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Heart rate variability (HRV) in deep breathing tests and 5-min short-term recordings: agreement of ear photoplethysmography with ECG measurements, in 343 subjects

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European Journal of Applied Physiology Aims and scope Submit manuscript

Abstract

Purpose

We analyzed heart rate variability (HRV) taken by ECG and photoplethysmography (PPG) to assess their agreement. We also analyzed the sensitivity and specificity of PPG to identify subjects with low HRV as an example of its potential use for clinical applications.

Methods

The HRV parameters: mean heart rate (HR), amplitude, and ratio of heart rate oscillation (E–I difference, E/I ratio), RMSSD, SDNN, and Power LF, were measured during 1-min deep breathing tests (DBT) in 343 individuals, followed by a 5-min short-term HRV (s-HRV), where the HRV parameters: HR, SD1, SD2, SDNN, Stress Index, Power HF, Power LF, Power VLF, and Total Power, were determined as well. Parameters were compared through correlation analysis and agreement analysis by Bland–Altman plots.

Results

PPG derived parameters HR and SD2 in s-HRV showed better agreement than SD1, Power HF, and stress index, whereas in DBT HR, E/I ratio and SDNN were superior to Power LF and RMSSD. DBT yielded stronger agreement than s-HRV. A slight overestimation of PPG HRV over HCG HRV was found. HR, Total Power, and SD2 in the s-HRV, HR, Power LF, and SDNN in the DBT showed high sensitivity and specificity to detect individuals with poor HRV. Cutoff percentiles are given for the future development of PPG-based devices.

Conclusion

HRV measured by PPG shows good agreement with ECG HRV when appropriate parameters are used, and PPG-based devices can be employed as an easy screening tool to detect individuals with poor HRV, especially in the 1-min DBT test.

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Abbreviations

DBT:

Deep breathing test

ECG:

Electrocardiogram

E–I:

Difference between the highest and the lowest heart rate within a breathing cycle

HR:

Heart rate

HF:

High frequency (0.15–0.4 Hz)

HRV:

Heart rate variability

Hz:

Hertz

LF:

Low frequency (0.04–0.15 Hz)

ms:

Millisecond

OB/GYN:

Obstetrics and Gynecology

PPG:

Photoplethysmography

RMSSD:

Root means square of successive differences

RR interval:

Time between two adjacent heart beats

RSA:

Respiratory sinus arrhythmia

SD:

Standard deviation

SD1:

“Width” of the Poincare plot, reflecting short term variability

SD2:

“Length” of the Poincare plot, reflecting short term variability

SDNN:

Standard deviation of the RR-intervals

s-HRV:

5-min short-term HRV measurement

VLF:

Very low frequency

References

  • Allen J (2007) Photoplethysmography and its application in clinical physiological measurement. Physiol Meas 28(3):R1–39

    Article  PubMed  Google Scholar 

  • Bendjelid K, Suter PM, Romand JA (2004) The respiratory change in preejection period: a new method to predict fluid responsiveness. J Appl Physiol 96(1):337–342

    Article  PubMed  Google Scholar 

  • Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310

    Article  CAS  PubMed  Google Scholar 

  • Charlot K, Cornolo J, Brugniaux JV, Richalet JP, Pichon A (2009) Interchangeability between heart rate and photoplethysmography variabilities during sympathetic stimulations. Physiol Meas 30(12):1357–1369

    Article  CAS  PubMed  Google Scholar 

  • Chreiteh SS, Belhage B, Hoppe K, Branebjerg J, Thomsen EV (2014) Sternal pulse rate variability compared with heart rate variability on healthy subjects. Conf Proc IEEE Eng Med Biol Soc 2014:3394–3397

    PubMed  Google Scholar 

  • Constant I, Laude D, Murat I, Elghozi JL (1999) Pulse rate variability is not a surrogate for heart rate variability. Clin Sci (Lond) 97(4):391–397

    Article  CAS  Google Scholar 

  • Dehkordi P, Garde A, Karlen W, Wensley D, Ansermino JM, Dumont GA (2013) Pulse rate variability compared with Heart Rate Variability in children with and without sleep disordered breathing. Conf Proc IEEE Eng Med Biol Soc 2013:6563–6566

    PubMed  Google Scholar 

  • Giardino ND, Lehrer PM, Edelberg R (2002) Comparison of finger plethysmograph to ECG in the measurement of heart rate variability. Psychophysiology 39(2):246–253

    Article  PubMed  Google Scholar 

  • Gil E, Orini M, Bailon R, Vergara JM, Mainardi L, Laguna P (2010) Photoplethysmography pulse rate variability as a surrogate measurement of heart rate variability during non-stationary conditions. Physiol Meas 31(9):1271–1290

    Article  CAS  PubMed  Google Scholar 

  • Giles D, Draper N, Neil W (2016) Validity of the Polar V800 heart rate monitor to measure RR intervals at rest. Eur J Appl Physiol 116(3):563–571

    Article  PubMed  Google Scholar 

  • Heathers JA (2013) Smartphone-enabled pulse rate variability: an alternative methodology for the collection of heart rate variability in psychophysiological research. Int J Psychophysiol 89(3):297–304

    Article  PubMed  Google Scholar 

  • Khandoker AH, Karmakar CK, Palaniswami M (2011) Comparison of pulse rate variability with heart rate variability during obstructive sleep apnea. Med Eng Phys 33(2):204–209

    Article  PubMed  Google Scholar 

  • Lollgen D, Mueck-Weymann M, Beise RD (2009) The deep breathing test: median-based expiration-inspiration difference is the measure of choice. Muscle Nerve 39(4):536–544

    Article  PubMed  Google Scholar 

  • Lu S, Zhao H, Ju K, Shin K, Lee M, Shelley K et al (2008) Can photoplethysmography variability serve as an alternative approach to obtain heart rate variability information? J Clin Monit Comput 22(1):23–29

    Article  PubMed  Google Scholar 

  • O’Brien PC, Dyck PJ (1995) Procedures for setting normal values. Neurology 45(1):17–23

    Article  PubMed  Google Scholar 

  • Radespiel-Troger M, Rauh R, Mahlke C, Gottschalk T, Muck-Weymann M (2003) Agreement of two different methods for measurement of heart rate variability. Clin Auton Res 13(2):99–102

    Article  PubMed  Google Scholar 

  • Rauh R, Limley R, Bauer RD, Radespiel-Troger M, Mueck-Weymann M (2004) Comparison of heart rate variability and pulse rate variability detected with photoplethysmography. Proc Soc Photo-Opt Instrum Eng 5474:115–126

    Google Scholar 

  • Schafer A, Vagedes J (2013) How accurate is pulse rate variability as an estimate of heart rate variability? A review on studies comparing photoplethysmographic technology with an electrocardiogram. Int J Cardiol 166(1):15–29

    Article  PubMed  Google Scholar 

  • Shiyovich A, Jafari J, Blaer Y, Rehby H, Orlov I, Cohen D et al (2010) Respiratory stress response: a novel diagnostic method for detection of significant coronary artery disease from finger pulse wave analysis during brief respiratory exercise. Am J Med Sci 339(5):440–447

    Article  PubMed  Google Scholar 

  • TaskForce (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 93(5):1043–1065

  • Urbaszek W (1976) Hemodynamic aspects in the evaluation of heart function using systolic time intervals. Z Gesamte Inn Med 31(14):513–520

    CAS  PubMed  Google Scholar 

  • Waksman R, Sushinsky S, Okubagzi P, Landry P, Torguson R, Bui A et al (2010) An innovative noninvasive respiratory stress test indicates significant coronary artery disease. Cardiovasc Revasc Med 11(1):20–28

    Article  PubMed  Google Scholar 

  • Wong JS, Lu WA, Wu KT, Liu M, Chen GY, Kuo CD (2012) A comparative study of pulse rate variability and heart rate variability in healthy subjects. J Clin Monit Comput 26(2):107–114

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank medical students Hanna Wisseler and Katharina Hennrich, Medical School University of Heidelberg, for their assistance in gathering patient data. We would like to express our gratitude to medical student Christina Armstrong for her excellent help in correcting the English text.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, 4.2., Medical School, Heidelberg University, Voßstr. 2, 69115, Heidelberg, Germany

    Stefan W. Weinschenk

  2. Biosign GmbH, 85570, Ottenhofen, Germany

    Reinhard D. Beise

  3. Hochschule für Angewandte Wissenschaften, Ulmenliet 20, 21033, Hamburg, Germany

    Jürgen Lorenz

  4. OB/GYN Practice, Bahnhofplatz 8, 76137, Karlsruhe, Germany

    Stefan W. Weinschenk

Authors
  1. Stefan W. Weinschenk
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  2. Reinhard D. Beise
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  3. Jürgen Lorenz
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Corresponding author

Correspondence to Stefan W. Weinschenk.

Ethics declarations

Ethical standards

We declare that our experiments comply with the current German laws.

Conflict of interest

R. D. Beise is an employee of Biosign GmbH, Germany. S. W. Weinschenk and J. Lorenz have no conflicts of interests.

Additional information

Communicated by Keith Phillip George.

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Weinschenk, S.W., Beise, R.D. & Lorenz, J. Heart rate variability (HRV) in deep breathing tests and 5-min short-term recordings: agreement of ear photoplethysmography with ECG measurements, in 343 subjects. Eur J Appl Physiol 116, 1527–1535 (2016). https://doi.org/10.1007/s00421-016-3401-3

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  • DOI: https://doi.org/10.1007/s00421-016-3401-3

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