

Background

Recurrent Major Depressive Disorder (MDD) is one of the most disabling mental disorders in modern society. Prior research has shown that self-compassion protects against ruminative tendencies, a key feature of recurrent MDD. In addition, self-compassion has been found to be positively related to higher psychophysiological flexibility (indexed by a higher vagally mediated heart rate variability; vmHRV) in young, healthy adults. To our knowledge, there is a lack of studies on how self-compassion relates to vmHRV in patients with recurrent MDD. The aim of the current study was to investigate whether higher self-compassion would associate with (1) lower ruminative tendencies and (2) higher vmHRV in a sample of adults with recurrent MDD.

Methods

We included a sample of 63 patients (46 females) between 20 and 71 years old (M = 40.24, SD = 12.8) with a history of three or more depressive episodes. They filled out the Self-Compassion Scale (SCS), Beck Depression Inventory (BDI), and Rumination Rating Scale (RRS). ECG (used to derive vmHRV) was acquired while resting and the square root of the mean squared differences of successive RR interval values (RMSSD) was calculated as measure of vmHRV.

Results

As hypothesized, self-compassion was associated with lower ruminative tendencies. However, self-compassion was not associated with level of vmHRV. Several confounding variables were controlled for in the statistical analyses, and higher age predicted lower vmHRV across all statistical analyses.

Conclusion

The results confirmed our hypothesis that higher self-compassion would be associated with lower ruminative tendencies in recurrent MDD. Contrary to our expectation, we did not find that the tendency to be more self-compassionate was associated with higher vmHRV. As such, higher self-compassion seems to relate with a lower tendency to ruminate about past mistakes and events but does not seem to relate to a flexible autonomic stress response (as indexed by higher vmHRV). Other potential explanatory factors for lower vmHRV in recurrent MDD is suggested as focus for exploration in future studies.

A New Approach for Evaluation of Cardiovascular Fitness and Cardiac Responses to Maximal Exercise Test in Master Runners: A Cross-Sectional Study

The aim of this study was to analyze the cardiac autonomic function at rest, at maximum exercise, and in recovery after exercise and to determine sex-specific and age-specific values for resting heart rate (RHR), hear rate (HR)-peak, HR recovery (HRR), and HR variability at rest in master runners. Fifty endurance runners (21 women) participated in this study (43.28 ± 5.25 years). The subjects came from different athletic clubs in Andalusia (Spain), and the testing protocol was performed in-season. A 3-km running test was performed and the cardiovascular response was monitored. Regarding sex, no significant differences were found regarding cardiovascular autonomic function at rest, during exercise, and following maximal exercise, only at rest, the standard deviation of all R-R intervals and low frequency values displayed significantly (p < 0.05) lower scores in women. 46% of athletes showed an RHR < 60 bpm. Additionally, HR-peak showed a significant correlation with age (r = −0.369; p = 0.009) and HRR5min (r = 0.476, p = 0.001). Also, endurance performance was inversely associated with obesity traits and cardiometabolic risk factors. In summary, age, sex, fitness, or anthropometrics characteristics did not show a relevant influence on cardiovascular autonomic modulation in master runners. However, the 3-km performance displayed a significant negative association with several factors of cardiometabolic risk.

Breathing rate variability in obstructive sleep apnea during wakefulness

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) is defined by pauses in breathing during sleep, but daytime breathing dysregulation may also be present. Sleep may unmask breathing instability in OSA that is usually masked by behavioral influences during wakefulness. A breath-hold (BH) challenge has been used to demonstrate breathing instability. One measure of breathing stability is breathing rate variability (BRV). We aimed to assess BRV during rest and in response to BH in OSA.

METHODS

We studied 62 participants (31 with untreated OSA: respiratory event index [mean ± SD] 20 ± 15 events/h, 12 females, age 51 ± 14 years, body mass index [BMI] 32 ± 8 kg/m²; 31 controls: 17 females, age 47 ± 13 years; BMI 26 ± 4 kg/m²). Breathing movements were collected using a chest belt for 5 minutes of rest and during a BH protocol (60 seconds baseline, 30 seconds BH, 90 seconds recovery, 3 repeats). From the breathing movements, we calculated median breathing rate (BR) and interquartile BRV at rest. We calculated change in BRV during BH recovery from baseline. Group comparisons of OSA vs control were conducted using analysis of covariance with age, sex, and BMI as covariates.

RESULTS

We found 10% higher BRV in OSA vs controls (P < .05) during rest. In response to BH, BRV increased 7% in OSA vs 1% in controls (P < .001). Resting BR was not significantly different in OSA and controls, and sex and age did not have any significant interaction effects. BMI was associated with BR at rest (P < .05) and change in BRV with BH (P < .001), but no significant BMI-by-group interaction effect was observed.

CONCLUSIONS

The findings suggest breathing instability as reflected by BRV is high in OSA during wakefulness, both at rest and in response to a stimulus. Breathing instability together with high blood pressure variability in OSA may reflect a compromised cardiorespiratory consequence in OSA during wakefulness.

CITATION

Pal A, Martinez F, Akey MA, et al. Breathing rate variability in obstructive sleep apnea during wakefulness. J Clin Sleep Med. 2022;18(3):825-833.

Heart rate variability is reduced during the menstrual phase in women with catamenial C1-type temporal lobe epilepsy

INTRODUCTION

Temporal lobe epilepsy (TLE) is the most frequent focal epilepsy in adulthood. Catamenial C1-type TLE, is characterized by a cyclic seizure exacerbation during the menstrual phase. The heart rate variability (HRV) analysis assesses cardiac autonomic control and may represent a biomarker for Sudden Unexpected Death in Epilepsy (SUDEP). It is plausible that female sex hormones can influence HRV. These changes might be more pronounced in patients suffering from catamenial C1-type TLE where hormonal changes also increase seizure susceptibility. To that aim, we evaluated HRV changes during the menstrual phase of women suffering from catamenial C1-type TLE.

METHODS

We enrolled 12 adults with a diagnosis of catamenial C1-type TLE (Catamenial Group) and 12 age-, and seizure-frequency-matched controls with TLE (Non-Catamenial Group). Each patient underwent a 20-minute EEG + EKG recording in resting state during the menstrual phase. HRV parameters were calculated with a short-lasting analysis of EKG records. Time domain-related, frequency domain-related, as well as non-linear analysis parameters, were compared between the two groups.

RESULT

Compared to the Non-Catamenial Group, the Catamenial Group showed significant reductions in SDNN (p-value = 0.01), RMSSD (p-value = 0.04), pNN50 (p-value = 0.001), LnLF ms² (p-value = 0.05), LnHF ms² (p-value = 0.007), SD1 (p-value = 0.02), and SD2 (p-value = 0.01). These results were independent from age, disease duration, numbers of ASM, and seizure etiology.

CONCLUSION

Our data provide experimental evidence that vagal output is reduced during the menstrual phase in patients with catamenial C1-type TLE. These results indicate that, during the menstrual phase, patients with catamenial C1-type TLE may be at a higher risk of developing cardiac dysfunctions and SUDEP.

Cardiac Autonomic Modulation Response Before, During, and After Submaximal Exercise in Older Adults With Intellectual Disability

The analysis of the heart rate variability (HRV) consists of changes in the time intervals between consecutive R waves. It provides information on the autonomic nervous system regulation and it is a predictor of adverse cardiovascular events. Several studies analyzed this parameter in youth and adults with Intellectual Disability (ID). Nevertheless, there is a lack of information regarding the HRV before, during, and after exercise in older adults with ID. Therefore, we aimed to describe and compare the cardiac autonomic modulation before, during, and after the six-minute walk test (6MWT) in older adults with and without ID. Twenty-four volunteers with ID and 24 without ID (non-ID) participated in this study. HRV was assessed by R-R intervals at rest, during and after the 6MWT. At rest and recovery periods, the participants remained sited. The symbolic analysis was used to evaluate non-linear HRV components. The recovery HR kinetics was assessed by the mean response time, which is equivalent to time constant (τ)+time delay (TD). Between groups differences in HRV variables were not significant. During the recovery period, HR kinetics time variables showed significant better results in non-ID participants (TD: 6±5s vs. 15±11s; τ: 19±10s vs. 35±17s; and MRT: 25±9s vs. 50±11s, all p<0.050). In conclusion, our results suggest that the HRV in older adults with and without ID is similar during rest, exercise, and recovery. Recovery HR kinetics after the 6MWT was slower in older adults with ID. The reason for these results may be a reduced post-exercise vagal rebound in older adults with ID.

Cortical thickness and resting-state cardiac function across the lifespan: A cross-sectional pooled mega-analysis

Understanding the association between autonomic nervous system [ANS] function and brain morphology across the lifespan provides important insights into neurovisceral mechanisms underlying health and disease. Resting-state ANS activity, indexed by measures of heart rate [HR] and its variability [HRV] has been associated with brain morphology, particularly cortical thickness [CT]. While findings have been mixed regarding the anatomical distribution and direction of the associations, these inconsistencies may be due to sex and age differences in HR/HRV and CT. Previous studies have been limited by small sample sizes, which impede the assessment of sex differences and aging effects on the association between ANS function and CT. To overcome these limitations, 20 groups worldwide contributed data collected under similar protocols of CT assessment and HR/HRV recording to be pooled in a mega-analysis (N = 1,218 (50.5% female), mean age 36.7 years (range: 12-87)). Findings suggest a decline in HRV as well as CT with increasing age. CT, particularly in the orbitofrontal cortex, explained additional variance in HRV, beyond the effects of aging. This pattern of results may suggest that the decline in HRV with increasing age is related to a decline in orbitofrontal CT. These effects were independent of sex and specific to HRV; with no significant association between CT and HR. Greater CT across the adult lifespan may be vital for the maintenance of healthy cardiac regulation via the ANS-or greater cardiac vagal activity as indirectly reflected in HRV may slow brain atrophy. Findings reveal an important association between CT and cardiac parasympathetic activity with implications for healthy aging and longevity that should be studied further in longitudinal research.

Age-related losses in cardiac autonomic activity during a daytime nap

In healthy, young individuals, a reduction in cardiovascular output and a shift from sympathetic to parasympathetic (vagal) dominance is observed from wake into stages of nocturnal and daytime sleep. This cardiac autonomic profile, measured by heart rate variability (HRV), has been associated with significant benefits for cardiovascular health. Aging is associated with decreased nighttime sleep quality and lower parasympathetic activity during both sleep and resting. However, it is not known whether age-related dampening of HRV extends to daytime sleep, diminishing the cardiovascular benefits of naps in the elderly. Here, we investigated this question by comparing the autonomic activity profile between young and older healthy adults during a daytime nap and a similar period of wakefulness (quiet wake; QW). For each condition, from the electrocardiogram (ECG), we obtained beat-to-beat HRV intervals (RR), root mean square of successive differences between adjacent heart-beat-intervals (RMSSD), high-frequency (HF), low-frequency (LF) power, and total power (TP), HF normalized units (HFnu ), and the LF/HF ratio. As previously reported, young subjects showed a parasympathetic dominance during NREM, compared with REM, prenap rest, and WASO. Moreover, older, compared to younger, adults showed significantly lower vagally mediated HRV (measured by RMSSD, HF, HFnu ) during NREM. Interestingly, however, no age-related differences were detected during prenap rest or QW. Altogether, our findings suggest a sleep-specific reduction in parasympathetic modulation that is unique to NREM sleep in older adults.

The everyday acoustic environment and its association with human heart rate: evidence from real-world data logging with hearing aids and wearables

We investigate the short-term association between multidimensional acoustic characteristics of everyday ambient sound and continuous mean heart rate. We used in-market data from hearing aid users who logged ambient acoustics via smartphone-connected hearing aids and continuous mean heart rate in 5 min intervals from their own wearables. We find that acoustic characteristics explain approximately 4% of the fluctuation in mean heart rate throughout the day. Specifically, increases in ambient sound pressure intensity are significantly related to increases in mean heart rate, corroborating prior laboratory and short-term real-world data. In addition, increases in ambient sound quality-that is, more favourable signal to noise ratios-are associated with decreases in mean heart rate. Our findings document a previously unrecognized mixed influence of everyday sounds on cardiovascular stress, and that the relationship is more complex than is seen from an examination of sound intensity alone. Thus, our findings highlight the relevance of ambient environmental sound in models of human ecophysiology.

Relationship of Cardiac Autonomic Modulation with Cardiovascular Parameters in Adults, According to Body Mass Index and Physical Activity

This study aimed to analyze the relationship between cardiac autonomic modulation (CAM) and cardiovascular parameters (blood pressure and resting heart rate) in a sample of 256 adults, grouped by body mass index and sufficient moderate-to-vigorous physical activity (≥150 min/week). The sample showed different cardiovascular parameters and CAM according to body mass index, but not according to physical activity. Adults who are overweight and physically active presented higher relationship between CAM and blood pressure than those who are insufficiently active, similarly to normal weight groups. Recommended levels of physical activity may play an important role in the relationship of HRV with cardiovascular parameters in overweight adults, regardless of sex, age, socioeconomic level, and central fat. Trial registration: Registered at ClinicalTrials.gov (NCT03986879). Graphical abstract.

Reproducibility of 24-h heart rate variability measures in preterm infants born at 28-32 weeks of gestation

AIMS

To determine the reproducibility and minimum detectable change (MDC) of heart rate variability (HRV) measures during two sequential 24-h periods, at week 32 of gestation, in preterm infants born between 28 and 32 weeks, hospitalized in the neonatal intensive care unit (NICU). The second aim is to assess postnatal changes in HRV measures between 32 and 35 weeks.

STUDY DESIGN

32 preterm infants born between 28 and 32 weeks of gestation were recruited. For each infant 48 h of recordings of RR interval were performed at week 32 and week 35. HRV parameters included time and frequency parameters.

RESULTS

At week 32, the intra-class correlation coefficient (ICC) of all HRV values was statistically significant with high correlation coefficients (ICC = 0.83-0.97). At week 35, a significant increase was noted in the HRV parameters, characterize mainly the sympathetic tone, with over half the infants showing an increase greater than the MDC for these parameters.

CONCLUSIONS

Using 24-h recording at week 32 of gestation during NICU routine is reliable, feasible, not costly and may have important implications for an early identification of premature in a state of stress such as sepsis, or as a follow-up measure.

The Source of Heart Rhythm Changes Caused by Swallowing

Swallowing can lead to the development of syncope in people who have difficulty swallowing during food intake. It has shown that even spontaneous saliva swallowing can change heart rate variability (HRV). Recently, it has been suggested that changes in heart rate during swallowing may be caused by respiratory activities. In this study, the hypothesis that swallowing induced HRV are caused from breathing changes during swallowing has been tested. For this purpose, electrocardiogram (ECG), chest circumference (respiration) signals and swallowing sounds were recorded simultaneously from 20 subjects. Subjects were asked not to swallow their saliva in the first 4 min of the experiment and to swallow them several times in the next 4 min. To observe respiratory effects on HRV during swallowing, a detailed cardio-respiratory system mathematical model was used. By applying recorded chest circumference signal to the mathematical model, respiration induced HRV changes were obtained. The HRV parameters of with and without swallowing regions of the real (obtained from ECG) and model-HRV (obtained from mathematical model) were compared by paired Student t test. Statistical differences seen in the real-HRV between the swallowing and non-swallowing regions (SDNN, LF power, approximate entropy) were not observed in the model-HRV. Considering that the only factor constituting HRV in the mathematical model is respiration, it was concluded that swallowing changes HRV with a mechanism other than breathing changes.

Development and validation of an integrated portable heart rate variability (HRV) analysis system - STREME

In this paper, we introduce an integrated, portable, affordable and simple to use heart rate variability (HRV) analysis tool STREME. The system consists of an ECG acquisition device and software for HRV analysis. We assessed the reliability and validity of using STREME against the reference standards RMS VarioWin and Kubios HRV for the short term HRV analysis. The validation study was carried out with the participation of 46 healthy subjects that included 15 men and 31 women with an average age of 27.67 ± 7.75yrs. The results showed that there is a significantly strong correlation (r > 0.95, p < 0.001) between STREME and reference systems in HRV indices. The Bland-Altman analysis of all features computed from STREME and reference system represent a close agreement for all the parameters. Hence STREME HRV analysis tool can be recommended to researchers and other professionals for the evaluation of autonomic function using short term HRV.

Reliability of short-term measurements of heart rate variability: Findings from a longitudinal study

Research on heart rate variability (HRV) received increasing attention. This study analysed the reliability of the most common HRV parameters for baseline measurements. 103 healthy students (83 women, M = 21.72 ± 3.31 years) participated in five short-term HRV sessions, each including supine, sitting, and standing positions, respectively, spanning a time interval of eleven months. Relative reliability was evaluated by intraclass correlation coefficients, and absolute reliability by standard errors of measurement, smallest real differences, and 95 % limits of random variation. No systematic mean differences between measurements emerged. Intraclass correlation coefficients were quite low (supine: .49-.64, sitting: .40-.57, standing: .35-.56). Absolute reliability indicators revealed pronounced variations between test and retest. Influences of posture and time between measurements on reliability were small and unsystematic. We conclude that such high levels of within-subjects variability in HRV measurements (a) hamper the detection of changes over time, and (b) should be considered carefully in future analyses.

Short-term Heart-rate Variability in Healthy Small and Medium-sized Dogs Over a Five-minute Measuring Period

Introduction

Five-minute heart-rate variability (HRV) measurement is a useful tool for assessing the autonomic nervous system (ANS) balance in humans, but there are no studies on healthy dogs. The aim of the study was, therefore, to provide the reference ranges in small and medium-sized breeds for short-term HRV time and frequency domain (TFD) analyses.

Material and Methods

A total of 79 healthy dogs were included in the study between 2015 and 2019. Grouping by age with the breakpoint at six years and subgrouping by reproductive status and sex was imposed. All the dogs were included after physical and cardiological examinations and blood analyses. The TFD of HRV were analysed from a five-minute-long digital ECG recording after removal of non-sinus complexes.

Results

There were no statistically significant differences in any TFD parameters between age, reproductive status or sex groups. A mild increase in all time domain parameters and the high-frequency (HF) band was observed in older dogs, and the low frequency (LF):HF ratio decreased in these dogs. In males, the time domain parameters and HF band increased slightly.

Conclusion

The normal ranges for HRV derived from short-term ECG recording in the usual clinical environment now have proposed reference ranges. Our findings suggest that accommodation time, age, sex, or reproductive status do not influence the results derived from these recordings, indicating that this method is reliable for assessing the ANS function in small and medium-sized dog breeds.

Soluble interleukin-6 receptor in young adults and its relationship with body composition and autonomic nervous system

BACKGROUND

The immune system generates inflammatory responses through cytokines like Interleukin 6 (IL-6) and the Tumor Necrosis Factor alpha (TNF α); these cytokines mediate cellular responses aided by the presence of soluble receptors such as: Soluble Interleukin 6 Receptor (sIL6R) and Soluble Tumor Necrosis Factor Receptors Type 1 and 2 (sTNFR1, sTNFR2); the literature is limited about the relationship between this cytokines and the role of its soluble receptors.

OBJECTIVES

This study is to determine a possible relationship between specific inflammatory markers and their soluble receptors with the autonomic nervous system's activity and body composition.

METHODS

27 subjects (13 men of 19.3 ± 1.6 years old and 14 women of 19.1 ± 1.7 years old) were evaluated. Body composition, autonomic nervous system activity and plasma concentration of inflammatory markers IL-6, TNF α, sIL6R, sTNFR1 and sTNFR2 were measured using bio-impedance, heart rate variability and ELISA respectively.

RESULTS

A positive association between body-fat percentage and the sIL6R (0.47, p = .013) as well as inverse relationship between muscular mass and the sIL6R (-0.45, p = .019) were found. The sIL6R was also positively correlated with sympathetic activity markers: Relation LF/HF (0.52, p = .006), cardiac sympathetic index (0.45, p = .008), and cardiac vagal index (-0.44, p = .022).

CONCLUSION

This study suggested that the IL-6 trans-signaling involving both the soluble receptor, sIL6R, and gp130 membrane co-receptor could produce inflammatory responses that generate an impact on the autonomic nervous system, possibly due to its direct action on the hypothalamus, the solitary tract nucleus, or the heart.

Autonomic reactivity during reading of a somatic distress script in patients with somatic symptom disorder

OBJECTIVE

The relationship between resting-state heart rate variability (HRV) and somatic symptom disorder (SSD) has been explored in several studies. We planned to examine HRV during the performance of psychological tasks, and assumed that it could be applied for the diagnosis of SSD.

METHODS

Fifty-three patients with SSD and 52 healthy controls were recruited. Demographic and psychological data were collected. Subjects' HRV was measured over five 5-minute blocks during which they viewed different scripts (resting state; health anxiety; somatic distress; depression; neutral topic). After each block they completed a self-assessment manikin. Generalized estimated equation analysis was used to analyze the impact of mental scripts, SSD and sex on physiological and psychological indicators.

RESULTS

In men there was a script*SSD interaction concerning high-frequency power (HF) involving the neutral script; SSD men showed significantly higher HF than healthy men when viewing neutral script. In women there were script*SSD interactions with respect to low-frequency power (LF) and HF involving the somatic distress script and a script*SSD interaction with respect to LF and emotional valence involving the neutral script; SSD women revealed significantly lower LF and HF than healthy women when viewing somatic distress script, they also showed significantly lower LF and higher valence than healthy ones during neutral script. The somatic distress script*SSD interaction still influenced LF and HF in women after adjusting for potential confounders.

CONCLUSION

In women cue-specific HRV is a better method of differentiating people with SSD from healthy individuals than resting-state HRV.

TRIAL REGISTRATION INFORMATION

The Research Ethics Committee of National Taiwan University Hospital approved this study (approval number: 201410050RINB).

Human behavior during close contact in a graduate student office

Close contact is a part of daily life, and proximity is known to play a primary role in the transmission of many respiratory infections. However, there are no data on close contact parameters such as movement of the head/body and relative location, which can affect both expiration and inspiration flows. Using video cameras, we collected such data for nearly 63 000 seconds of total close contact duration in a graduate student office in Beijing, China. Each student had on average 9.6 close contacts per hour and spent 9.9% of their time participating in close contact interactions. Males made more body/head movements than females during close contact. The probability distribution of interpersonal distance follows a log-normal distribution. The average interpersonal distance was 0.67 m. Students preferred a relative face orientation angle between 15° and 45°. When the relative face orientation angle increased, the interpersonal distance increased. Students had a high probability (73%-97%) of maintaining their head, body, and relative position during close contact, while the probability of body/head or relative position changing from any location/angle to another is also given. These data may be used for assessment of infection risk via close contact in crowded indoor environments.

Heart rate (variability) and the association between relational peer victimization and internalizing symptoms in elementary school children

Relational victimization typically emerges first during the elementary school period, and has been associated with increased levels of internalizing symptoms in children. Individual differences in autonomic nervous system functioning have been suggested as a potential factor linking social stressors and internalizing symptoms. The aim of this study was therefore to examine whether heart rate and heart rate variability mediated the association between relational victimization and internalizing symptoms in 373 mainstream elementary school children. Children were assessed in 2015 (T0; Grades 3–5, M age = 9.78 years, 51% boys) and reassessed in 2016 (T1). Heart rate and heart rate variability were assessed during a regular school day at T1. A multi-informant (teacher and peer report) cross-time measure of relational victimization, and a multi-informant (self- and teacher report) measure of internalizing problems at T1 was used. Results showed that heart rate variability, but not heart rate, mediated the association between relational victimization and internalizing symptoms. This study provides tentative support that in children from a general population sample, a psychobiological factor may mediate the association of relational victimization with internalizing symptoms.

The Pulse-Respiration Quotient: A Powerful but Untapped Parameter for Modern Studies About Human Physiology and Pathophysiology

A specific and unique aspect of cardiorespiratory activity can be captured by dividing the heart rate (HR) by the respiration rate (RR), giving the pulse-respiration quotient (PRQ = HR/RR). In this review article, we summarize the main findings of studies using and investigating the PRQ. We describe why the PRQ is a powerful parameter that captures complex regulatory states of the cardiorespiratory system, and we highlight the need to re-introduce the use of this parameter into modern studies about human physiology and pathophysiology. In particular, we show that the PRQ (i) changes during human development, (ii) is time-dependent (ultradian, circadian, and infradian rhythms), (iii) shows specific patterns during sleep, (iv) changes with physical activity and body posture, (v) is linked with psychophysical and cognitive activity, (vi) is sex-dependent, and (vii) is determined by the individual physiological constitution. Furthermore, we discuss the medical aspects of the PRQ in terms of applications for disease classification and monitoring. Finally, we explain why there should be a revival in the use of the PRQ for basic research about human physiology and for applications in medicine, and we give recommendations for the use of the PRQ in studies and medical applications.

Match Fatigue Time-Course Assessment Over Four Days: Usefulness of the Hooper Index and Heart Rate Variability in Professional Soccer Players

The aims of the present study were to (a) examine recovery time-course and (b) analyze the usefulness of the Hooper-Index (wellness index) and resting heart rate variability (HRV) in professional soccer players during an in-season phase. The Hooper-Index and resting HRV were collected on matchday and on the four following days in three consecutive in-season weeks in nine players (25.2 ± 4.3-years). The usefulness of monitoring variables was assessed by (a) comparing noise (typical error, TE) to the smallest worthwhile change (SWC) (TE/SWC) and (b) comparing match-related changes (i.e., signal) to TE (i.e., signal-to-noise ratio). Between-days standardized differences in the changes of Hooper-Index and HRV were compared to the SWC using magnitude-based inferences. The magnitudes of TE were small and moderate for the Hooper-Index and HRV, respectively. The Hooper-Index showed to be more useful than HRV for monitoring match-induced fatigue as having a lower TE/SWC (3.1 versus 4.4) and a higher signal-to-noise ratio (5.5 versus 1.5). Small-to-very large [range of effect sizes, 0.48; 2.43, confidence limits (0.22; 2.91)] and moderate-to-large [-1.71; -0.61 (-2.44; -0.03)] detrimental changes in Hooper-Index and HRV, respectively, were observed on the days following matchday. While group analyses showed a similar pattern for recovery time-course, more individual players responded, similarly when tracked using the Hooper -Index compared to when they were tracked using HRV. An inverse moderate within-individual relationship was observed between changes in the Hooper index and HRV [r = -0.41, (-0.60, 0.18)]. The Hooper index is an easy-to-use, no-cost, and non-invasive monitoring tool and seems promising for tracking match-induced fatigue during in the season in professional soccer.

Relationship Between Exercise-induced Oxidative Stress Changes and Parasympathetic Activity in Chronic Fatigue Syndrome: An Observational Study in Patients and Healthy Subjects

PURPOSE

Oxidative stress has been proposed as a contributor to pain in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). During incremental exercise in patients with ME/CFS, oxidative stress enhances sooner and antioxidant response is delayed. We explored whether oxidative stress is associated with pain symptoms or pain changes following exercise, and the possible relationships between oxidative stress and parasympathetic vagal nerve activity in patients with ME/CFS versus healthy, inactive controls.

METHODS

The present study reports secondary outcomes from a previous work. Data from 36 participants were studied (women with ME/CFS and healthy controls). Subjects performed a submaximal exercise test with continuous cardiorespiratory monitoring. Levels of thiobarbituric acid-reactive substances (TBARSs) were used as a measure of oxidative stress, and heart rate variability was used to assess vagal activity. Before and after the exercise, subjects were asked to rate their pain using a visual analogic scale.

FINDINGS

Significant between-group differences in pain at both baseline and following exercise were found (both, P < 0.007). In healthy controls, pain was significantly improved following exercise (P = 0.002). No change in oxidative stress level after exercise was found. Significant correlation between TBARS levels and pain was found at baseline (r = 0.540; P = 0.021) and after exercise (r = 0.524; P = 0.024) in patients only. No significant correlation between TBARS and heart rate variability at baseline or following exercise was found in either group. However, a significant correlation was found between exercise-induced changes in HRV and TBARS in healthy controls (r = -0.720; P = 0.001).

IMPLICATIONS

Oxidative stress showed an association with pain symptoms in people with ME/CFS, but no exercise-induced changes in oxidative stress were found. In addition, the change in parasympathetic activity following exercise partially accounted for the change in oxidative stress in healthy controls. More research is required to further explore this link.

Beyond Self-Report: A Review of Physiological and Neuroscientific Methods to Investigate Consumer Behavior

The current paper investigates the value and application of a range of physiological and neuroscientific techniques in applied marketing research and consumer science, highlighting new insights from research in social psychology and neuroscience. We review measures of sweat secretion, heart rate, facial muscle activity, eye movements, and electrical brain activity, using techniques including skin conductance, pupillometry, eyetracking, and magnetic brain imaging. For each measure, after a brief explanation of the underlying technique, we illustrate concepts and mechanisms that the measure allows researchers in marketing and consumer science to investigate, with a focus on consumer attitudes and behavior. By providing reviews on recent research that applied these methods in consumer science and relevant related fields, we also highlight methodological and theoretical strengths and limitations, with an emphasis on ecological validity. We argue that the inclusion of physiological and neuroscientific techniques can advance consumer research by providing insights into the often unconscious mechanisms underlying consumer behavior. Therefore, such technologies can help researchers and marketing practitioners understand the mechanisms of consumer behavior and improve predictions of consumer behavior.

Artificial-Intelligence-Based Prediction of Clinical Events among Hemodialysis Patients Using Non-Contact Sensor Data

Non-contact sensors are gaining popularity in clinical settings to monitor the vital parameters of patients. In this study, we used a non-contact sensor device to monitor vital parameters like the heart rate, respiration rate, and heart rate variability of hemodialysis (HD) patients for a period of 23 weeks during their HD sessions. During these 23 weeks, a total number of 3237 HD sessions were observed. Out of 109 patients enrolled in the study, 78 patients reported clinical events such as muscle spasms, inpatient stays, emergency visits or even death during the study period. We analyzed the sensor data of these two groups of patients, namely an event and no-event group. We found a statistically significant difference in the heart rates, respiration rates, and some heart rate variability parameters among the two groups of patients when their means were compared using an independent sample t-test. We further developed a supervised machine-learning-based prediction model to predict event or no-event based on the sensor data and demographic information. A mean area under curve (ROC AUC) of 90.16% with 96.21% mean precision, and 88.47% mean recall was achieved. Our findings point towards the novel use of non-contact sensors in clinical settings to monitor the vital parameters of patients and the further development of early warning solutions using artificial intelligence (AI) for the prediction of clinical events. These models could assist healthcare professionals in taking decisions and designing better care plans for patients by early detecting changes to vital parameters.

Transmission of Influenza A in a Student Office Based on Realistic Person-to-Person Contact and Surface Touch Behaviour

Influenza A viruses result in the deaths of hundreds of thousands of individuals worldwide each year. In this study, influenza A transmission in a graduate student office is simulated via long-range airborne, fomite, and close contact routes based on real data from more than 3500 person-to-person contacts and 127,000 surface touches obtained by video-camera. The long-range airborne, fomite and close contact routes contribute to 54.3%, 4.2% and 44.5% of influenza A infections, respectively. For the fomite route, 59.8%, 38.1% and 2.1% of viruses are transmitted to the hands of students from private surfaces around the infected students, the students themselves and other susceptible students, respectively. The intranasal dose via fomites of the students' bodies, belongings, computers, desks, chairs and public facilities are 8.0%, 6.8%, 13.2%, 57.8%, 9.3% and 4.9%, respectively. The intranasal dose does not monotonously increase or decrease with the virus transfer rate between hands and surfaces. Mask wearing is much more useful than hand washing for control of influenza A in the tested office setting. Regular cleaning of high-touch surfaces, which can reduce the infection risk by 2.14%, is recommended and is much more efficient than hand-washing.

Heart Rate and Heart Rate Variability during Sleep in Family Dogs (Canis familiaris). Moderate Effect of Pre-Sleep Emotions

Simple Summary

It is common knowledge that negative emotions in humans are accompanied by both impaired subjective experience as well as maladaptive changes in behavior and physiology. The present paper investigates heart rate—one of the most commonly used emotion-related physiology measures—in the family dog, with the aim of uncovering its potential relationship with emotions. Sleep recordings were conducted following a positive versus a negative social interaction, as sleep alternations are one of the most conspicuous changes in response to negative affect. We observed differences in heart rate following the positive versus negative interactions, however these were only apparent during wakefulness, but not during sleep.

Abstract

The domestic dog (Canis familiaris) has been shown to both excel in recognising human emotions and produce emotion-related vocalisations and postures that humans can easily recognise. However, little is known about the effect of emotional experiences on subsequent sleep physiology, a set of phenomena heavily interrelated with emotions in the case of humans. The present paper examines heart rate (HR) and heart rate variability (HRV) during dogs’ sleep, measures that are influenced by both positive and negative emotions in awake dogs. In Study I, descriptive HR and HRV data is provided on N = 12 dogs about the different sleep stages (wake, drowsiness, non-rapid eye movement (non-REM), REM; scoring based on electroencephalogram (EEG) data). We conclude that wakefulness is characterised by higher HR and lower HRV compared to all sleep stages. Furthermore, drowsiness is characterised by higher HR and lower HRV than non-REM and REM, but only if the electrocardiogram (ECG) samples are taken from the first occurrence of a given sleep stage, not when the longest periods of each sleep stage are analysed. Non-REM and REM sleep were not found to be different from each other in either HR or HRV parameters. In Study II, sleep HR and HRV measures are compared in N = 16 dogs after a positive versus negative social interaction (within-subject design). The positive social interaction consisted of petting and ball play, while the negative social interaction was a mixture of separation, threatening approach and still face test. Results are consistent with the two-dimensional emotion hypothesis in that following the intense positive interaction more elevated HR and decreased HRV is found compared to the mildly negative (lower intensity) interaction. However, although this trend can be observed in all sleep stages except for REM, the results only reach significance in the wake stage. In sum, the present findings suggest that HR and HRV are possible to measure during dogs’ sleep, and can potentially be used to study the effect of emotions not only during but also after such interactions.

Short-Term Test-Retest Reliability of Respiratory Sinus Arrhythmia (RSA) in Young Adults

Abstract. Despite the burgeoning use of respiratory sinus arrhythmia (RSA), heart period (HP), and blood pressure (BP) to study individual differences in autonomic regulatory processes in young adults, few studies have examined the short-term reliability of such autonomic measures in emerging adulthood. If resting autonomic measures indeed reflect “trait-like” individual differences, they should have acceptable levels of test-retest reliability. We examined the 1-month test-retest reliability of resting measures of RSA as well as HP, systolic (SBP) and diastolic blood pressure (DBP) in a sample of 41 healthy young adults. Test-retest reliability of all four measures was good-to-excellent across the 1-month period. However, uncontrolled mean RSA declined from Time 1 to Time 2, suggesting that while individual differences in RSA were stable, mean RSA appeared to be sensitive to condition effects. Even with random variation, all of these measures were stable across one month, demonstrating acceptable short-term test-retest reliability in emerging adulthood.

Association between diabetic peripheral neuropathy and heart rate variability in subjects with type 2 diabetes

AIM

This study evaluated the association of Heart rate variability (HRV) measurements with diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes.

METHODS

This study included 102 Korean subjects with type 2 diabetes. The Michigan neuropathy screening instrument (MNSI) questionnaire score, the MNSI examination score (MNSIES) and the total symptom score were examined for DPN evaluation. Noninvasive HRV measurements were performed using photoelectric plethysmography. Patients with a MNSIES > 2 were considered to have DPN.

RESULTS

The MNSIES showed significant negative associations with the high frequency (HF) (r = -0.212, p = 0.033) and low frequency (LF) (r = -0.286, p = 0.004) powers. Multiple linear regression analysis revealed that only HF power maintained a significant negative association with the MNSIES (β = -0.184; 95% CI -0.365 to -0.003; p = 0.047), after controlling for significant related confounders, with HRV parameters in male patients with type 2 diabetes. The HF (p = 0.010) and LF (p = 0.025) powers differed significantly between male patients without and those with DPN according to the MNSIES.

CONCLUSIONS

This study revealed a negative association of DPN, as assessed by the MNSIES, with HF power in male patients with type 2 diabetes. DPN defined by foot examination was predictive of cardiac autonomic neuropathy.

Diminution of Heart Rate Variability in Bipolar Depression

Autonomic nervous system (ANS) dysregulation in depression is associated with symptoms associated with the ANS. The beat-to-beat pattern of heart rate defined as heart rate variability (HRV) provides a noninvasive portal to ANS function and has been proposed to represent a means of quantifying resting vagal tone. We quantified HRV in bipolar depressed (BDD) patients as a measure of ANS dysregulation seeking to establish HRV as a potential diagnostic and prognostic biomarker for treatment outcome. Forty-seven BDD patients were enrolled. They were randomized to receive either escitalopram-celecoxib or escitalopram-placebo over 8 weeks in a double-blind study design. Thirty-five patients completed the HRV studies. Thirty-six healthy subjects served as controls. HRV was assessed at pretreatment and end of study and compared with that of controls. HRV was quantified and corrected for artifacts using an algorithm that incorporates time and frequency domains to address non-stationarity of the beat-to-beat heart rate pattern. Baseline high frequency-HRV (i.e., respiratory sinus arrhythmia) was lower in BDD patients than controls, although the difference did not reach significance. Baseline low-frequency HRV was significantly lower in BDD patients (ln4.20) than controls (ln = 5.50) (p < 0.01). Baseline heart period was significantly shorter (i.e., faster heart rate) in BDD patients than controls. No significant change in HRV parameters were detected over the course of the study with either treatment. These findings suggest that components of HRV may be diminished in BDD patients.

A Meta-Analysis on Sex Differences in Resting-State Vagal Activity in Children and Adolescents

Lower vagal activity is associated with psychopathology independent of age. Research suggests that alterations of vagal activity precede the development of psychopathology. The present review aimed to quantify sex differences in vagal activity in children and adolescents. Studies reporting on sex differences on measures of vagally-mediated heart rate variability derived from short-term recordings under resting conditions in boys and girls were included. Drawing on data from more than 5,000 children and adolescents, we provide evidence that healthy young girls display lower vagal activity and greater mean heart rate compared to boys, a finding that may have implications for risk associated with the development of internalizing psychopathology and somatic ill-health.

HEART RATE VARIABILITY AND BODY COMPOSITION AS VO2MAX DETERMINANTS

ABSTRACT Introduction: The maximum oxygen consumption (VO2max) is the gold standard in the cardiorespiratory endurance assessment. Objective: This study aimed to develop a mathematical model that contains variables to determine the VO2max of sedentary people. Methods: Twenty participants (10 men and 10 women) with a mean age of 19.8±1.77 years were included. For each participant, body composition (percentage of fat and muscle), heart rate variability (HRV) at rest (supine and standing), and VO2max were evaluated through an indirect test on a cycloergometer. A multivariate linear regression model was developed from the data obtained, and the model assumptions were verified. Results: Using the data obtained, including percentage of fat (F), percentage of muscle (M), percentage of power at very low frequency (VLF), α-value of the detrended fluctuation analysis (DFAα1), heart rate (HR) in the resting standing position, and age of the participants, a model was established for men, which was expressed as VO2max = 4.216 + (Age*0.153) + (F*0.110) - (M*0.053) - (VLF*0.649) - (DFAα1*2.441) - (HR*0.014), with R2 = 0.965 and standard error = 0.146 L/min. For women, the model was expressed as VO2max = 1.947 - (Age*0.047) + (F*0.024) + (M*0.054) + (VLF*1.949) - (DFAα1*0.424) - (HR*0.019), with R2 = 0.987 and standard error = 0.077 L/min. Conclusion: The obtained model demonstrated the influence exerted by body composition, the autonomic nervous system, and age in the prediction of VO2max.

Vagally Mediated Heart Rate Variability Promotes the Perception of Paradoxical Pain

Abstract. Self-regulation mechanisms are governed by prefrontal inhibitory processes and play a crucial role in the modulation of pain. In the present study the thermal grill paradigm was used to investigate the association of vagally mediated resting heart rate variability, a psychophysiological marker of trait self-regulatory capacity, with paradoxical pain sensations induced by non-noxious stimulation. This thermal grill illusion is only perceived by part of the tested individuals. The mechanisms underlying the observed interindividual differences in paradoxical pain sensitivity are largely unknown. During the experimental task, a temperature combination of 15 °C and 41 °C was set at the glass tubes of the thermal grill. The 52 healthy participants placed their dominant hand on the grill for a duration of one min. The magnitude of sensory and affective pain sensations perceived during stimulation was assessed with numerical rating scales. Before stimulation, a short-term electrocardiogram was recorded to compute vagally mediated heart rate variability at rest. Logistic regression analyses revealed that participants with higher vagal tone were significantly more likely to perceive the thermal grill illusion than subjects displaying lower resting heart rate variability. Paradoxical pain sensations were primarily predicted by normalized respiratory sinus arrhythmia. Our results confirm that the magnitude of vagally mediated resting heart rate variability is associated with the individual disposition to illusive pain perceptions. Since the latter is considered to be a marker of trait self-regulation ability, the present findings may corroborate and complement previous evidence for an impact of psychological characteristics on paradoxical pain sensitivity.

Resting Heart Rate Variability Among Professional Baseball Starting Pitchers

Cornell, DJ, Paxson, JL, Caplinger, RA, Seligman, JR, Davis, NA, and Ebersole, KT. Resting heart rate variability among professional baseball starting pitchers. J Strength Cond Res 31(3): 575-581, 2017-The purpose of this study was to examine the changes in resting heart rate variability (HRV) across a 5-day pitching rotation schedule among professional baseball starting pitchers. The HRV data were collected daily among 8 Single-A level professional baseball starting pitchers (mean ± SD, age = 21.9 ± 1.3 years; height = 185.4 ± 3.6 cm; weight = 85.2 ± 7.5 kg) throughout the entire baseball season with the participant quietly lying supine for 10 minutes. The HRV was quantified by calculating the natural log of the square root of the mean sum of the squared differences (lnRMSSD) during the middle 5 minutes of each R-R series data file. A split-plot repeated-measures analysis of variance was used to examine the influence of pitching rotation day on resting lnRMSSD. A statistically significant main effect of rotation day was identified (F4,706 = 3.139, p = 0.029). Follow-up pairwise analyses indicated that resting lnRMSSD on day 2 was significantly (p ≤ 0.05) lower than all other rotation days. In addition, a statistically significant main effect of pitcher was also identified (F7,706 = 83.388, p < 0.001). These results suggest that professional baseball starting pitchers display altered autonomic nervous system function 1 day after completing a normally scheduled start, as day 2 resting HRV was significantly lower than all other rotation days. In addition, the season average resting lnRMSSD varied among participants, implying that single-subject analysis of resting measures of HRV may be more appropriate when monitoring cumulative workload among this cohort population of athletes.