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Lu L, Zhu T, Morelli D, Creagh A, Liu Z, Yang J, Liu F, Zhang YT, Clifton DA. Uncertainties in the Analysis of Heart Rate Variability: A Systematic Review. IEEE Rev Biomed Eng 2024; 17:180-196. [PMID: 37186539 DOI: 10.1109/rbme.2023.3271595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Heart rate variability (HRV) is an important metric with a variety of applications in clinical situations such as cardiovascular diseases, diabetes mellitus, and mental health. HRV data can be potentially obtained from electrocardiography and photoplethysmography signals, then computational techniques such as signal filtering and data segmentation are used to process the sampled data for calculating HRV measures. However, uncertainties arising from data acquisition, computational models, and physiological factors can lead to degraded signal quality and affect HRV analysis. Therefore, it is crucial to address these uncertainties and develop advanced models for HRV analysis. Although several reviews of HRV analysis exist, they primarily focus on clinical applications, trends in HRV methods, or specific aspects of uncertainties such as measurement noise. This paper provides a comprehensive review of uncertainties in HRV analysis, quantifies their impacts, and outlines potential solutions. To the best of our knowledge, this is the first study that presents a holistic review of uncertainties in HRV methods and quantifies their impacts on HRV measures from an engineer's perspective. This review is essential for developing robust and reliable models, and could serve as a valuable future reference in the field, particularly for dealing with uncertainties in HRV analysis.
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Oswald V, Vanhaudenhuyse A, Annen J, Martial C, Bicego A, Rousseaux F, Sombrun C, Harel Y, Faymonville ME, Laureys S, Jerbi K, Gosseries O. Autonomic nervous system modulation during self-induced non-ordinary states of consciousness. Sci Rep 2023; 13:15811. [PMID: 37737222 PMCID: PMC10516905 DOI: 10.1038/s41598-023-42393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023] Open
Abstract
Self-induced cognitive trance (SICT) is a voluntary non-ordinary state of consciousness characterized by a lucid yet narrowed awareness of the external surroundings. It involves a hyper-focused immersive experience of flow, expanded inner imagery, modified somatosensory processing, and an altered perception of self and time. SICT is gaining attention due to its potential clinical applications. Similar states of non-ordinary state of consciousness, such as meditation, hypnosis, and psychedelic experiences, have been reported to induce changes in the autonomic nervous system. However, the functioning of the autonomic nervous system during SICT remains poorly understood. In this study, we aimed to investigate the impact of SICT on the cardiac and respiratory signals of 25 participants proficient in SICT. To accomplish this, we measured various metrics of heart rate variability (HRV) and respiration rate variability (RRV) in three conditions: resting state, SICT, and a mental imagery task. Subsequently, we employed a machine learning framework utilizing a linear discriminant analysis classifier and a cross-validation scheme to identify the features that exhibited the best discrimination between these three conditions. The results revealed that during SICT, participants experienced an increased heart rate and a decreased level of high-frequency (HF) HRV compared to the control conditions. Additionally, specific increases in respiratory amplitude, phase ratio, and RRV were observed during SICT in comparison to the other conditions. These findings suggest that SICT is associated with a reduction in parasympathetic activity, indicative of a hyperarousal state of the autonomic nervous system during SICT.
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Affiliation(s)
- Victor Oswald
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Avenue de l'Hôpital 1, B34, 4000, Liège, Belgium.
- Cognitive and Computational Neuroscience Lab, Psychology Département, University of Montréal, Montreal, Canada.
| | - Audrey Vanhaudenhuyse
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Avenue de l'Hôpital 1, B34, 4000, Liège, Belgium.
- Interdisciplinary Algology Center, CHU, University Hospital of Liège, B35, Liège, Belgium.
| | - Jitka Annen
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Aminata Bicego
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Avenue de l'Hôpital 1, B34, 4000, Liège, Belgium
| | - Floriane Rousseaux
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Avenue de l'Hôpital 1, B34, 4000, Liège, Belgium
| | | | - Yann Harel
- Cognitive and Computational Neuroscience Lab, Psychology Département, University of Montréal, Montreal, Canada
| | - Marie-Elisabeth Faymonville
- Interdisciplinary Algology Center, CHU, University Hospital of Liège, B35, Liège, Belgium
- Arsène Burny Center, Hospital of Liège University, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, Hospital of Liège University, Avenue de l'Hôpital 1, B34, 4000, Liège, Belgium
- CERVO Research Institute, Laval University, Quebec, Canada
| | - Karim Jerbi
- Cognitive and Computational Neuroscience Lab, Psychology Département, University of Montréal, Montreal, Canada
| | - Olivia Gosseries
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Avenue de l'Hôpital 1, B34, 4000, Liège, Belgium.
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.
- Centre du Cerveau, Hospital of Liège University, Avenue de l'Hôpital 1, B34, 4000, Liège, Belgium.
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Beranbaum S, Kouri N, Van der Merwe N, DePierro VK, D’Andrea W. Behavioral and Biological Indicators of Risk and Well-Being in a Sample of South African Youth. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:163-172. [PMID: 37234824 PMCID: PMC10205918 DOI: 10.1007/s40653-021-00426-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 05/28/2023]
Abstract
Self report measures have been widely used in research to illustrate high rates of exposure to violence among youth in trauma-saturated regions, such as Cape Town, South Africa. To better understand the risk and resilience factors of youth who have been exposed to, witnessed, or directly experienced violence, the current study used a multi-method assessment in a naturalistic setting that included heart rate variability (an index of regulatory flexibility and cardiovascular health), a computerized risk-taking task, and self report measures. Youth (N = 83) from Cape Town, South Africa, participated in a psychobiological assessment. Findings suggest elevated age-adjusted heart rate variability compared to age related norms, which is indicative of overregulation of behavior and emotion. Additionally, youth, all of whom had witnessed or experienced violence at least once, demonstrated a low risk taking and reward seeking propensity. Low risk taking in the context of elevated heart rate variability may reflect youth's affective and behavioral inhibition, suggestive of stress among children who have an overgeneralized threat response. These results both demonstrate the feasibility of psychophysiological research in community youth settings, and counter the traditional narrative that there is an overarching lack of capacity to regulate and a high propensity to risk in violence-exposed youth. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-021-00426-1.
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Comparing prenatal and postpartum stress among women with previous adverse pregnancy outcomes and normal obstetric histories: A longitudinal cohort study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100820. [PMID: 36774741 DOI: 10.1016/j.srhc.2023.100820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/24/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The aim of this study was to compare subjectively and objectively measured stress during pregnancy and the three months postpartum in women with previous adverse pregnancy outcomes and women with normal obstetric histories. METHODS We recruited two cohorts in southwestern Finland for this longitudinal study: (1) pregnant women (n = 32) with histories of preterm births or late miscarriages January-December 2019 and (2) pregnant women (n = 30) with histories of full-term births October 2019-March 2020. We continuously measured heart rate variability (HRV) using a smartwatch from 12 to 15 weeks of pregnancy until three months postpartum, and subjective stress was assessed with a smartphone application. RESULTS We recruited the women in both cohorts at a median of 14.2 weeks of pregnancy. The women with previous adverse pregnancy outcomes delivered earlier and more often through Caesarean section compared with the women with normal obstetric histories. We found differences in subjective stress between the cohorts in pregnancy weeks 29 and 34. The cohort of women with previous adverse pregnancy outcomes had a higher root mean square of successive differences between normal heartbeats (RMSSD), a well-known HRV parameter, compared with the other cohort in pregnancy weeks 26 (64.9 vs 55.0, p = 0.04) and 32 (63.0 vs 52.3, p = 0.04). Subjective stress did not correlate with HRV parameters. CONCLUSIONS Women with previous adverse pregnancy outcomes do not suffer from stress in subsequent pregnancies more than women with normal obstetric histories. Healthcare professionals need to be aware that interindividual variation in stress during pregnancy is considerable.
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Angelopoulou K, Zaverdinou E, Bacopoulou F, Chrousos GP, Giannakakis G, Kanaka-Gantenbein C, Mavrogeni S, Charalampopoulou M, Katimertzi M, Darviri C. The Effect of Pythagorean Self-Awareness on Heart Rate Variability, Perceived Stress and Behavior of Preschool Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101529. [PMID: 36291465 PMCID: PMC9600468 DOI: 10.3390/children9101529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
Stress is associated with unhealthy habits and non-communicable diseases. It is also linked to communicable diseases due to its impact on immune function. These can be prevented through intervention programs in schools. The aim of this study was to examine the effect of the simplified Pythagorean Self-Awareness Intervention on heart rate variability (HRV) parameters, perceived stress and behaviors of preschool children. The sample of the study consisted of 45 preschool students. A “one group (double) pretest—posttest design” was used, to allow for comparisons of the measurements before and after the intervention. Students were assessed via two questionnaires (“Perceived Stress Scale for Children” (PSS-C) and “Checklist for Screening Behavioral Problems in Preschool Children”) and a photoplethysmographic (PPG) device. The intervention lasted 9 weeks and included practicing of the Pythagorean Self-awareness techniques and the adoption of healthy behaviors. The results showed no statistically significant differences between the two pretests (p > 0.05 for all comparisons) and statistically significant differences between the second pretest and posttest (“Perceived Stress Scale for Children”, (PSS-C) p < 0.0001, “Checklist for Screening Behavioral Problems in Preschool Children” p < 0.0001 and two indices of PPG device: heart rate mean, p < 0.0001, low frequency/very low frequency, p = 0.034). In conclusion, the Pythagorean Self-Awareness Intervention had a beneficial effect on the sample of preschool students examined, as the results showed an improvement in the perceived stress and the HRV parameters tested, and in engaging healthier behaviors, findings that indicate a relaxed psychologic state and a healthier lifestyle.
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Affiliation(s)
- Kyriaki Angelopoulou
- Postgraduate Course of Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
- Correspondence: (K.A.); (E.Z.)
| | - Eleni Zaverdinou
- Postgraduate Course of Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
- Correspondence: (K.A.); (E.Z.)
| | - Flora Bacopoulou
- Postgraduate Course of Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
- Center for Adolescent Medicine, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, National and Kapodistrian University of Athens, 15771 Athens, Greece
- UNESCO Chair in Adolescent Health Care First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - George P. Chrousos
- Postgraduate Course of Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
- Center for Adolescent Medicine, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, National and Kapodistrian University of Athens, 15771 Athens, Greece
- UNESCO Chair in Adolescent Health Care First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
- Unit of Clinical and Translational Research in Endocrinology, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - Giorgos Giannakakis
- Postgraduate Course of Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
- Foundation for Research and Technology—Hellas, 70013 Crete, Greece
| | - Christina Kanaka-Gantenbein
- Postgraduate Course of Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | | | - Maria Charalampopoulou
- Postgraduate Course of Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - Maria Katimertzi
- Postgraduate Course of Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - Christina Darviri
- Postgraduate Course of Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, 15771 Athens, Greece
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Heart rate variability and atrial fibrillation in the general population: a longitudinal and Mendelian randomization study. Clin Res Cardiol 2022:10.1007/s00392-022-02072-5. [PMID: 35962833 DOI: 10.1007/s00392-022-02072-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/20/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Sex differences and causality of the association between heart rate variability (HRV) and atrial fibrillation (AF) in the general population remain unclear. METHODS 12,334 participants free of AF from the population-based Rotterdam Study were included. Measures of HRV including the standard deviation of normal RR intervals (SDNN), SDNN corrected for heart rate (SDNNc), RR interval differences (RMSSD), RMSSD corrected for heart rate (RMSSDc), and heart rate were assessed at baseline and follow-up examinations. Joint models, adjusted for cardiovascular risk factors, were used to determine the association between longitudinal measures of HRV with new-onset AF. Genetic variants for HRV were used as instrumental variables in a Mendelian randomization (MR) analysis using genome-wide association studies (GWAS) summary-level data. RESULTS During a median follow-up of 9.4 years, 1302 incident AF cases occurred among 12,334 participants (mean age 64.8 years, 58.3% women). In joint models, higher SDNN (fully-adjusted hazard ratio (HR), 95% confidence interval (CI) 1.24, 1.04-1.47, p = 0.0213), and higher RMSSD (fully-adjusted HR, 95% CI 1.33, 1.13-1.54, p = 0.0010) were significantly associated with new-onset AF. Sex-stratified analyses showed that the associations were mostly prominent among women. In MR analyses, a genetically determined increase in SDNN (odds ratio (OR), 95% CI 1.60, 1.27-2.02, p = 8.36 × 10-05), and RMSSD (OR, 95% CI 1.56, 1.31-1.86, p = 6.32 × 10-07) were significantly associated with an increased odds of AF. CONCLUSION Longitudinal measures of uncorrected HRV were significantly associated with new-onset AF, especially among women. MR analyses supported the causal relationship between uncorrected measures of HRV with AF. Our findings indicate that measures to modulate HRV might prevent AF in the general population, in particular in women. AF; atrial fibrillation, GWAS; genome-wide association study, IVW; inverse variance weighted, MR; Mendelian randomization, MR-PRESSO; MR-egger and mendelian randomization pleiotropy residual sum and outlier, RMSSD; root mean square of successive RR interval differences, RMSSDc; root mean square of successive RR interval differences corrected for heart rate, SDNN; standard deviation of normal to normal RR intervals, SDNNc; standard deviation of normal to normal RR intervals corrected for heart rate, WME; weighted median estimator. aRotterdam Study n=12,334 bHRV GWAS n=53,174 cAF GWAS n=1,030,836.
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Sarhaddi F, Azimi I, Axelin A, Niela-Vilen H, Liljeberg P, Rahmani AM. Trends in Heart Rate and Heart Rate Variability During Pregnancy and the 3-Month Postpartum Period: Continuous Monitoring in a Free-living Context. JMIR Mhealth Uhealth 2022; 10:e33458. [PMID: 35657667 PMCID: PMC9206203 DOI: 10.2196/33458] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 03/03/2022] [Indexed: 01/16/2023] Open
Abstract
Background Heart rate variability (HRV) is a noninvasive method that reflects the regulation of the autonomic nervous system. Altered HRV is associated with adverse mental or physical health complications. The autonomic nervous system also has a central role in physiological adaption during pregnancy, causing normal changes in HRV. Objective The aim of this study was to assess trends in heart rate (HR) and HRV parameters as a noninvasive method for remote maternal health monitoring during pregnancy and 3-month postpartum period. Methods A total of 58 pregnant women were monitored using an Internet of Things–based remote monitoring system during pregnancy and 3-month postpartum period. Pregnant women were asked to continuously wear Gear Sport smartwatch to monitor their HR and HRV extracted from photoplethysmogram (PPG) signals. In addition, a cross-platform mobile app was used to collect background and delivery-related information. We analyzed PPG signals collected during the night and discarded unreliable signals by applying a PPG quality assessment method to the collected signals. HR, HRV, and normalized HRV parameters were extracted from reliable signals. The normalization removed the effect of HR changes on HRV trends. Finally, we used hierarchical linear mixed models to analyze the trends of HR, HRV, and normalized HRV parameters. Results HR increased significantly during the second trimester (P<.001) and decreased significantly during the third trimester (P=.006). Time-domain HRV parameters, average normal interbeat intervals (IBIs; average normal IBIs [AVNN]), SD of normal IBIs (SDNN), root mean square of the successive difference of normal IBIs (RMSSD), normalized SDNN, and normalized RMSSD decreased significantly during the second trimester (P<.001). Then, AVNN, SDNN, RMSSD, and normalized SDNN increased significantly during the third trimester (with P=.002, P<.001, P<.001, and P<.001, respectively). Some of the frequency-domain parameters, low-frequency power (LF), high-frequency power (HF), and normalized HF, decreased significantly during the second trimester (with P<.001, P<.001, and P=.003, respectively), and HF increased significantly during the third trimester (P=.007). In the postpartum period, normalized RMSSD decreased (P=.01), and the LF to HF ratio (LF/HF) increased significantly (P=.004). Conclusions Our study indicates the physiological changes during pregnancy and the postpartum period. We showed that HR increased and HRV parameters decreased as pregnancy proceeded, and the values returned to normal after delivery. Moreover, our results show that HR started to decrease, whereas time-domain HRV parameters and HF started to increase during the third trimester. The results also indicated that age was significantly associated with HRV parameters during pregnancy and postpartum period, whereas education level was associated with HRV parameters during the third trimester. In addition, our results demonstrate the possibility of continuous HRV monitoring in everyday life settings.
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Affiliation(s)
| | - Iman Azimi
- Department of Computing, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
- Department of Obstetrics and Gynaecology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | | | - Pasi Liljeberg
- Department of Computing, University of Turku, Turku, Finland
| | - Amir M Rahmani
- Department of Computer Science, University of California, Irvine, Irvine, CA, United States
- School of Nursing, University of California, Irvine, Irvine, CA, United States
- Institute for Future Health, University of California, Irvine, Irvine, CA, United States
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Cardiac Evaluation of Exercise Testing in a Contemporary Population of Preschool Children: A New Approach Providing Reference Values. CHILDREN 2022; 9:children9050654. [PMID: 35626831 PMCID: PMC9139640 DOI: 10.3390/children9050654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/26/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022]
Abstract
The objective of this study was to evaluate cardiac autonomic function at rest, during maximal exercise, and in post-exercise recovery, to determine sex-specific and age-specific differences in resting heart rate (RHR), linear and spectral parameters of Heart Rate Variability (HRV), HRpeak, and heart rate recovery (HRR) after one and five minutes, in preschool children. This study involved a cohort of 167 healthy children (79 girls) aged 3 to 6 years that were selected from several schools in southern Spain. A 10 × 20 m test was conducted, and the cardiovascular response was recorded. No significant differences were found in all variables between the sexes. However, a significant reduction in RHR and an increase in HRR were found from age 4 to age 6. HRV parameters at rest were higher in older children. No associations between 10 × 20 m performance, weight status, and cardiac parameters were found. Simple linear regression analysis revealed that heart rate reserve (HRr), HRR5min, RMSSD, and HF were the variables that showed association with all HR parameters. There was also a significant correlation between HRr and HRR5min. In conclusion, cardiovascular autonomic function during rest, exercise, and recovery in Spanish preschool children was not influenced by sex, although older children showed greater cardiovascular modulation. Cardiorespiratory fitness status was not associated with HR response.
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Heart Rate Variability during Auricular Acupressure at Heart Point in Healthy Volunteers: A Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1019029. [PMID: 35509626 PMCID: PMC9060987 DOI: 10.1155/2022/1019029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022]
Abstract
Heart rate variability (HRV) is the variation in time between each heartbeat. Increasing HRV may contribute to improving autonomic nervous system dysfunctions. Acupuncture stimulation through the vagus plexus in the ear is considered as a method that can improve HRV. In this pilot study, we examined 114 healthy volunteers at the Faculty of Traditional Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, from January to May 2020. During a 20-minute interval, participants were stimulated two times at the acupoint in the left ear with Semen seed. The heart rate and HRV values were monitored before, during, and after acupressure every 5 minutes. When we compared the experimental group with the control group, HRV significantly increased in the stage of ear-stimulated acupressure compared with the stage before and after the auricular acupressure (p=0.01, p=0.04, p=0.04 and p=0.02) and the difference was not statistically significant compared with the phase of nonstimulated (p=0.15, p=0.28). The changes in other values including SDNN (standard deviation of the average NN), RMSSD (root mean square of successive RR interval differences), LF (low-frequency power), and HF (high-frequency power) in all stages were not statistically significant (p=>0.05) between groups. Based on the results, we can determine the increase in HRV when conducting auricular acupressure with stimulation at the heart acupoint on the left ear. This leads to a direction in further studies for clinical application for patients with autonomic nervous disorder.
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Anthropometric Determinants of Respiratory Sinus Arrhythmia in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010566. [PMID: 35010824 PMCID: PMC8744931 DOI: 10.3390/ijerph19010566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/23/2021] [Accepted: 12/31/2021] [Indexed: 11/17/2022]
Abstract
Background: The study was conducted to investigate the implications of anthropometry in school-aged children on the degree of respiratory sinus arrhythmia observed in clinical settings. Methods: In a cohort study, 626 healthy children (52% male) aged 10.8 ± 0.5 years attending primary school in a single town underwent a 12-lead electrocardiogram coupled with measurements of height, weight and blood pressure. Indices of respiratory sinus arrhythmia (pvRSA, RMSSD, RMSSDc) were derived from semi-automatic measurements of RR intervals. Height, weight, BMI, blood pressure as well as waist and hip circumferences were compared between subjects with rhythmic heart rate and respiratory sinus arrhythmia, and correlations between indices of sinus arrhythmia and anthropometry were investigated. Results: Respiratory sinus arrhythmia was recognized in 43% of the participants. Subjects with sinus arrhythmia had lower heart rate (p < 0.001), weight (p = 0.009), BMI (p = 0.005) and systolic (p = 0.018) and diastolic (p = 0.004) blood pressure. There were important inverse correlations of heart rate and indices of sinus arrhythmia (r = −0.52 for pvRSA and r = −0.58 for RMSSD), but not the anthropometry. Conclusion: Lower prevalence of respiratory sinus arrhythmia among children with overweight and obesity is a result of higher resting heart rate observed in this population.
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Lubocka P, Sabiniewicz R. Respiratory Sinus Arrhythmia in Children-Predictable or Random? Front Cardiovasc Med 2021; 8:643846. [PMID: 34095247 PMCID: PMC8172810 DOI: 10.3389/fcvm.2021.643846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Respiratory sinus arrhythmia (RSA) is associated with better health in children. Aim: The study was conducted to analyze the trajectory of RSA in 10-year-olds. Methods: A follow-up study on 120 healthy children (62 boys) aged 10.7 ± 0.5 years consisted of a standard 12-lead electrocardiogram, measurements of height, weight and blood pressure. The protocol was repeated after 3 years. Assessment of RSA based on semi-automatic measurements of RR intervals included: the difference between the longest and shortest RR interval duration (pvRSA), the root mean square of differences between successive RR intervals (RMSSD), the standard deviation of the RR interval length (SDNN) and their equivalents corrected for heart rate (RMSSDc and SDNNc). Results: A the first visit 61.7% of children presented with RSA; 51.7% 3 years later. 23.3% of them had RSA only on the first examination; 13.3% only on the second one. The pvRSA, RMSSD, and SDNN measured in 2019 did not differ significantly from their 2016 equivalents (p > 0.05). The decline in RSA defined by RMSSD was noted in 52.5% of children and in 54.2% when defined by SDNN. The corrected values decreased in 68.3 and 64.2% of the participants for RMSSDc and SDNNc, respectively. The students with RSA at both visits had lower heart rate (p < 0.001) and systolic blood pressure (p = 0.010) compared to those with rhythmic electrocardiograms. Conclusions: RSA in children is changeable, though its measurable indices should be adjusted to heart rate.
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Affiliation(s)
- Paulina Lubocka
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdańsk, Gdańsk, Poland
| | - Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdańsk, Gdańsk, Poland
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Lo WB, Chevill B, Philip S, Agrawal S, Walsh AR. Seizure improvement following vagus nerve stimulator (VNS) battery change with cardiac-based seizure detection automatic stimulation (AutoStim): early experience in a regional paediatric unit. Childs Nerv Syst 2021; 37:1237-1241. [PMID: 33174154 DOI: 10.1007/s00381-020-04962-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/03/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The recent VNS models (AspireSR® Model 106, SenTiva™ Model 1000 (VNS Therapy®, LivaNova)) include a new function of cardiac-based seizure detection (CBSD) automatic stimulation, known as 'AutoStim'. This algorithm uses tachycardia as a proxy to a seizure, and the battery delivers a closed-loop electrical current in addition to its programmed stimulation. This function leads to further seizure reduction in adults, but this advantage has not been reported in the paediatric population. This study aims to investigate whether battery change with AutoStim leads to further seizure reduction in children. METHODS This observational study included the first 10 cases of VNS battery change from non-AutoStim to AutoStim function. During the battery change operation, the new VNS was switched on, with the same normal and magnet mode settings as the previous VNS. The AutoStim mode was activated at the same time. Data on seizure burden were collected at 3 time points: (1) before the first VNS insertion, (2) before battery replacement (post-1st VNS) and (3) 12 months post-battery change (post-AutoStim). The net effect of AutoStim, the only changed parameter, was evaluated by comparing the seizure burden prior to and 12 months following battery change in each child. RESULTS The seizure reduction improved significantly from 60 to 83% following battery change with AutoStim. Categorising the outcome according the McHugh classification, children achieving class I and II outcome (≥ 50% seizure reduction) improved from 70 to 90%. CONCLUSION This is the first study to demonstrate the additional efficacy of AutoStim in children treated with VNS.
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Affiliation(s)
- William B Lo
- Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, B4 6NH, UK.
| | - Bethany Chevill
- Department of Neurology, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
| | - Sunny Philip
- Department of Neurology, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
| | - Shakti Agrawal
- Department of Neurology, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
| | - A Richard Walsh
- Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
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13
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Sitovskyi AM, Radchenko OV, Dmytruk VS, Andriichuk OY, Roda OB, Savchuk IV. Heart Rate Variability in 12- to 13-Year-Old Adolescents. NEUROPHYSIOLOGY+ 2021. [DOI: 10.1007/s11062-021-09883-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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14
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Harteveld LM, Nederend I, Ten Harkel ADJ, Schutte NM, de Rooij SR, Vrijkotte TGM, Oldenhof H, Popma A, Jansen LMC, Suurland J, Swaab H, de Geus EJC. Maturation of the Cardiac Autonomic Nervous System Activity in Children and Adolescents. J Am Heart Assoc 2021; 10:e017405. [PMID: 33525889 PMCID: PMC7955328 DOI: 10.1161/jaha.120.017405] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Despite the increasing interest in cardiac autonomic nervous activity, the normal development is not fully understood. The main aim was to determine the maturation of different cardiac sympathetic‐(SNS) and parasympathetic nervous system (PNS) activity parameters in healthy patients aged 0.5 to 20 years. A second aim was to determine potential sex differences. Methods and Results Five studies covering the 0.5‐ to 20‐year age range provided impedance‐ and electrocardiography recordings from which heart rate, different PNS‐parameters (eg, respiratory sinus arrhythmia) and an SNS‐parameter (pre‐ejection period) were collected. Age trends were computed in the mean values across 12 age‐bins and in the age‐specific variances. Age was associated with changes in mean and variance of all parameters. PNS‐activity followed a cubic trend, with an exponential increase from infancy, a plateau phase during middle childhood, followed by a decrease to adolescence. SNS‐activity showed a more linear trend, with a gradual decrease from infancy to adolescence. Boys had higher SNS‐activity at ages 11 to 15 years, while PNS‐activity was higher at 5 and 11 to 12 years with the plateau level reached earlier in girls. Interindividual variation was high at all ages. Variance was reasonably stable for SNS‐ and the log‐transformed PNS‐parameters. Conclusions Cardiac PNS‐ and SNS‐activity in childhood follows different maturational trajectories. Whereas PNS‐activity shows a cubic trend with a plateau phase during middle childhood, SNS‐activity shows a linear decrease from 0.5 to 20 years. Despite the large samples used, clinical use of the sex‐specific centile and percentile normative values is modest in view of the large individual differences, even within narrow age bands.
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Affiliation(s)
- Lisette M Harteveld
- Department of Pediatric Cardiology Leiden University Medical Center Leiden The Netherlands
| | - Ineke Nederend
- Department of Pediatric Cardiology Leiden University Medical Center Leiden The Netherlands.,Department of Biological Psychology Faculty of Human Behavioral and Movement Sciences Vrije Universiteit AmsterdamAmsterdam Public Health Research Institute Amsterdam The Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology Leiden University Medical Center Leiden The Netherlands
| | - Nienke M Schutte
- Department of Biological Psychology Faculty of Human Behavioral and Movement Sciences Vrije Universiteit AmsterdamAmsterdam Public Health Research Institute Amsterdam The Netherlands
| | - Susanne R de Rooij
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics Amsterdam University Medical CenterAcademic Medical Center Amsterdam The Netherlands.,Department of Public Health Amsterdam Public Health Research InstituteAmsterdam University Medical CenterUniversity of Amsterdam Amsterdam The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health Amsterdam Public Health Research InstituteAmsterdam University Medical CenterUniversity of Amsterdam Amsterdam The Netherlands
| | - Helena Oldenhof
- Department of Child and Adolescent Psychiatry Amsterdam University Medical CenterVU University Medical Centre Amsterdam The Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry Amsterdam University Medical CenterVU University Medical Centre Amsterdam The Netherlands
| | - Lucres M C Jansen
- Department of Child and Adolescent Psychiatry Amsterdam University Medical CenterVU University Medical Centre Amsterdam The Netherlands
| | - Jill Suurland
- Department of Clinical Child and Adolescent Studies and Leiden Institute for Brain and Cognition Leiden University Leiden The Netherlands
| | - Hanna Swaab
- Department of Clinical Child and Adolescent Studies and Leiden Institute for Brain and Cognition Leiden University Leiden The Netherlands
| | - Eco J C de Geus
- Department of Biological Psychology Faculty of Human Behavioral and Movement Sciences Vrije Universiteit AmsterdamAmsterdam Public Health Research Institute Amsterdam The Netherlands
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15
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Gąsior JS, Zamunér AR, Silva LEV, Williams CA, Baranowski R, Sacha J, Machura P, Kochman W, Werner B. Heart Rate Variability in Children and Adolescents with Cerebral Palsy-A Systematic Literature Review. J Clin Med 2020; 9:jcm9041141. [PMID: 32316278 PMCID: PMC7230809 DOI: 10.3390/jcm9041141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/04/2020] [Accepted: 04/13/2020] [Indexed: 12/14/2022] Open
Abstract
Cardiac autonomic dysfunction has been reported in patients with cerebral palsy (CP). The aim of this study was to assess the existing literature on heart rate variability (HRV) in pediatric patients with CP and a special attention was paid to the compliance of the studies with the current HRV assessment and interpretation guidelines. A systematic review was performed in PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases searched for English language publications from 1996 to 2019 using Medical Subject Headings (MeSH) terms “heart rate variability” and “cerebral palsy” in conjunction with additional inclusion criteria: studies limited to humans in the age range of 0–18 years and empirical investigations. Out of 47 studies, 12 were included in the review. Pediatric patients with CP presented a significantly higher resting heart rate and reduced HRV, different autonomic responses to movement stimuli compared to children with normal development, but also reduced HRV parameters in the children dependent on adult assistance for mobility compared to those generally independent. None of the included studies contained the necessary details concerning RR intervals acquisition and HRV measurements as recommended by the guidelines. Authors of HRV studies should follow the methodological guidelines and recommendations on HRV measurement, because such an approach may allow a direct comparison of their results.
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Affiliation(s)
- Jakub S. Gąsior
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities, 26-600 Radom, Poland
- Correspondence: ; Tel.: +48-793-199-222
| | | | - Luiz Eduardo Virgilio Silva
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo 14049-900, Brazil;
| | - Craig A. Williams
- Children’s Health and Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St Luke’s Campus, Exeter EX1 2LU, UK;
| | - Rafał Baranowski
- Department of Heart Rhythm Disorders, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland;
- Department of Cardiology, University Hospital in Opole, University of Opole, 45-401 Opole, Poland
| | - Paulina Machura
- Department of Gynaecological Endocrinology, Medical University of Warsaw, 00-950 Warsaw, Poland;
| | - Wacław Kochman
- Clinical Department of Cardiology at Bielanski Hospital, National Institute of Cardiology, 01-809 Warsaw, Poland;
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland;
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16
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Lee CH, Shin HW, Shin DG. Impact of Oxidative Stress on Long-Term Heart Rate Variability: Linear Versus Non-Linear Heart Rate Dynamics. Heart Lung Circ 2019; 29:1164-1173. [PMID: 31495726 DOI: 10.1016/j.hlc.2019.06.726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/29/2019] [Accepted: 06/18/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Heart rate variability (HRV) is a widely used non-invasive and quantitative marker of cardiac autonomic control. Elevated oxidative stress (OS) and reduced HRV have been proven in specific disease subsets. However, the impact of OS on the long-term heart rate dynamics of both conventional linear and non-linear origin in the general population is not known. METHODS The 24-hour ambulatory electrocardiogram recordings and plasma 8-iso-prostaglandin F2α (8-iso-PGF2α) levels as an OS marker were acquired simultaneously in 71 consecutive patients. The conventional time and frequency domain HRV parameters and non-linear parameters were measured. RESULTS The 8-iso-PGF2α is a significant determinant of most long-term conventional time and frequency domain HRV parameters and standard deviation (SD1, perpendicular to the line of identity; SD2, along the line of identity) descriptors from Poincaré plot analysis, but not of non-linear complexity and fractal parameters. Patients with a high OS burden had lower absolute low-frequency and high-frequency powers during both the night and morning periods, with a significant decrease in high-frequency power in the morning. CONCLUSIONS Oxidative stress is one of the significant determinants of the HRV. The severity of OS is reflected in the conventional time and frequency domain HRV parameters, but not in the non-linear measurements.
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Affiliation(s)
- Chan-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Hyun-Woo Shin
- School of Biotechnology, Yeungnam University, Daegu, Republic of Korea
| | - Dong-Gu Shin
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Republic of Korea.
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17
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Gąsior JS, Sacha J, Pawłowski M, Zieliński J, Jeleń PJ, Tomik A, Książczyk TM, Werner B, Dąbrowski MJ. Normative Values for Heart Rate Variability Parameters in School-Aged Children: Simple Approach Considering Differences in Average Heart Rate. Front Physiol 2018; 9:1495. [PMID: 30405445 PMCID: PMC6207594 DOI: 10.3389/fphys.2018.01495] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 10/03/2018] [Indexed: 01/01/2023] Open
Abstract
Background: Heart rate variability (HRV) analysis is a clinical tool frequently used to characterize cardiac autonomic status. The aim of this study was to establish normative values for short-term HRV parameters by considering their main determinants in school-aged children. Methods: Five-minute electrocardiograms were taken from 312 non-athlete children (153 boys) at age of 6 to 13 years for computation of conventional time- and frequency-domain HRV parameters. Heart rate (HR), respiratory rate, age, body mass index, and sex were considered as their potential determinants. Multiple regression analysis revealed that HR was the principal predictor of all standard HRV indices. To develop their universal normative limits, standard HRV parameters were corrected for prevailing HR. Results: The HRV correction for HR yielded the parameters which became independent on both sex and HR, and only poorly dependent on age (with small effect size). Normal ranges were calculated for both time- and frequency-domain indices (the latter computed with either fast Fourier transform and autoregressive method). To facilitate recalculation of standard HRV parameters into corrected ones, a calculator was created and attached as a Supplementary Material that can be downloaded and used for both research and clinical purposes. Conclusion: This study provides HRV normative values for school-aged children which have been developed independently of their major determinants. The calculator accessible in the Supplementary Material can considerably simplify determination if HRV parameters accommodate within normal limits.
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Affiliation(s)
- Jakub S Gąsior
- Faculty of Health Sciences and Physical Education, Kazimierz Pulaski University of Technology and Humanities in Radom, Radom, Poland.,Cardiology Clinic of Physiotherapy Division of the 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland.,Department of Cardiology, University Hospital, Faculty of Natural Sciences and Technology, University of Opole, Opole, Poland
| | - Mariusz Pawłowski
- Faculty of Health Sciences and Physical Education, Kazimierz Pulaski University of Technology and Humanities in Radom, Radom, Poland.,Cardiology Clinic of Physiotherapy Division of the 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jakub Zieliński
- Department of Biophysics and Human Physiology, Medical University of Warsaw, Warsaw, Poland.,Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw, Warsaw, Poland
| | - Piotr J Jeleń
- Department of Biophysics and Human Physiology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Tomik
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz M Książczyk
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Marek J Dąbrowski
- Cardiology Clinic of Physiotherapy Division of the 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
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18
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van den Berg ME, Rijnbeek PR, Niemeijer MN, Hofman A, van Herpen G, Bots ML, Hillege H, Swenne CA, Eijgelsheim M, Stricker BH, Kors JA. Normal Values of Corrected Heart-Rate Variability in 10-Second Electrocardiograms for All Ages. Front Physiol 2018; 9:424. [PMID: 29755366 PMCID: PMC5934689 DOI: 10.3389/fphys.2018.00424] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/05/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose: Heart-rate variability (HRV) measured on standard 10-s electrocardiograms (ECGs) has been associated with increased risk of cardiac and all-cause mortality, but age- and sex-dependent normal values have not been established. Since heart rate strongly affects HRV, its effect should be taken into account. We determined a comprehensive set of normal values of heart-rate corrected HRV derived from 10-s ECGs for both children and adults, covering both sexes. Methods: Five population studies in the Netherlands (Pediatric Normal ECG Study, Leiden University Einthoven Science Project, Prevention of Renal and Vascular End-stage Disease Study, Utrecht Health Project, Rotterdam Study) provided 10-s, 12-lead ECGs. ECGs were stored digitally and analyzed by well-validated analysis software. We included cardiologically healthy participants, 42% being men. Their ages ranged from 11 days to 91 years. After quality control, 13,943 ECGs were available. Heart-rate correction formulas were derived using an exponential model. Two time-domain HRV markers were analyzed: the corrected standard deviation of the normal-to-normal RR intervals (SDNNc) and corrected root mean square of successive RR-interval differences (RMSSDc). Results: There was a considerable age effect. For both SDNNc and RMSSDc, the median and the lower limit of normal decreased steadily from birth until old age. The upper limit of normal decreased until the age of 60, but increased markedly after that age. Differences of the median were minimal between men and women. Conclusion: We report the first comprehensive set of normal values for heart-rate corrected 10-s HRV, which can be of value in clinical practice and in further research.
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Affiliation(s)
- Marten E van den Berg
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Maartje N Niemeijer
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Gerard van Herpen
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hans Hillege
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Cees A Swenne
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark Eijgelsheim
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Internal Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.,Health and Youth Care Inspectorate, Utrecht, Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
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19
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Cavalcante Neto JL, Zamunér AR, Moreno BC, Silva E, Tudella E. Linear and Nonlinear Analyses of the Cardiac Autonomic Control in Children With Developmental Coordination Disorder: A Case-Control Study. Front Physiol 2018; 9:267. [PMID: 29623050 PMCID: PMC5874518 DOI: 10.3389/fphys.2018.00267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/08/2018] [Indexed: 01/25/2023] Open
Abstract
Children with Developmental Coordination Disorder (DCD) and children at risk for DCD (r-DCD) present motor impairments interfering in their school, leisure and daily activities. In addition, these children may have abnormalities in their cardiac autonomic control, which together with their motor impairments, restrict their health and functionality. Therefore, this study aimed to assess the cardiac autonomic control, by linear and nonlinear analysis, at supine and during an orthostatic stimulus in DCD, r-DCD and typically developed children. Thirteen DCD children (11 boys and 2 girls, aged 8.08 ± 0.79 years), 19 children at risk for DCD (13 boys and 6 girls, aged 8.10 ± 0.96 years) and 18 typically developed children, who constituted the control group (CG) (10 boys and 8 girls, aged 8.50 ± 0.96 years) underwent a heart rate variability (HRV) examination. R-R intervals were recorded in order to assess the cardiac autonomic control using a validated HR monitor. HRV was analyzed by linear and nonlinear methods and compared between r-DCD, DCD, and CG. The DCD group presented blunted cardiac autonomic adjustment to the orthostatic stimulus, which was not observed in r-DCD and CG. Regarding nonlinear analysis of HRV, the DCD group presented lower parasympathetic modulation in the supine position compared to the r-DCD and CG groups. In the within group analysis, only the DCD group did not increase HR from supine to standing posture. Symbolic analysis revealed a significant decrease in 2LV (p < 0.0001) and 2UV (p < 0.0001) indices from supine to orthostatic posture only in the CG. In conclusion, r-DCD and DCD children present cardiac autonomic dysfunction characterized by higher sympathetic, lower parasympathetic and lower complexity of cardiac autonomic control in the supine position, as well as a blunted autonomic adjustment to the orthostatic stimulus. Therefore, cardiovascular health improvement should be part of DCD children's management, even in cases of less severe motor impairment.
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Affiliation(s)
- Jorge L Cavalcante Neto
- Núcleo de Estudos em Neuropediatria e Motricidade, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Antonio R Zamunér
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | - Bianca C Moreno
- Pró-Reitoria de Pesquisa e Pós-Graduação, Fisioterapia, Universidade do Sagrado Coração, Bauru, Brazil
| | - Ester Silva
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Eloisa Tudella
- Núcleo de Estudos em Neuropediatria e Motricidade, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, Brazil
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20
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Cohen E, Wong FY, Wallace EM, Mockler JC, Odoi A, Hollis S, Horne RSC, Yiallourou SR. Fetal-growth-restricted preterm infants display compromised autonomic cardiovascular control on the first postnatal day but not during infancy. Pediatr Res 2017; 82:474-482. [PMID: 28388597 DOI: 10.1038/pr.2017.105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/03/2017] [Indexed: 12/26/2022]
Abstract
BackgroundFetal growth restriction (FGR) is associated with increased perinatal mortality and long-term cardiovascular and neurodevelopmental sequelae. We hypothesized that FGR impacts on the development of autonomic heart rate and blood pressure control, contributing to unfavorable short- and long-term outcomes following FGR.MethodsWe studied 25 preterm FGR and 22 preterm and 19 term appropriate for gestational age (AGA) infants. Preterm neonates were studied on postnatal day 1, and all infants were studied at 1 and 6 months post-term age. To investigate autonomic cardiovascular control, we examined heart rate variability (HRV) and baroreflex sensitivity using spectral power and transfer-function analyses.ResultsPreterm FGR neonates exhibited higher heart rates and reduced HRV compared with preterm AGA controls on postnatal day 1. No significant differences were found between the three groups at 1 or 6 months post-term age.ConclusionPreterm FGR neonates display compromised HRV on postnatal day 1, which may suggest increased vulnerability to circulatory instability. This may predispose these neonates to systemic and cerebral hypoperfusion and increase the risk of long-term neurodevelopmental sequelae. Differences were no longer found at 1 and 6 months post-term age, suggesting that the maturation of autonomic cardiovascular control may be preserved following FGR.
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Affiliation(s)
- Emily Cohen
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics Monash University, Melbourne, Victoria, Australia
| | - Flora Y Wong
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics Monash University, Melbourne, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Joanne C Mockler
- Department of Obstetrics and Gynaecology, Monash University and Monash Women's, Monash Health, Melbourne, Victoria, Australia
| | - Alexsandria Odoi
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics Monash University, Melbourne, Victoria, Australia
| | - Samantha Hollis
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics Monash University, Melbourne, Victoria, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics Monash University, Melbourne, Victoria, Australia
| | - Stephanie R Yiallourou
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Paediatrics Monash University, Melbourne, Victoria, Australia
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21
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Koenig J, Rash JA, Campbell TS, Thayer JF, Kaess M. A Meta-Analysis on Sex Differences in Resting-State Vagal Activity in Children and Adolescents. Front Physiol 2017; 8:582. [PMID: 28883794 PMCID: PMC5573740 DOI: 10.3389/fphys.2017.00582] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/28/2017] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of HeidelbergHeidelberg, Germany
| | - Joshua A Rash
- Department of Psychology, University of CalgaryCalgary, AB, Canada.,Department of Psychology, Memorial University of NewfoundlandSt. John's, NL, Canada
| | - Tavis S Campbell
- Department of Psychology, University of CalgaryCalgary, AB, Canada
| | - Julian F Thayer
- Department of Psychology, The Ohio State UniversityColumbus, OH, United States
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of HeidelbergHeidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBern, Switzerland
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22
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Bobkowski W, Stefaniak ME, Krauze T, Gendera K, Wykretowicz A, Piskorski J, Guzik P. Measures of Heart Rate Variability in 24-h ECGs Depend on Age but Not Gender of Healthy Children. Front Physiol 2017; 8:311. [PMID: 28572771 PMCID: PMC5435822 DOI: 10.3389/fphys.2017.00311] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 04/29/2017] [Indexed: 12/05/2022] Open
Abstract
Many methods computing heart rate variability (HRV) have been applied in studies in children. Not all of these methods have a comprehensive physiological interpretation, and not all of studies are in agreement with the Task Force Standards on HRV from 1996, and the New Joint Position Statement on the advances of HRV from 2015. The study aim was to analyse HRV in the 24-h ECGs of healthy children by the Poincare plots and Lomb-Scargle periodograms, and to follow proper HRV recommendations. Additionally, we investigated the associations between age, children's sex and measured HRV indices. One hundred healthy children, aged 3–18 underwent 24-h ECG Holter monitoring. HRV was analyzed by the Poincaré plots and spectral by Lomb-Scargle periodograms of RR intervals. The Mann-Whitney test was used to compare sex differences in HRV, the van Elteren's test was used to correct for the age-gender interaction, and non-parametric Spearman correlation was applied to analyse the association between age and HRV indices. None of the HRV measures differed significantly between boys and girls. None of the HRV indices was modified by the age-gender interaction. There were statistically significant associations of age with measures of ultra-low (rho = 0.42; p < 0.0001), very low (rho = 0.35; p = 00004) and low (rho = 0.30; p = 0.0028) frequency powers, the ratio of the low to high frequency power (rho = 0.38; p = 0.0001), indices of long-term (SD2; rho = 0.37; p = 0.0002) and total (SDNN; rho = 0.33; p = 0.0008) HRV, and the contribution of the long-term HRV to total HRV (CL; rho = 0.32; p = 0.0012). In general, HRV parameters derived from the analyses of Poincaré plots and Lomb-Scargle periodograms appear not to be affected by gender, however, most of them increase with age in the 24-h ECG recordings in healthy children.
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Affiliation(s)
- Waldemar Bobkowski
- Department of Pediatric Cardiology and Nephrology, Poznan University of Medical SciencesPoznan, Poland
| | - Magdalena E Stefaniak
- Department of Pediatric Cardiology and Nephrology, Poznan University of Medical SciencesPoznan, Poland
| | - Tomasz Krauze
- Department of Cardiology- Intensive Therapy and Internal Diseases, Poznan University of Medical SciencesPoznan, Poland
| | - Katarzyna Gendera
- Department of Pediatric Cardiology and Nephrology, Poznan University of Medical SciencesPoznan, Poland
| | - Andrzej Wykretowicz
- Department of Cardiology- Intensive Therapy and Internal Diseases, Poznan University of Medical SciencesPoznan, Poland
| | - Jaroslaw Piskorski
- Institute of Physics, University of Zielona GoraZielona Gora, Poland.,Faculty of Medicine and Health Sciences, University of Zielona GoraZielona Gora, Poland
| | - Przemyslaw Guzik
- Department of Cardiology- Intensive Therapy and Internal Diseases, Poznan University of Medical SciencesPoznan, Poland
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23
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Silva LEV, Silva CAA, Salgado HC, Fazan R. The role of sympathetic and vagal cardiac control on complexity of heart rate dynamics. Am J Physiol Heart Circ Physiol 2017; 312:H469-H477. [DOI: 10.1152/ajpheart.00507.2016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/05/2016] [Accepted: 12/20/2016] [Indexed: 11/22/2022]
Abstract
Analysis of heart rate variability (HRV) by nonlinear approaches has been gaining interest due to their ability to extract additional information from heart rate (HR) dynamics that are not detectable by traditional approaches. Nevertheless, the physiological interpretation of nonlinear approaches remains unclear. Therefore, we propose long-term (60 min) protocols involving selective blockade of cardiac autonomic receptors to investigate the contribution of sympathetic and parasympathetic function upon nonlinear dynamics of HRV. Conscious male Wistar rats had their electrocardiogram (ECG) recorded under three distinct conditions: basal, selective (atenolol or atropine), or combined (atenolol plus atropine) pharmacological blockade of autonomic muscarinic or β1-adrenergic receptors. Time series of RR interval were assessed by multiscale entropy (MSE) and detrended fluctuation analysis (DFA). Entropy over short (1 to 5, MSE1–5) and long (6 to 30, MSE6–30) time scales was computed, as well as DFA scaling exponents at short (αshort, 5 ≤ n ≤ 15), mid (αmid, 30 ≤ n ≤ 200), and long (αlong, 200 ≤ n ≤ 1,700) window sizes. The results show that MSE1–5 is reduced under atropine blockade and MSE6–30 is reduced under atropine, atenolol, or combined blockade. In addition, while atropine expressed its maximal effect at scale six, the effect of atenolol on MSE increased with scale. For DFA, αshort decreased during atenolol blockade, while the αmid increased under atropine blockade. Double blockade decreased αshort and increased αlong. Results with surrogate data show that the dynamics during combined blockade is not random. In summary, sympathetic and vagal control differently affect entropy (MSE) and fractal properties (DFA) of HRV. These findings are important to guide future studies. NEW & NOTEWORTHY Although multiscale entropy (MSE) and detrended fluctuation analysis (DFA) are recognizably useful prognostic/diagnostic methods, their physiological interpretation remains unclear. The present study clarifies the effect of the cardiac autonomic control on MSE and DFA, assessed during long periods (1 h). These findings are important to help the interpretation of future studies.
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Affiliation(s)
| | | | - Helio Cesar Salgado
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Rubens Fazan
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Herzig D, Eser P, Radtke T, Wenger A, Rusterholz T, Wilhelm M, Achermann P, Arhab A, Jenni OG, Kakebeeke TH, Leeger-Aschmann CS, Messerli-Bürgy N, Meyer AH, Munsch S, Puder JJ, Schmutz EA, Stülb K, Zysset AE, Kriemler S. Relation of Heart Rate and its Variability during Sleep with Age, Physical Activity, and Body Composition in Young Children. Front Physiol 2017; 8:109. [PMID: 28286485 PMCID: PMC5323426 DOI: 10.3389/fphys.2017.00109] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 02/09/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Recent studies have claimed a positive effect of physical activity and body composition on vagal tone. In pediatric populations, there is a pronounced decrease in heart rate with age. While this decrease is often interpreted as an age-related increase in vagal tone, there is some evidence that it may be related to a decrease in intrinsic heart rate. This factor has not been taken into account in most previous studies. The aim of the present study was to assess the association between physical activity and/or body composition and heart rate variability (HRV) independently of the decline in heart rate in young children. Methods: Anthropometric measurements were taken in 309 children aged 2–6 years. Ambulatory electrocardiograms were collected over 14–18 h comprising a full night and accelerometry over 7 days. HRV was determined of three different night segments: (1) over 5 min during deep sleep identified automatically based on HRV characteristics; (2) during a 20 min segment starting 15 min after sleep onset; (3) over a 4-h segment between midnight and 4 a.m. Linear models were computed for HRV parameters with anthropometric and physical activity variables adjusted for heart rate and other confounding variables (e.g., age for physical activity models). Results: We found a decline in heart rate with increasing physical activity and decreasing skinfold thickness. HRV parameters decreased with increasing age, height, and weight in HR-adjusted regression models. These relationships were only found in segments of deep sleep detected automatically based on HRV or manually 15 min after sleep onset, but not in the 4-h segment with random sleep phases. Conclusions: Contrary to most previous studies, we found no increase of standard HRV parameters with age, however, when adjusted for heart rate, there was a significant decrease of HRV parameters with increasing age. Without knowing intrinsic heart rate correct interpretation of HRV in growing children is impossible.
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Affiliation(s)
- David Herzig
- Preventive Cardiology and Sports Medicine, University Clinic for Cardiology, Inselspital, Bern University Hospital, University of Bern Bern, Switzerland
| | - Prisca Eser
- Preventive Cardiology and Sports Medicine, University Clinic for Cardiology, Inselspital, Bern University Hospital, University of Bern Bern, Switzerland
| | - Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich Zurich, Switzerland
| | - Alina Wenger
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich Zurich, Switzerland
| | - Thomas Rusterholz
- Institute of Pharmacology and Toxicology, University of ZurichZurich, Switzerland; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBern, Switzerland
| | - Matthias Wilhelm
- Preventive Cardiology and Sports Medicine, University Clinic for Cardiology, Inselspital, Bern University Hospital, University of Bern Bern, Switzerland
| | - Peter Achermann
- Institute of Pharmacology and Toxicology, University of ZurichZurich, Switzerland; Zurich Center for Integrative Human Physiology, University of ZurichZurich, Switzerland
| | - Amar Arhab
- Endocrinology, Diabetes, and Metabolism Service, Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Switzerland
| | - Oskar G Jenni
- Child Development Center, University Children's Hospital ZurichZurich, Switzerland; Children's Research Center, University Children's Hospital ZurichZurich, Switzerland
| | - Tanja H Kakebeeke
- Child Development Center, University Children's Hospital ZurichZurich, Switzerland; Children's Research Center, University Children's Hospital ZurichZurich, Switzerland
| | | | - Nadine Messerli-Bürgy
- Endocrinology, Diabetes, and Metabolism Service, Centre Hospitalier Universitaire Vaudois (CHUV)Lausanne, Switzerland; Department of Clinical Psychology and Psychotherapy, University of FribourgFribourg, Switzerland
| | - Andrea H Meyer
- Department of Psychology, University of Basel Basel, Switzerland
| | - Simone Munsch
- Department of Clinical Psychology and Psychotherapy, University of Fribourg Fribourg, Switzerland
| | - Jardena J Puder
- Endocrinology, Diabetes, and Metabolism Service, Centre Hospitalier Universitaire Vaudois (CHUV)Lausanne, Switzerland; Division of Pediatric Endocrinology, Diabetology and Obesity, Centre Hospitalier Universitaire Vaudois (CHUV)Lausanne, Switzerland
| | - Einat A Schmutz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich Zurich, Switzerland
| | - Kerstin Stülb
- Department of Clinical Psychology and Psychotherapy, University of Fribourg Fribourg, Switzerland
| | - Annina E Zysset
- Child Development Center, University Children's Hospital Zurich Zurich, Switzerland
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich Zurich, Switzerland
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25
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Gąsior JS, Sacha J, Jeleń PJ, Zieliński J, Przybylski J. Heart Rate and Respiratory Rate Influence on Heart Rate Variability Repeatability: Effects of the Correction for the Prevailing Heart Rate. Front Physiol 2016; 7:356. [PMID: 27588006 PMCID: PMC4988971 DOI: 10.3389/fphys.2016.00356] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/04/2016] [Indexed: 01/22/2023] Open
Abstract
Background: Since heart rate variability (HRV) is associated with average heart rate (HR) and respiratory rate (RespRate), alterations in these parameters may impose changes in HRV. Hence the repeatability of HRV measurements may be affected by differences in HR and RespRate. The study aimed to evaluate HRV repeatability and its association with changes in HR and RespRate. Methods: Forty healthy volunteers underwent two ECG examinations 7 days apart. Standard HRV indices were calculated from 5-min ECG recordings. The ECG-derived respiration signal was estimated to assess RespRate. To investigate HR impact on HRV, HRV parameters were corrected for prevailing HR. Results: Differences in HRV parameters between the measurements were associated with the changes in HR and RespRate. However, in multiple regression analysis only HR alteration proved to be independent determinant of the HRV differences—every change in HR by 1 bpm changed HRV values by 16.5% on average. After overall removal of HR impact on HRV, coefficients of variation of the HRV parameters significantly dropped on average by 26.8% (p < 0.001), i.e., by the same extent HRV reproducibility improved. Additionally, the HRV correction for HR decreased association between RespRate and HRV. Conclusions: In stable conditions, HR but not RespRate is the most powerful factor determining HRV reproducibility and even a minimal change of HR may considerably alter HRV. However, the removal of HR impact may significantly improve HRV repeatability. The association between HRV and RespRate seems to be, at least in part, HR dependent.
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Affiliation(s)
- Jakub S Gąsior
- Cardiology Clinic of Physiotherapy Division of the 2nd Faculty of Medicine, Medical University of Warsaw Warsaw, Poland
| | - Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, Opole University of Technology Opole, Poland
| | - Piotr J Jeleń
- Department of Biophysics and Human Physiology, Medical University of Warsaw Warsaw, Poland
| | - Jakub Zieliński
- Department of Biophysics and Human Physiology, Medical University of WarsawWarsaw, Poland; Interdisciplinary Centre for Mathematical and Computational Modelling, University of WarsawWarsaw, Poland
| | - Jacek Przybylski
- Department of Biophysics and Human Physiology, Medical University of Warsaw Warsaw, Poland
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26
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Lutfi MF, Elhakeem RF. Effect of Fasting Blood Glucose Level on Heart Rate Variability of Healthy Young Adults. PLoS One 2016; 11:e0159820. [PMID: 27441373 PMCID: PMC4956167 DOI: 10.1371/journal.pone.0159820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/09/2016] [Indexed: 01/10/2023] Open
Abstract
Background Previous studies reported increased risk of cardiac events in subjects with fasting blood glucose (FBG) levels lower than the diagnostic threshold of diabetes mellitus. However, whether increased cardiac events in those with upper normal FBG is secondary to the shift of their cardiac sympathovagal balance towards sympathetic predominance is unknown. Aims To assess the association between FBG levels and cardiac autonomic modulation (CAM) in euglycaemic healthy subjects based on heart rate variability (HRV) derived indices. Subjects and Methods The study enrolled 42 healthy young adults. Following sociodemographic and clinical assessment, blood samples were collected to measure FBG levels. Five minutes ECG recordings were performed to all participants to obtain frequency domain HRV measurements, namely the natural logarithm (Ln) of total power (LnTP), very low frequency (LnVLF), low frequency (LnLF) and high frequency (LnHF), low frequency/ high frequency ratio (LnLF/HF), normalized low frequency (LF Norm) and high frequency (HF Norm). Results FBG levels correlated positively with LnHF (r = 0.33, P = 0.031) and HF Norm (r = 0.35, P = 0.025) and negatively with LF Norm (r = -0.35, P = 0.025) and LnLF/HF (r = -0.33, P = 0.035). LnHF and HF Norm were significantly decreased in subjects with the lower (4.00 (1.34) ms2/Hz and 33.12 (11.94) n.u) compared to those with the upper FBG quartile (5.64 (1.63) ms2/Hz and 49.43 (17.73) n.u, P = 0.013 and 0.032 respectively). LF Norm and LnLF/HF were significantly increased in subjects with the lower (66.88 (11.94) n.u and 0.73 (0.53)) compared to those with the higher FBG quartile (50.58 (17.83) n.u and 0.03 (0.79), P = 0.032 and 0.038 respectively). Conclusion The present study is the first to demonstrate that rise of blood glucose concentration, within physiological range, is associated with higher parasympathetic, but lower sympathetic CAM. Further researches are needed to set out the glycemic threshold beyond which further increase in glucose level readjusts sympathovagal balance towards sympathetic predominance again.
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Affiliation(s)
- Mohamed Faisal Lutfi
- Department of Physiology, Faculty of Medicine and Health Sciences, Al-Neelain University, Khartoum, Sudan
- * E-mail:
| | - Ramaze Farouke Elhakeem
- Department of Physiology, Faculty of Medicine and Health Sciences, Al-Neelain University, Khartoum, Sudan
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