ORCID Profile
0000-0003-2984-2167
Current Organisation
University of Adelaide
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Biomedical Engineering | Signal Processing | Biomedical Engineering Not Elsewhere Classified | Autonomic Nervous System | Biomedical Engineering not elsewhere classified | Autonomic Nervous System | Cardiology (incl. Cardiovascular Diseases) |
Cardiovascular System and Diseases | Respiratory system and diseases (incl. asthma) | Nervous System and Disorders | Child health | Diagnostic methods
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2006
Publisher: Elsevier BV
Date: 07-2023
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.CLINPH.2010.06.017
Abstract: The aim of this study was to assess cardiac ventricular repolarization in patients with postural tachycardia syndrome (POTS) and further the possible link between ventricular repolarization and sympathetic nervous system activity. We recorded body surface ECGs together with plasma noradrenaline (NE) spillover, and muscle sympathetic nerve activity (MSNA) in twelve healthy control subjects (CON 5 males age: 23±2 yrs) and 13 subjects with postural tachycardia syndrome (POTS 4 males 32±13 yrs) during graded head-up tilt (0°-20°-30°-40°). Ventricular repolarization was assessed by computing various measures of beat-to-beat QT interval variability and T wave litude. In patients with POTS, baseline heart rates were higher and MSNA increases during tilt were more pronounced than in CON. None of the QT variability measures was significantly affected by tilt or different between CON and POTS when corrected for heart rate. Contrary, the T wave litude flattened due to tilt (p<0.001) and this effect was significantly more pronounced in POTS (32% at 40°) than in CON (21% at 40° p=0.03). Beat-to-beat variability of the QT interval is normal in patients with POTS. However, significantly more attenuated T waves during head-up tilt together with elevated MSNA levels suggest increased sympathetic outflow to the ventricular myocardium in patients with POTS. Monitoring of the T wave during tilt test may provide a non-invasive tool for assessing excessive sympathetic outflow to the ventricular myocardium.
Publisher: Frontiers Media SA
Date: 20-09-2017
Publisher: IOP Publishing
Date: 14-07-2006
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 09-2019
Publisher: IEEE
Date: 08-2012
Publisher: Oxford University Press (OUP)
Date: 08-2014
DOI: 10.5665/SLEEP.3930
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.IJCARD.2018.04.076
Abstract: Sleep disordered breathing (SDB) is highly prevalent in patients with atrial fibrillation, heart failure and hypertension and is associated with increased risk of mortality, cardiovascular (CV) events and arrhythmias. Current assessment of the severity of SDB is mainly based on the apnea-hypopnea index (AHI) representing the number of hypopneas and apneas per hour of sleep. However, this event-based parameter alone may not sufficiently reflect the complex pathophysiological mechanisms underlying SDB potentially contributing to CV outcome risk. In this review article, we highlight important limitations and pitfalls of current assessment, quantification and interpretation of SDB-severity in patients with CV disease and will discuss pathophysiological considerations from preclinical and clinical mechanistic studies and possible clinical implications.
Publisher: Oxford University Press (OUP)
Date: 07-09-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2014
DOI: 10.1161/CIRCEP.113.000882
Abstract: Surviving myocytes within scar may form channels that support ventricular tachycardia (VT) circuits. There are little data on the properties of channels that comprise VT circuits and those that are non-VT supporting channels. In 22 patients with ischemic cardiomyopathy and VT, high-density mapping was performed with the PentaRay catheter and Ensite NavX system during sinus rhythm. A channel was defined as a series of matching pace-maps with a stimulus (S) to QRS time of ≥40 ms. Sites were determined to be part of a VT channel if there were matching pace-maps to the VT morphology. This was confirmed with entrainment mapping when possible. Of the 238 channels identified, 57 channels corresponded to an inducible VT. Channels that were part of a VT circuit were more commonly located within dense scar than non-VT channels (97% versus 82% P =0.036). VT supporting channels were of greater length (mean±SEM, 53±5 versus 33±4 mm), had higher longest S-QRS (130±12 versus 82±12 ms), longer conduction time (103±14 versus 43±13 ms), and slower conduction velocity (0.87±0.23 versus 1.39±0.21 m/s) than non-VT channels ( P .001). Of all the fractionated, late, and very late potentials located in scar, only 21%, 26%, and 29%, respectively, were recorded within VT channels. High-density mapping shows substantial differences among channels in ventricular scar. Channels supporting VT are more commonly located in dense scar, longer than non-VT channels, and have slower conduction velocity. Only a minority of scar-related potentials participate in the VT supporting channels.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 12-2005
Publisher: Wiley
Date: 28-12-2010
DOI: 10.1111/J.1365-2869.2009.00798.X
Abstract: Arousal from sleep is associated with transient and abrupt cardiorespiratory changes, and elevated arousals associated with sleep disorders may trigger adverse cardiovascular sequela. In this paper, we provide the first data in children on cardiorespiratory responses to cortical arousal. Heart rate and ventilatory responses to arousal from stage 2 and rapid eye movement (REM) sleep were investigated in 40 normal, healthy Caucasian children (age: 7.7 +/- 2.6 years body mass index z-score: 0.30 +/- 0.8). All children underwent overnight polysomnography studies. Cortical arousals were scored according to standard criteria. Heart rate changes were assessed over 30 s, starting 15 s prior to cortical arousal onset. Breathing rates were quantified three breaths before and after arousal onset. Arousals from stage 2 as well as REM sleep resulted in an R-R interval shortening of about 15%, independent of age and gender. The R-R interval shortening initiated at least 3 s before the cortical arousal onset. The breathing interval immediately after cortical arousal onset was significantly shortened (P < 0.001). In conclusion, cortical arousals in children are associated with an increase in breathing rate and significant heart rate accelerations, which typically precede the cortical arousal onset.
Publisher: Wiley
Date: 09-03-2015
DOI: 10.1111/PACE.12594
Publisher: IOP Publishing
Date: 2021
Publisher: Wiley
Date: 04-12-2012
DOI: 10.1111/JCE.12039
Abstract: QT Variability and Sympathetic Dysinnervation. The mechanism of adverse prognosis attributable to proarrhythmic cardiac sympathetic dysinnervation in patients with type 2 diabetes is incompletely understood. This study sought the association of cardiac sympathetic dysinnervation with temporal instability of ventricular repolarization assessed by beat-to-beat QT interval variability. (123) I-metaiodobenzylguanidine ((123) I-MIBG) scintigraphy was analyzed in 31 type 2 diabetic patients for cardiac sympathetic dysinnervation (4-hour heart-to-mediastinum ratio <1.8) and regional sympathetic integrity and washout rate (from 15-minute (123) I-MIBG uptake). Relative QT variability was defined from a continuous 5-minute ECG in the supine position (n = 31) and standing position (subgroup n = 15) by the log ratio of absolute QT variability (QT variance ided by the mean QT interval squared) to heart rate (HR) variability (HR variance ided by the mean HR squared). Patients with (n = 16 52%) versus without cardiac sympathetic dysinnervation demonstrated higher relative QT variability in the supine position (P < 0.001), owing to lower HR variability. However, on standing, absolute QT variability was significantly raised in these patients (P = 0.009) despite similar HR variability in the 2 groups. Correlations of heart-to-mediastinum ratio with standing QT variability (relative [r =-0.63, P = 0.013] and absolute [r =-0.79, P = 0.001]) were superior to corresponding supine measures (relative [r =-0.47, P = 0.008] and absolute [P = NS]). No associations of QT variability with washout rate or regional (123) I-MIBG uptake were identified. Elevated QT variability is associated with cardiac sympathetic dysinnervation in type 2 diabetes and may contribute to adverse prognosis. Moreover, QT variability may be more specific for cardiac sympathetic innervation when measured in the context of sympathetic activation. (J Cardiovasc Electrophysiol, Vol. 24, pp. 305-313, March 2013).
Publisher: Frontiers Media SA
Date: 29-04-2016
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.PSYNEUEN.2019.104406
Abstract: This study had two specific objectives, 1) to investigate the impact of being on-call on overnight heart rate variability during sleep and 2) to examine whether being on-call overnight impacted next-day salivary cortisol concentrations. Data are reported from three within-subject laboratory studies (n = 24 in each study) that assessed varying on-call conditions. Healthy male participants (n = 72 total) completed a four-night laboratory protocol, comprising an adaptation night, a control night, and two counterbalanced on-call nights with varying on-call conditions. These on-call conditions were designed to determine the impact of, Study 1: the likelihood of receiving a call (definitely, maybe), Study 2: task stress (high-stress, low-stress), and Study 3: chance of missing the alarm (high-chance, low-chance), on measures of physiological stress. Overnight heart rate variability (HRV) (during sleep) was measured using two-lead electrocardiography, and time- and frequency-domain variables were analysed. Saliva s les were collected at 15-min time intervals from 0700-0800 h to determine cortisol awakening response outcomes and at four daily time points (0930 h, 1230 h, 1430 h, and 1730 h) to assess diurnal cortisol profiles. There were few differences in HRV measures during sleep across all three studies. The only exception was in Study 1 where the standard deviation of the time interval between consecutive heartbeats and the root mean square of consecutive differences between heartbeats were lower across all sleep stages in the definitely condition, when compared to control. Across all three studies, being on-call overnight also had little impact on next-day cortisol awakening response (CAR), with the exception of Study 2 where the 1) CAR area under the curve with respect to increase was blunted in the high-stress condition, compared to the control and low-stress conditions and, 2) CAR reactivity was higher in low-stress condition, compared with the high-stress condition. In Study 1, diurnal cortisol area under the curve with respect to ground was lower in the on-call conditions (definitely and maybe) when compared to control. There were no differences in diurnal cortisol measures in Study 3. This is the first study to investigate how different aspects of being on-call affect physiological stress responses. Overall, relatively little differences in measures of overnight heart rate variability and next-day cortisol response were recorded in all three studies. Further research utilising real on-call work tasks, not just on-call expectations (as in the current study) will help determine the impact of on-call work on the physiological stress response.
Publisher: World Scientific Pub Co Pte Lt
Date: 12-2005
DOI: 10.1142/S0219477505003026
Abstract: Heart rate exhibits spontaneous fluctuations that are mainly modulated by control loops within the autonomic nervous system. Assessing the dynamics of heart rate fluctuations can provide valuable information about regulatory processes and patho-physiological behavior. In this paper heart rate fluctuations and its entropy are assessed using an algorithmic information theoretic concept applying a data compressor. First, the beat-to-beat fluctuations of heart rate are binary coded for decreases and increases, respectively. Subsequently, those symbol sequences are compressed using the LZ77 algorithm. The ratio of the length of the compressed sequences to the original length is used as an estimate of entropy. We investigated the compressibility of heart rate fluctuations in athletes before, during, and after a training c . Heart rate time series were obtained from ECGs recorded over 30 minutes under supine resting conditions. We found a significant entropy reduction during the training c , reflecting the effects of physical fatigue. In conclusion, the compression entropy seems to be a suitable approach to assess the complexity of heart rate fluctuations.
Publisher: Oxford University Press (OUP)
Date: 03-2006
DOI: 10.1016/J.AMJHYPER.2005.08.008
Abstract: Abnormal uterine perfusion is associated with the development of hypertensive pregnancy disorders. However, its impact on maternal autonomic cardiovascular control is poorly understood. The aim of our study was to investigate the adaptation of autonomic control during pregnancy with abnormal uterine perfusion with normal and pathologic outcome in comparison to normal pregnancies. based on blood pressure variability (BPV), baroreflex sensitivity (BRS), and heart rate variability (HRV) analyses. A total of 32 healthy pregnant women (CON, age 28 years, range 24 to 31 years) 16 women with abnormal uterine perfusion and normal outcome (AP-NO, age 29 years, range 28 to 33 years) and 19 women with abnormal uterine perfusion and pathologic outcome (AP-PO, age 26 years, range 25 to 30 years), were recruited for this longitudinal study. Beginning in the 20th week of pregnancy, the women were monitored every fourth week until delivery. For the analysis of BPV, BRS, and HRV, high-resolution ECG, and noninvasive continuous blood pressure (BP) recordings were taken simultaneously for 30 minutes. CON showed pregnancy-induced adaptation of cardiovascular control in the course of gestation BPV was increased while parameters of HRV and BRS were reduced. On the contrary, no changes during the second half of pregnancy could be observed in pregnancies with abnormal perfusion. Variability parameters were significantly altered in women with abnormal perfusion compared with CON, whereas these changes were more pronounced in AP-PO compared with AP-NO. Abnormal uterine perfusion, independently of the pregnancy outcome, has a significant impact on maternal cardiovascular control. Measures of BPV, BRS and HRV might be used for improved risk stratification.
Publisher: IEEE
Date: 05-2014
Publisher: Oxford University Press (OUP)
Date: 09-05-2019
Publisher: Oxford University Press (OUP)
Date: 08-2022
Abstract: The general public increasingly adopts smart wearable devices to quantify sleep characteristics and dedicated devices for sleep assessment. The rapid evolution of technology has outpaced the ability to implement validation approaches and demonstrate relevant clinical applicability. There are untapped opportunities to validate and refine consumer devices in partnership with scientists in academic institutions, patients, and the private sector to allow effective integration into clinical management pathways and facilitate trust in adoption once reliability and validity have been demonstrated. We call for the formation of a working group involving stakeholders from academia, clinical care and industry to develop clear professional recommendations to facilitate appropriate and optimized clinical utilization of such technologies.
Publisher: Springer Science and Business Media LLC
Date: 03-2002
DOI: 10.1007/BF02348131
Publisher: American Physiological Society
Date: 06-2016
DOI: 10.1152/AJPREGU.00541.2015
Abstract: Muscle sympathetic nerve activity (MSNA) variability is traditionally computed through a low-pass filtering procedure that requires normalization. We proposed a new beat-to-beat MSNA variability computation that preserves dimensionality typical of an integrated neural discharge (i.e., bursts per unit of time). The calibrated MSNA (cMSNA) variability technique is contrasted with the traditional uncalibrated MSNA (ucMSNA) version. The powers of cMSNA and ucMSNA variabilities in the low-frequency (LF, from 0.04 to 0.15 Hz) band were computed with those of the heart period (HP) of systolic and diastolic arterial pressure (SAP and DAP, respectively) in seven healthy subjects (age, 20–28 years median, 22 years 5 women) during a graded head-up tilt. Subjects were sequentially tilted at 0°, 20°, 30°, 40°, and 60° table inclinations. The LF powers of ucMSNA and HP variabilities were expressed in normalized units (LFnu), whereas all remaining spectral markers were expressed in absolute units. We found that 1) the LF power of cMSNA variability was positively correlated with tilt angle, whereas the LFnu power of the ucMSNA series was uncorrelated 2) the LF power of cMSNA variability was correlated with LF powers of SAP and DAP, LFnu power of HP and noradrenaline concentration, whereas the relationship of the LFnu power of ucMSNA variability to LF powers of SAP and DAP was weaker and that to LFnu power of HP was absent and 3) the stronger relationship of cMSNA variability to SAP and DAP spectral markers compared with the ucMSNA series was confirmed in idually. The cMSNA variability appears to be more suitable in describing sympathetic control in humans than traditional ucMSNA variability.
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.HRTHM.2012.03.062
Abstract: Atrial premature contractions (APCs) are well described to precede the initiation of paroxysmal atrial fibrillation (pAF). However, whether APC characteristics alter with progression of the arrhythmia is unknown. To determine the APC characteristics in terms of burden and relative coupling interval with progression of the AF disease process. Fifty consecutive patients with pAF, 50 consecutive patients with persistent AF (perAF), and 25 age-matched controls underwent clinical review, transthoracic echocardiography, and ambulatory electrocardiogram monitoring. After excluding 29 patients who had AF for the entire recording (n = 24) or unreliable recordings (n = 5), we analyzed data from 49 patients with pAF, 24 patients with perAF, and 23 healthy controls. All normal morphology R-R intervals with a >25% decrease in R-R coupling compared with the previous R-R interval (coupling interval index) were deemed APCs (n = 95,873). The median APC burden was higher in patients with pAF (2 [1-22] APCs/h P = .004) and perAF (3 [1-6] APCs/h P = .04) than in controls (1 [0-1] APCs/h) but was not different (P = .66) between the AF subgroups. Patients with pAF had a distinct increase in ectopy burden after 7 PM and elevation throughout the night (P = .002) in comparison with a blunted and complementary temporal response in the perAF cohort (P = .01). Patients with pAF demonstrated a greater proportion of shortly coupled APCs (29% [13-45] P = .04) compared with persistent arrhythmia (17% [5-29]). "Real-life" atrial trigger statistics of APC burden, timing, and diurnal rhythms track the transition from a trigger-based, autonomically sensitive paroxysmal arrhythmia to a more substrate-based persistent disease.
Publisher: Springer Science and Business Media LLC
Date: 05-01-2004
Publisher: IEEE
Date: 07-2013
Publisher: Springer Science and Business Media LLC
Date: 14-12-2006
DOI: 10.1007/S10439-006-9220-7
Abstract: Ventricular tachycardia (VT) provokes sudden cardiac death (SCD), which is a major cause of mortality in developed countries. Implantable cardioverter-defibrillators (ICDs) are an efficient therapy for SCD prevention. In this study we analyze heart rate variability (HRV) in data stored by ICDs. In 29 patients exhibiting VT episodes, the last 1000 normal beat-to-beat intervals are analyzed and compared to an in idually acquired control time series (CON). HRV analysis is performed with standard parameters of time and frequency domain as suggested by the HRV Task Force. For scaling analyses of heart rate time series, the fractal dimension is analysed, applying Higuchi's algorithm (HFD). Furthermore, detrended fluctuation analysis (DFA) is performed. None of the standard HRV parameters shows significant differences between CON and VT. Before the onset of VT, the scaling characteristics by means of HFD and DFA are significantly changed. In conclusion, scaling analysis reveals changes in autonomic heart rate modulation preceding VT.
Publisher: Oxford University Press (OUP)
Date: 27-01-2016
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 02-2016
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.SLEEP.2015.08.004
Abstract: This study aimed to evaluate whether the vascular dysfunction perceived in adults with sleep-disordered breathing (SDB) was also evident in children with snoring referred for evaluation of clinically suspected SDB. This study compared flow-mediated dilatation (FMD), measured at the brachial artery, at rest and during hyperaemic stress between children who snore [n = 23 mean standard deviation (SD) age = 7.51 (1.3) years] and healthy, non-snoring children [n = 11 age = 8.0 (1.3) years]. Children with suspected obstructive sleep apnoea (OSA) and healthy non-snoring controls underwent overnight polysomnography (PSG). Using standard techniques, non-invasive FMD and brachial arterial blood flow velocity during rest and hyperaemia were subsequently measured by ultrasound imaging Resting and hyperaemic velocity time integral (area under the curve of mean systolic velocity × ejection time), maximal dilation response (highest percentage difference from baseline diameter) and the time taken to reach maximal dilation were calculated. Children awaiting adenotonsillectomy compared to healthy non-snoring control children had higher velocity time integrals at rest (14 ± 3 m vs. 20 ± 8 m, p < 0.01) and during hyperaemic stress (56 ± 6m vs. 63 ± 13m, p < 0.01) despite having only mild SDB on polysomnographic assessment. Lower nadir oxygen saturation values during non-rapid eye movement sleep were negatively associated with higher resting (r = -0.58, p <0.001) and hyperaemic (r = -0.36, p < 0.05) velocity time integrals. Maximal FMD dilatation response was not significantly different between snoring and non-snoring groups, but the estimated time to reach maximal dilation was significantly delayed in children who snored (60.7 ± 28.4 vs. 39.2 ± 13.2 s, p < 0.05). Children with mild SDB showed increased blood flow velocity at rest and during hyperaemic stress suggesting altered cardiovascular and haemodynamic function. The delay in time to maximal vessel dilatation in children who snored also suggests possible reduced vascular compliance in response to hyperaemic sheer stress. Mild SDB appears to alter the peripheral vascular response in young children. The long-term vascular implications of these changes in the growing child are unknown and warrant further investigation.
Publisher: Springer Berlin Heidelberg
Date: 2009
Publisher: IEEE
Date: 08-2015
Publisher: American Physiological Society
Date: 08-2009
DOI: 10.1152/AJPHEART.00236.2009
Abstract: Changes in measures of heart rate variability (HRV) have been associated with an increased risk for sudden cardiac death. The mechanisms underlying this association are not known. The objective of this study was to assess the relationship between the amount of norepinephrine (NE) released from the cardiac sympathetic terminals and short-term HRV. The study comprised 8 healthy subjects, 12 patients with major depression, and 7 patients with panic disorder. Cardiac NE spillover was determined using direct coronary sinus blood s ling coupled with an NE isotope dilution methodology. Short-term HRV was quantified using detrended fluctuation analysis, symbolic dynamics, s le entropy, and standard time and frequency domain measures. Neither HRV nor cardiac NE spillover was significantly different between the analyzed groups. None of the standard HRV metrics was significantly correlated with cardiac NE spillover, but there was a moderate correlation between two complexity measures of HRV (symbolic dynamics) and cardiac NE spillover (patterns with 2 like variations, r = −0.37 and P = 0.05 and patterns with no variations: r = 0.34 and P = 0.06). In conclusion, there is no correlation between standard HRV measures and cardiac NE spillover in humans. Short-term complexity of heart rate is only moderately affected by sympathetic neural outflow. Therefore, the predictive value of most HRV measures for sudden cardiac death may predominantly result from their capacity to capture vagally mediated heart rate modulations.
Publisher: IEEE
Date: 08-2015
Publisher: Informa UK Limited
Date: 11-12-2013
DOI: 10.3109/10641955.2013.821481
Abstract: We studied the short-term response of autonomic control to delivery in normal pregnancies and pregnancies with preecl sia (PE). Fourteen healthy pregnant women and 13 women with PE were monitored within four days before and four days after delivery and compared to values of 14 non-pregnant women as controls using high-resolution electrocardiogram and noninvasive continuous blood pressure monitoring. In PE, blood pressure remained elevated four days postpartum, but markers for arterial stiffness normalized. In contrast, none of heart rate variability and baroreflex sensitivity parameters, altered due to either pregnancy or disease, were normalized 96 h after delivery. Four days after delivery, the maternal cardiovascular system is still strongly affected by pregnancy independent of the health status.
Publisher: Oxford University Press (OUP)
Date: 07-06-2023
Abstract: To determine the effect of transvenous phrenic nerve stimulation (TPNS) on nocturnal heart rate perturbations in patients with CSA. In this ancillary study of the remedē System Pivotal Trial, we analyzed electrocardiograms from baseline and follow-up overnight polysomnograms (PSG) in 48 CSA patients in sinus rhythm with implanted TPNS randomized to stimulation (treatment group TPNS on) or no stimulation (control group TPNS off). We quantified heart rate variability in the time and frequency domain. Mean change from baseline and standard error is provided. TPNS titrated to reduce respiratory events is associated with reduced cyclical heart rate variations in the very low-frequency domain across REM (VLFI: 4.12 ± 0.79% vs. 6.87 ± 0.82%, p = 0.02) and NREM sleep (VLFI: 5.05 ± 0.68% vs. 6.74 ± 0.70%, p = 0.08) compared to the control group. Further, low-frequency oscillations were reduced in the treatment arm in REM (LFn: 0.67 ± 0.03 n.u. vs. 0.77 ± 0.03 n.u., p = 0.02) and NREM sleep (LFn: 0.70 ± 0.02 n.u. vs. 0.76 ± 0.02 n.u., p = 0.03). In adult patients with moderate to severe central sleep apnea, transvenous phrenic nerve stimulation reduces respiratory events and is associated with the normalization of nocturnal heart rate perturbations. Long-term follow-up studies could establish whether the reduction in heart rate perturbation by TPNS also translates into cardiovascular mortality reduction. A Randomized Trial Evaluating the Safety and Effectiveness of the remedē® System in Patients With Central Sleep Apnea, ClinicalTrials.gov, NCT01816776
Publisher: Oxford University Press (OUP)
Date: 20-04-2021
DOI: 10.1093/EURHEARTJ/EHAB151
Abstract: To quantify the arousal burden (AB) across large cohort studies and determine its association with long-term cardiovascular (CV) and overall mortality in men and women. We measured the AB on overnight polysomnograms of 2782 men in the Osteoporotic Fractures in Men Study (MrOS) Sleep study, 424 women in the Study of Osteoporotic Fractures (SOF) and 2221 men and 2574 women in the Sleep Heart Health Study (SHHS). During 11.2 ± 2.1 years of follow-up in MrOS, 665 men died, including 236 CV deaths. During 6.4 ± 1.6 years of follow-up in SOF, 105 women died, including 47 CV deaths. During 10.7 ± 3.1 years of follow-up in SHHS, 987 participants died, including 344 CV deaths. In women, multivariable Cox proportional hazard analysis adjusted for common confounders demonstrated that AB is associated with all-cause mortality [SOF: hazard ratio (HR) 1.58 (1.01–2.42), P = 0.038 SHHS-women: HR 1.21 (1.06–1.42), P = 0.012] and CV mortality [SOF: HR 2.17 (1.04–4.50), P = 0.037 SHHS-women: HR 1.60 (1.12–2.28), P = 0.009]. In men, the association between AB and all-cause mortality [MrOS: HR 1.11 (0.94–1.32), P = 0.261 SHHS-men: HR 1.31 (1.06–1.62), P = 0.011] and CV mortality [MrOS: HR 1.35 (1.02–1.79), P = 0.034 SHHS-men: HR 1.24 (0.86–1.79), P = 0.271] was less clear. Nocturnal AB is associated with long-term CV and all-cause mortality in women and to a lesser extent in men.
Publisher: IOP Publishing
Date: 06-10-2022
Abstract: Objective . Beat-to-beat fluctuations in the QT interval—QT variability (QTV)—have been shown to vary amongst the different ECG leads. This study aims to compare the utility of single and multi-lead ECG to disentangle the mechanisms contributing to QTV. Approach . Twelve-lead ECG was analysed in 57 coronary artery disease patients before and after an elective percutaneous transluminal coronary angiography (PTCA) procedure. QT, RR and respiration time series were extracted. QTV was decomposed into contributions by heart rate, respiration and QTV independent of heart rate and respiration using parametric autoregressive modelling. Signal-to-noise ratio, model goodness-of-fit, mean QT, corrected QT, QT variability and RR variability were also computed. Results from two single leads (Lead II and V5) and three one-dimensional representations of 12-lead ECG (principal component analysis (PCA), vector magnitude (VM), and root mean square of the 8 independent leads of the standard 12 leads (RMS8)) were compared during resting conditions, before and after PTCA, and between patients with myocardial infarction and those without. Main results . At baseline, mean QT and corrected QT were significantly lower in VM and RMS8 compared to single leads. While overall QT variability was not different between the leads, QT independent of heart rate and respiration was significantly lower in VM and RMS8. Following PTCA, changes in these variables were similar in all leads. Differences between patients with MI and those without MI were consistent in all leads. Significance . Despite the differences in some QTV components amongst various leads, single-lead ECG could be sufficient for analyzing QTV in populations with pathological cardiovascular conditions compared to those without, or for quantification of intervention effects.
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.SLEEP.2010.07.018
Abstract: Upper airway obstruction (UAO) during childhood is associated with cardiovascular morbidity. The aim of this study was to investigate the cardio-respiratory response to cortical arousal during sleep in children with UAO. Standard paediatric overnight polysomnography (PSG) was conducted in 40 children with UAO (25M, 7.5±2.7yrs) prior to and 6 months following adenotonsillectomy. For comparison a control group of 40 normal, sex and age matched children (21M, 7.5±2.6yrs) underwent two PSGs without intervention at the same time points. Heart rate and respiratory rate were measured during spontaneous and respiratory arousals in stage 2 and REM sleep 15s prior to and 15s immediately following cortical arousal onset. Cortical arousal was associated with a significant increase in heart and respiratory rate in both groups of children. UAO children, however, showed a significantly higher heart rate response in stage 2 sleep (-17.5±6.0 vs. -14.4±4.8% p<0.05), a lower pre-arousal baseline respiratory rate (stage 2: 17.1±1.4 vs. 18.2±1.7 BPM p<0.01) and a prolonged increase in respiratory rate compared to control children. Cardiac and respiratory arousal responses were not significantly different from controls following adenotonsillectomy in the UAO children. UAO in children is associated with an altered cardiorespiratory response to spontaneous arousal from sleep, which may indicate early signs of autonomic dysfunction. Surgical treatment of UAO appears to reverse these outcomes.
Publisher: Elsevier BV
Date: 07-2016
Publisher: Walter de Gruyter GmbH
Date: 10-2006
DOI: 10.1515/BMT.2006.037
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 12-2019
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.METABOL.2014.05.007
Abstract: Autonomic dysfunction may contribute to the etiology and exercise intolerance of subclinical diabetic heart disease. This study sought the efficacy of exercise training for improvement of peak oxygen uptake (VO₂(peak)) and cardiac autonomic function in type 2 diabetic patients with non-ischemic subclinical left-ventricular (LV) dysfunction. Forty-nine type 2 diabetic patients with early diastolic tissue Doppler velocity >1 standard deviation below the age-based mean entered an exercise intervention (n=24) or usual care (n=25) for 6-months (controlled, pre- ost- design). Co-primary endpoints were treadmill VO₂(peak) and 5-min heart-rate variability (by the coefficient of variation of normal RR intervals [CVNN]). Autonomic function was additionally assessed by resting heart-rate (for sympathovagal balance estimation), baroreflex sensitivity, cardiac reflexes, and exercise/recovery heart-rate profiles. Echocardiography was performed for LV function (systolic/diastolic tissue velocities, myocardial deformation) and myocardial fibrosis (calibrated integrated backscatter). VO₂(peak) increased by 11% during the exercise intervention (p=0.001 vs. -1% in controls), but CVNN did not change (p=0.23). Reduction of resting heart-rate in the intervention group (p<0.05) was associated with an improvement in the secondary endpoint of heart-rate variability total spectral power (p<0.05). However, baroreflex sensitivity, cardiac reflexes, and exercise/recovery heart-rate profiles showed no significant benefit. No effects on LV function were observed despite favorable reduction of calibrated integrated backscatter in the intervention group (p<0.05). The exercise intolerance of subclinical diabetic heart disease was amenable to improvement by exercise training. Despite a reduction in resting heart-rate and potential attenuation of myocardial fibrosis, no other cardiac autonomic or LV functional adaptations were detected.
Publisher: IEEE
Date: 07-2013
Publisher: Wiley
Date: 11-02-2015
Abstract: Flow-mediated dilatation (FMD) is a tool widely used to measure arterial responsiveness to sheer stress. However, there is scant literature to show how the peripheral arterial response changes as the vascular system matures. One reason for this is that the feasibility of measuring FMD in younger children has not been established. The aim of the present study was to assess brachial artery function at rest and during the FMD response after 4 min ischaemia of the forearm in children aged 6-15 years. Time to reach maximum FMD (FMDmax ) was found to be correlated with age (r = 0.4, P < 0.05), resting brachial artery diameter (r = 0.4, P < 0.05), height (r = 0.4, P < 0.05), body mass index (BMI r = 0.45, P < 0.05), body surface area (r = 0.44, P < 0.05) and resting blood flow (r = 0.37, P < 0.05). However, there was no correlation between the traditional FMD response at 60 s or FMD maximal dilation and age, resting brachial artery diameter, height, weight, BMI, body surface area and resting blood flow. In conclusion, the time taken to reach the maximal dilation response is related to age, brachial artery luminal diameter and body habitus, but not the traditional measure of FMD response at 60 s or the maximal dilatation percentage.
Publisher: IOP Publishing
Date: 26-09-2012
DOI: 10.1088/0967-3334/33/10/1747
Abstract: Time irreversibility is a characteristic feature of non-equilibrium, complex systems such as the cardiovascular control mediated by the autonomic nervous system (ANS). Time irreversibility analysis of heart rate variability (HRV) and blood pressure variability (BPV) represents a new approach to assess cardiovascular regulatory mechanisms. The aim of this paper was to assess the changes in HRV and BPV irreversibility during the active orthostatic test (a balance of ANS shifted towards sympathetic predominance) in 28 healthy young subjects. We used three different time irreversibility indices-Porta's, Guzik's and Ehler's indices (P%, G% and E, respectively) derived from data segments containing 1000 beat-to-beat intervals on four timescales. We observed an increase in the HRV and a decrease in the BPV irreversibility during standing compared to the supine position. The postural change in irreversibility was confirmed by surrogate data analysis. The differences were more evident in G% and E than P% and for higher scale factors. Statistical analysis showed a close relationship between G% and E. Contrary to this, the association between P% and G% and P% and E was not proven. We conclude that time irreversibility of beat-to-beat HRV and BPV is significantly altered during orthostasis, implicating involvement of the autonomous nervous system in its generation.
Publisher: Springer Science and Business Media LLC
Date: 27-03-2012
DOI: 10.1007/S00330-012-2417-2
Abstract: To investigate whether grid-tag myocardial strain evaluation can characterise 'border-zone' peri-infarct region and identify patients at risk of ventricular arrhythmia as the peri-infarct myocardial zone may represent an important contributor to ventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI). Forty-five patients with STEMI underwent cardiac magnetic resonance (CMR) imaging on days 3 and 90 following primary percutaneous coronary intervention (PCI). Circumferential peak circumferential systolic strain (CS) and strain rate (CSR) were calculated from grid-tagged images. Myocardial segments were classified into 'infarct', 'border-zone', 'adjacent' and 'remote' regions by late-gadolinium enhancement distribution. The relationship between CS and CSR and these distinct myocardial regions was assessed. Ambulatory Holter monitoring was performed 14 days post myocardial infarction (MI) to estimate ventricular arrhythmia risk via evaluation of heart-rate variability (HRV). We analysed 1,222 myocardial segments. Remote and adjacent regions had near-normal parameters of CS and CSR. Border-zone regions had intermediate CS (-9.0 ± 4.6 vs -5.9 ± 7.4, P < 0.001) and CSR (-86.4 ± 33.3 vs -73.5 ± 51.4, P < 0.001) severity compared with infarct regions. Patients with 'border-zone' peri-infarct regions had reduced very-low-frequency power on HRV analysis, which is a surrogate for ventricular arrhythmia risk (P = 0.03). Grid-tagged CMR-derived myocardial strain accurately characterises the mechanical characteristics of 'border-zone' peri-infarct region. Presence of 'border-zone' peri-infarct region correlated with a surrogate marker of heightened arrhythmia risk following STEMI. • Grid-tagged cardiac magnetic resonance (CMR) offers new insights into myocardial mechanical function. • Grid-tagged CMR identified different characteristics in 'border-zone' and 'adjacent' peri-infarct myocardial regions. • Reduced very-low-frequency (VLF) power is associated with arrhythmic and mortality risk. • The presence of 'border-zone' peri-infarct region correlated with reduced VLF power.
Publisher: American Physiological Society
Date: 10-2015
DOI: 10.1152/AJPHEART.00230.2015
Abstract: Beat-to-beat variability of the QT interval (QTV) is sought to provide an indirect noninvasive measure of sympathetic nerve activity, but a formal quantification of this relationship has not been provided. In this study we used power contribution analysis to study the relationship between QTV and muscle sympathetic nerve activity (MSNA). ECG and MSNA were recorded in 10 healthy subjects in the supine position and after 40° head-up tilt. Power spectrum analysis was performed using a linear autoregressive model with two external inputs: heart period (RR interval) variability (RRV) and MSNA. Total and low-frequency power of QTV was decomposed into contributions by RRV, MSNA, and sources independent of RRV and MSNA. Results show that the percentage of MSNA power contribution to QT is very small and does not change with tilt. RRV power contribution to QT power is notable and decreases with tilt, while the greatest percentage of QTV is independent of RRV and MSNA in the supine position and after 40° head-up tilt. In conclusion, beat-to-beat QTV in normal subjects does not appear to be significantly affected by the rhythmic modulations in MSNA following low to moderate orthostatic stimulation. Therefore, MSNA oscillations may not represent a useful surrogate for cardiac sympathetic nerve activity at moderate levels of activation, or, alternatively, sympathetic influences on QTV are complex and not quantifiable with linear shift-invariant autoregressive models.
Publisher: World Scientific Pub Co Pte Lt
Date: 12-2005
DOI: 10.1142/S0219477505003002
Abstract: Arterial blood pressure is modulated by several physiological regulatory processes. The analysis of beat-to-beat blood pressure dynamics provides information about cardiovascular control and patho-physiological conditions. In this paper we investigated the long-term correlations and fractal dimension of systolic blood pressure time series applying detrended fluctuation analysis (DFA) and Higuchi's algorithm (HFD). Thirty-minute blood pressure recordings in 25 patients with dilated cardiomyopathy (DCM) and 27 healthy controls (CON) were analyzed. The DFA and HFD revealed multifractal features in the blood pressure dynamics of CON as well as of DCM. At small scales, DFA and HFD of CON were significantly different from those of CON, reflecting patho-physiological changes. In conclusion, scaling analysis of blood pressure dynamics might lead to an enhanced assessment of autonomic cardiovascular control in patients with DCM.
Publisher: Walter de Gruyter GmbH
Date: 10-2006
DOI: 10.1515/BMT.2006.028
Publisher: Wiley
Date: 19-05-2009
DOI: 10.1111/J.1365-2869.2008.00720.X
Abstract: Sudden cardiac death appears to be more prevalent during the normal sleeping hours in obstructive sleep apnoea (OSA) patients compared with the general population as well as to cardiovascular disease patients. The reasons for this remain unclear, but there are three likely main contributors to nocturnal death in OSA patients cardiac arrhythmias, stroke/ruptured cerebral aneurism and myocardial infarction. Particularly marked cardiovascular system activation with arousal may play a role in initiating sudden adverse cardiovascular events in OSA. The purpose of this study was to investigate cardiac RR, QT and PR interval changes in the electrocardiogram (ECG) associated with spontaneous and respiratory-related arousals in OSA patients. A detailed observational study of ECG records obtained during conventional diagnostic sleep study with no further interventions was carried out in 20 patients (12 males, age 42.8 +/- 2.1 years, body mass index 35.1 +/- 1.9 kg m(-2), and respiratory disturbance index 51.8 +/- 6.4 events/hour). RR and QT intervals showed significant shortening during arousals. RR interval shortening was found to be greater during respiratory arousals when compared to spontaneous arousals. PR interval showed a trend toward a greater prolongation during respiratory arousal. QT interval shortening was weakly correlated with arterial oxygen saturation levels preceding arousal. In conclusion, these data suggest that despite greater cardiac acceleration following respiratory versus spontaneous arousals from sleep, QT shortening and PR prolongation responses are similar independent of arousal type. These data support that arousals produce quite marked and differential cardiac conduction system activation in OSA and that the degree and pattern of activation may be partly influenced by the presence and severity of preceding respiratory events.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.SLEEP.2018.05.020
Abstract: The aim of this study was to assess cardiovascular autonomic modulation in children with upper airway obstruction (UAO), to compare this modulation to that of non-snoring children and to investigate the effect of adenotonsillectomy (AT). ECG and finger photoplethysmographic signals obtained from overnight polysomnographic (PSG) recordings of 31 children with mild-to-moderate UAO and 34 non-snoring children were analysed. The extent of autonomic modulation was assessed by symbolic analysis of heart period (HP), pulse wave litude (PWA), and their joint dynamics during non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. Children with UAO showed more frequent patterns of monotonically increasing and decreasing HP in NREM sleep and monotonically increasing and decreasing joint PWA-HP patterns in REM and NREM sleep at baseline compared to controls, even when considering only periods of sleep free of discrete respiratory events. Following AT, HP, and joint PWA-HP dynamics significantly altered towards levels observed in the control group. In children with mild-to-moderate UAO, cardiovascular autonomic modulation is more prevalent, even during quiet, event-free sleep. AT appears to reverse this pattern.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.SLEEP.2015.02.528
Abstract: Heartbeat-evoked potentials (HEPs) in electroencephalogram (EEG) provide a quantitative measure of cardiac interoception during sleep. We previously reported reduced HEPs in children with sleep-disordered breathing (SDB), indicative of attenuated cardiac information processing. The objective of this study was to investigate the link between HEP and respiration. From the overnight polysomnograms of 40 healthy children and 40 children with SDB, we measured HEPs during epochs of stage 2, slow-wave and rapid eye movement (REM) sleep free of abnormal respiratory events. HEPs were analysed with respect to respiratory phase. We observed a marked association between respiratory phase and HEP in children with SDB during REM sleep, but not in normal children. In children with SDB, HEP waveforms were attenuated during expiration compared to inspiration. Following adenotonsillectomy, expiratory HEP peak litude increased in the SDB children and was no longer different from those of normal children. The expiratory phase of respiration is primarily associated with attenuated cardiac information processing in children with SDB, establishing a pathophysiological link between breathing and HEP attenuation.
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.PHYSBEH.2010.04.004
Abstract: Our aim was to assess the impact of motor activity and of arousing stimuli on respiratory rate in the awake rats. The study was performed in male adult Sprague-Dawley (SD, n=5) and Hooded Wistar (HW, n=5) rats instrumented for ECG telemetry. Respiratory rate was recorded using whole-body plethysmograph, with a piezoelectric sensor attached for the simultaneous assessment of motor activity. All motor activity was found to be associated with an immediate increase in respiratory rate that remained elevated for the whole duration of movement this was reflected by: i) bimodal distribution of respiratory intervals (modes for slow peak: 336+/-19 and 532+/-80 ms for HW and SD, p<0.05 modes for fast peak 128+/-6 and 132+/-7 ms for HW and SD, NS) and ii) a tight correlation between total movement time and total time of tachypnoea, with an R(2) ranging 0.96-0.99 (n=10, p<0001). The extent of motor-related tachypnoea was significantly correlated with the intensity of associated movement. Mild alerting stimuli produced stereotyped tachypnoeic responses, without affecting heart rate: tapping the chamber raised respiratory rate from 117+/-7 to 430+/-15 cpm sudden side move--from 134+/-13 to 487+/-16 cpm, and turning on lights--from 136+/-12 to 507+/-14 cpm (n=10 p<0.01 for all no inter-strain differences). We conclude that: i) sniffing is an integral part of the generalized arousal response and does not depend on the modality of sensory stimuli ii) tachypnoea is a sensitive index of arousal and iii) respiratory rate is tightly correlated with motor activity.
Publisher: IEEE
Date: 08-2011
Publisher: IOP Publishing
Date: 08-10-2013
DOI: 10.1088/0967-3334/34/11/1435
Abstract: Ageing has been associated with changes in cardiac electrophysiology that result in QT interval prolongation. The effect of age on rate-adaptation dynamics of the QT interval is less well understood. The aim of this study was to assess age-related changes in the temporal relationship between QT and RR interval variability. Resting ECG of 20 young and 20 elderly healthy subjects were analyzed. Beat-to-beat RR and QT interval time series were automatically extracted. Coupling between QT and RR was assessed by means of the QT variability index, coherence in the frequency domain, rate-corrected QT interval, cross-multiscale entropy, information based similarity index and joint symbolic dynamics. In addition to QT interval prolongation (433 ± 31 versus 405 ± 33 ms, p = 0.008), elderly subjects were characterized by a significantly increased QT variability index (-1.26 ± 0.28 versus -1.52 ± 0.22 ms, p < 0.0001), reduced coherence in high (0.11 ± 0.09 versus 0.29 ± 0.14 ms, p = 0.003), and low frequency bands (0.20 ± 0.16 versus 0.49 ± 0.15 ms, p < 0.0001), reduced information domain synchronization index (0.13 ± 0.07 versus 0.19 ± 0.05 ms, p = 0.001) as well as increased entropy and disparity in joint symbolic dynamics of QT and RR interval time series. In conclusion, ageing is associated with decoupling of QT variability from heart rate variability. Complexity analysis in addition to standard metrics may provide additional insight.
Publisher: IEEE
Date: 08-2012
Publisher: Oxford University Press (OUP)
Date: 24-08-2018
DOI: 10.1093/SLEEP/ZSY171
Publisher: Oxford University Press (OUP)
Date: 20-07-2017
DOI: 10.1093/SLEEP/ZSX127
Abstract: To assess cardiovascular control during sleep in children with sleep-disordered breathing (SDB) and the effect of adenotonsillectomy in comparison to healthy nonsnoring children. Cardiorespiratory signals obtained from overnight polysomnographic recordings of 28 children with SDB and 34 healthy nonsnoring children were analyzed. We employed an autoregressive closed-loop model with heart period (RR) and pulse transit time (PTT) as outputs and respiration as an external input to obtain estimates of respiratory gain and baroreflex gain. Mean and variability of PTT were increased in children with SDB across all stages of sleep. Low frequency power of RR and PTT were attenuated during non-rapid eye movement (REM) sleep. Baroreflex sensitivity was reduced in children with SDB in stage 2 sleep, while respiratory gain was increased in slow wave sleep. After adenotonsillectomy, these indices normalized in the SDB group attaining values comparable to those of healthy children. In children with mild-to-moderate SDB, vasomotor activity is increased and baroreflex sensitivity decreased during quiet, event-free non-REM sleep. Adenotonsillectomy appears to reverse this effect.
Publisher: MDPI AG
Date: 28-09-2023
Publisher: IEEE
Date: 07-2013
Publisher: Copernicus GmbH
Date: 27-06-2014
DOI: 10.5194/NHESS-14-1625-2014
Abstract: Abstract. Both aleatory and epistemic uncertainties associated with different sources and components of risk (hazard, exposure, vulnerability) are present at each step of seismic risk assessments. All in idual sources of uncertainty contribute to the total uncertainty, which might be very high and, within the decision-making context, may therefore lead to either very conservative and expensive decisions or the perception of considerable risk. When anatomizing the structure of the total uncertainty, it is therefore important to propagate the different in idual uncertainties through the computational chain and to quantify their contribution to the total value of risk. The present study analyses different uncertainties associated with the hazard, vulnerability and loss components by the use of logic trees. The emphasis is on the analysis of epistemic uncertainties, which represent the reducible part of the total uncertainty, including a sensitivity analysis of the resulting seismic risk assessments with regard to the different uncertainty sources. This investigation, being a part of the EU FP7 project MATRIX (New Multi-Hazard and Multi-Risk Assessment Methods for Europe), is carried out for the ex le of, and with reference to, the conditions of the city of Cologne, Germany, which is one of the MATRIX test cases. At the same time, this particular study does not aim to revise nor to refine the hazard and risk level for Cologne it is rather to show how large are the existing uncertainties and how they can influence seismic risk estimates, especially in less well-studied areas, if hazard and risk models adapted from other regions are used.
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.IJCARD.2018.07.124
Abstract: Sleep-disordered breathing (SDB) is highly prevalent in patients with atrial fibrillation (AF) and its treatment can improve rhythm control. Polysomnography (PSG) is the gold standard for the diagnosis of SDB but its high cost and limited availability constrain its role as a standard SDB screening tool. We sought to assess the diagnostic utility of overnight oximetry in predicting SDB in AF patients. We analyzed prospectively collected data on 439 patients with documented AF (62% paroxysmal AF) who underwent PSG. Overnight oximetry was used to determine the oxygen desaturation index (ODI, number of desaturation/h) by a novel automated computer algorithm. ODI was validated against PSG derived apnea-hypopnea index (AHI). The s le consisted of 69% men with a mean age of 59.9 ± 11.3 years and body mass index of 30 ± 5 kg/m ODI derived from a simple and low-cost overnight oximetry can be used as an accessible and reliable screening tool, particularly to rule out SDB.
Publisher: Public Library of Science (PLoS)
Date: 13-05-2010
Publisher: Elsevier BV
Date: 05-2008
DOI: 10.1016/J.CLINPH.2007.12.017
Abstract: The aim of this study was to test whether new heart rate variability (HRV) complexity measures provide diagnostic information regarding early subclinical autonomic dysfunction in diabetes mellitus (DM). HRV in DM type 1 patients (n=17, 10f, 7m) aged 12.9-31.5 years (duration of DM 12.4+/-1.2 years) was compared to a control group of 17 healthy matched probands. The length of R-R intervals was measured over 1h using a telemetric ECG system. In addition to linear measures, we assessed HRV complexity measures, including multiscale entropy (MSE), compression entropy and various symbolic dynamic measures (Shannon and Renyi entropies, normalized complexity index (NCI), and pattern classification). HRV magnitude was significantly reduced in patients with DM. Several HRV complexity parameters (MSE at scales 2-4, Renyi entropy, NCI) were also significantly reduced in diabetics. MSE indices and compression entropy did not correlate with linear measures. The magnitude and complexity of HRV are reduced in young patients with DM, indicating vagal dysfunction. The quantification of HRV complexity in combination with its magnitude may provide an improved diagnostic tool for cardiovascular autonomic neuropathy in DM.
Publisher: American Physiological Society
Date: 03-2019
DOI: 10.1152/AJPHEART.00649.2018
Abstract: The objective of the present study was to quantify repolarization lability and its association with sex, sleep stage, and cardiovascular mortality. We analyzed polysomnographic recordings of 2,263 participants enrolled in the Sleep Heart Health Study (SHHS-2). Beat-to-beat QT interval variability (QTV) was quantified for consecutive epochs of 5 min according to the dominant sleep stage [wakefulness, nonrapid eye movement stage 2 (NREM2), nonrapid eye movement stage 3 (NREM3), and rapid eye movement (REM)]. To explore the effect of sleep stage and apnea-hypopnea index (AHI) on QT interval parameters, we used a general linear mixed model and mixed ANOVA. The Cox proportional hazards model was used for cardiovascular disease (CVD) death prediction. Sex-related differences in T wave litude ( P 0.001) resulted in artificial QTV differences. Hence, we corrected QTV parameters by T wave litude for further analysis. Sleep stages showed a significant effect ( P 0.001) on QTV. QTV was decreased in deep sleep compared with wakefulness, was higher in REM than in NREM, and showed a distinct relation to AHI in all sleep stages. The T wave litude-corrected QTV index (cQTVi) in REM sleep was predictive of CVD death (hazard ratio: 2.067, 95% confidence interval: 1.105–3.867, P 0.05) in a proportional hazards model. We demonstrated a significant impact of sleep stages on ventricular repolarization variability. Sex differences in QTV are due to differences in T wave litude, which should be corrected for. Independent characteristics of QTV measures to sleep stages and AHI showed different behaviors of heart rate variability and QTV expressed as cQTVi. cQTVi during REM sleep predicts CVD death. NEW & NOTEWORTHY We demonstrate here, for the first time, a significant impact of sleep stages on ventricular repolarization variability, quantified as QT interval variability (QTV). We showed that QTV is increased in rapid eye movement sleep, reflective of high sympathetic drive, and predicts death from cardiovascular disease. Sex-related differences in QTV are shown to be owing to differences in T wave litude, which should be corrected for.
Publisher: Springer Science and Business Media LLC
Date: 17-07-2021
DOI: 10.1007/S11325-021-02425-W
Abstract: To investigate the effect of adenotonsillectomy on OSAS symptoms based on a data-driven approach and thereby identify criteria that may help avoid unnecessary surgery in children with OSAS. In 323 children enrolled in the Childhood Adenotonsillectomy Trial, randomised to undergo either early adenotonsillectomy (eAT N = 165) or a strategy of watchful waiting with supportive care (WWSC N = 158), the apnea-hypopnea index, heart period pattern dynamics, and thoraco-abdominal asynchrony measurements from overnight polysomnography (PSG) were measured. Using machine learning, all children were classified into one of two different clusters based on those features. The cluster transitions between follow-up and baseline PSG were investigated for each to predict those children who recovered spontaneously, following surgery and those who did not benefit from surgery. The two clusters showed significant differences in OSAS symptoms, where children assigned in cluster A had fewer physiological and neurophysiological symptoms than cluster B. Whilst the majority of children were assigned to cluster A, those children who underwent surgery were more likely to stay in cluster A after seven months. Those children who were in cluster B at baseline PSG were more likely to have their symptoms reversed via surgery. Children who were assigned to cluster B at both baseline and 7 months after surgery had significantly higher end-tidal carbon dioxide at baseline. Children who spontaneously changed from cluster B to A presented highly problematic ratings in behaviour and emotional regulation at baseline. Data-driven analysis demonstrated that AT helps to reverse and to prevent the worsening of the pathophysiological symptoms in children with OSAS. Multiple pathophysiological markers used with machine learning can capture more comprehensive information on childhood OSAS. Children with mild physiological and neurophysiological symptoms could avoid AT, and children who have UAO symptoms post AT may have sleep-related hypoventilation disease which requires further investigation. Furthermore, the findings may help surgeons more accurately predict children on whom they should perform AT.
Publisher: Elsevier BV
Date: 12-2016
Publisher: The Royal Society
Date: 13-02-2015
Publisher: The Royal Society
Date: 13-02-2015
Abstract: Beat-to-beat variations in heart period provide information on cardiovascular control and are closely linked to variations in arterial pressure and respiration. Joint symbolic analysis of heart period, systolic arterial pressure and respiration allows for a simple description of their shared short-term dynamics that are governed by cardiac baroreflex control and cardiorespiratory coupling. In this review, we discuss methodology and research applications. Studies suggest that analysis of joint symbolic dynamics provides a powerful tool for identifying physiological and pathophysiological changes in cardiovascular and cardiorespiratory control.
Publisher: American Physiological Society
Date: 2008
DOI: 10.1152/AJPREGU.00464.2007
Abstract: To better understand the central mechanisms that mediate increases in heart rate (HR) during psychological stress, we examined the effects of systemic and intramedullary (raphe region) administration of the serotonin-1A (5-HT 1A ) receptor agonist 8-hydroxy-2-(di- n-propylamino)tetraline (8-OH-DPAT) on cardiac changes elicited by restraint in hooded Wistar rats with preimplanted ECG telemetric transmitters. 8-OH-DPAT reduced basal HR from 356 ± 12 to 284 ± 12 beats/min, predominantly via a nonadrenergic, noncholinergic mechanism. Restraint stress caused tachycardia (an initial transient increase from 318 ± 3 to 492 ± 21 beats/min with a sustained component of 379 ± 12 beats/min). β-Adrenoreceptor blockade with atenolol suppressed the sustained component, whereas muscarinic blockade with methylscopolamine (50 μg/kg) abolished the initial transient increase, indicating that sympathetic activation and vagal withdrawal were responsible for the tachycardia. Systemic administration of 8-OH-DPAT (10, 30, and 100 μg/kg) attenuated stress-induced tachycardia in a dose-dependent manner, and this effect was suppressed by the 5-HT 1A antagonist WAY-100635 (100 μg/kg). Given alone, the antagonist had no effect. Systemically injected 8-OH-DPAT (100 μg/kg) attenuated the sympathetically mediated sustained component (from +85 ± 19 to +32 ± 9 beats/min) and the vagally mediated transient (from +62 ± 5 to +25 ± 3 beats/min). Activation of 5-HT 1A receptors in the medullary raphe by microinjection of 8-OH-DPAT mimicked the antitachycardic effect of the systemically administered drug but did not affect basal HR. We conclude that tachycardia induced by restraint stress is due to a sustained increase in cardiac sympathetic activity associated with a transient vagal withdrawal. Activation of central 5-HT 1A receptors attenuates this tachycardia by suppressing autonomic effects. At least some of the relevant receptors are located in the medullary raphe-parapyramidal area.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 10-2023
Publisher: Walter de Gruyter GmbH
Date: 07-2006
DOI: 10.1515/BMT.2006.014
Publisher: IEEE
Date: 04-2015
Publisher: Oxford University Press (OUP)
Date: 12-2014
DOI: 10.5665/SLEEP.4264
Publisher: IEEE
Date: 08-2015
Publisher: IEEE
Date: 07-2013
Publisher: IEEE
Date: 12-2011
Publisher: American Physiological Society
Date: 09-2008
DOI: 10.1152/AJPHEART.00301.2008
Abstract: Suggestions were made that increased myocardial sympathetic activity is reflected by elevated QT variability (dynamic changes in QT interval duration). However, the relationship between QT variability and the amount of norepinephrine released from the cardiac sympathetic terminals is unknown. We thus attempted to assess this relationship. The study was performed in 17 subjects (12 with major depressive disorder and 5 with panic disorder). Cardiac norepinephrine spillover (measured by direct catheter technique coupled with norepinephrine isotope dilution methodology) was assessed before and 4 mo after treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants. The distribution of the cardiac norepinephrine spillover was bimodal, with the majority of patients having values of ≤10 ng/min. There was a positive correlation between cardiac norepinephrine spillover and corrected QT interval ( r = 0.7, P = 0.03) but not with any of the QT variability measures. However, in a subgroup of five patients who had high levels of cardiac norepinephrine spillover ( ng/min) a tendency for a strong positive correlation with variance of QT intervals ( r = 0.9, P = 0.08) was observed. There were significant correlations between the severity of depression and QT variability indexes normalized to the heart rate [QTVi and QT interval/R-R interval (QT/RR) coherence] and between the severity of anxiety and the QT/RR residual and regression coefficient, respectively. Treatment with SSRI antidepressants substantially reduced depression score but did not affect any of the QT variability indexes. We conclude that in depression anic disorder patients with near-normal cardiac norepinephrine levels QT variability is not correlated with cardiac norepinephrine spillover and is not affected by treatment with SSRI.
Publisher: IACSIT Press
Date: 2012
Publisher: IOP Publishing
Date: 27-06-2017
Abstract: A network physiology approach to evaluate the strength of the directed interactions among cardiac controls at sinoatrial and ventricular levels and respiration (R) is proposed. The network is composed of three nodes (i.e. sinoatrial and ventricular cardiac controls and R) and their activity is exemplified by the variability of heart period (HP), the variability of the duration of the electrical activity of the heart approximated as the temporal distance between Q-wave onset and T-wave end or apex (i.e. QTe or QTa) and thoracic movements respectively. Model-based transfer entropy provided the estimate of the strength of the causal link from the source to the destination conditioned on the remaining node activity. The interactions were monitored in 15 healthy subjects aged from 24 to 54 years (9 males). Increasing levels of sympathetic activity were induced by graded head-up tilt with table inclination of 0, 15, 30, 45, 60, 75°. We found that: (i) the strength of the causal link from HP to QTe gradually decreases with tilt table angle, while that in the reverse direction is weak, even though significant, and constant (ii) the action of R on HP is stronger than that from R to QTe (iii) the strength of the relation from R to HP is weakly related to tilt table inclination, while that from R to QTe does not depend on it (iv) while QTe cannot affect R, a weak causal dependence of R on HP is detected (v) the network computed over QTa is qualitatively similar to that over QTe, even though the strength of the causal relations might be different. The proposed network physiology approach provides a comprehensive picture of the directed links among relevant cardiac regulatory mechanisms and their evolution with sympathetic tone usable to identify pathological conditions.
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.AAP.2013.09.003
Abstract: Drivers are not always aware that they are becoming impaired as a result of sleepiness. Using specific symptoms of sleepiness might assist with recognition of drowsiness related impairment and help drivers judge whether they are safe to drive a vehicle, however this has not been evaluated. In this study, 20 healthy volunteer professional drivers completed two randomized sessions in the laboratory - one under 24h of acute sleep deprivation, and one with alcohol. The Psychomotor Vigilance Task (PVT) and a 30min simulated driving task (AusEdTM) were performed every 3-4h in the sleep deprivation session, and at a BAC of 0.00% and 0.05% in the alcohol session, while electroencephalography (EEG) and eye movements were recorded. After each test session, drivers completed the Karolinska Sleepiness Scale (KSS) and the Sleepiness Symptoms Questionnaire (SSQ), which includes eight specific sleepiness and driving performance symptoms. A second baseline session was completed on a separate day by the professional drivers and in an additional 20 non-professional drivers for test-retest reliability. There was moderate test-retest agreement on the SSQ (r=0.59). Significant correlations were identified between in idual sleepiness symptoms and the KSS score (r values 0.50-0.74, p<0.01 for all symptoms). The frequency of all SSQ items increased during sleep deprivation (χ(2) values of 28.4-80.2, p<0.01 for all symptoms) and symptoms were related to increased subjective sleepiness and performance deterioration. The symptoms "struggling to keep your eyes open", "difficulty maintaining correct speed", "reactions were slow" and "head dropping down" were most closely related to increased alpha and theta activity on EEG (r values 0.49-0.59, p<0.001) and "nodding off to sleep" and "struggling to keep your eyes open" were related to slow eye movements (r values 0.67 and 0.64, p<0.001). Symptoms related to visual disturbance and impaired driving performance were most accurate at detecting severely impaired driving performance (AUC on ROC curve of 0.86-0.91 for detecting change in lateral lane position greater than the change at a BAC of 0.05%). In idual sleepiness symptoms are related to impairment during acute sleep deprivation and might be able to assist drivers in recognizing their own sleepiness and ability to drive safely.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2021
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.JELECTROCARD.2013.07.009
Abstract: The dynamics of cardiovascular variables are modulated by respiration. The aim of this study was to assess baroreflex function in normal subjects based on the joint symbolic dynamics of heart rate, blood pressure and respiration. ECG, continuous blood pressure and respiration were recorded in ten healthy subjects during rest in the supine position and upon standing. Beat-to-beat time series of heart rate, systolic blood pressure and respiratory phase were extracted and transformed into binary symbol sequences. Words of length two that were reflective of baroreflex activity were statistically analysed with respect to the respiratory phase. Symbolic analysis showed a significant influence of the respiratory phase on the occurrence of baroreflex patterns. Upon standing, the frequency of baroreflex words increased and the effect of respiration appeared to be reduced. Symbolic dynamics provide a simple representation of cardiovascular dynamics and may be useful for assessing baroreflex function.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2022
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.COMPBIOMED.2011.03.019
Abstract: Pregnancy leads to physiological changes in various parameters of the cardiovascular system. The aim of this study was to investigate longitudinal changes in the structure and complexity of heart rate variability (HRV) and QT interval variability during the second half of normal gestation. We analysed 30-min high-resolution ECGs recorded monthly in 32 pregnant women, starting from the 20th week of gestation. Heart rate and QT variability were quantified using multiscale entropy (MSE) and detrended fluctuation analyses (DFA). DFA of HRV showed significantly higher scaling exponents towards the end of gestation (p<0.0001). MSE analysis showed a significant decrease in s le entropy of HRV with progressing gestation on scales 1-4 (p<0.05). MSE analysis and DFA of QT interval time series revealed structures significantly different from those of HRV with no significant alteration during the second half of gestation. In conclusion, pregnancy is associated with increases in long-term correlations and regularity of HRV, but it does not affect QT variability. The structure of QT time series is significantly different from that of RR time series, despite its close physiological dependence.
Publisher: IOP Publishing
Date: 28-07-2011
DOI: 10.1088/0967-3334/32/9/006
Abstract: Cardiovascular control acts over multiple time scales, which introduces a significant amount of complexity to heart rate and blood pressure time series. Multiscale entropy (MSE) analysis has been developed to quantify the complexity of a time series over multiple time scales. In previous studies, MSE analyses identified impaired cardiovascular control and increased cardiovascular risk in various pathological conditions. Despite the increasing acceptance of the MSE technique in clinical research, information underpinning the involvement of the autonomic nervous system in the MSE of heart rate and blood pressure is lacking. The objective of this study is to investigate the effect of orthostatic challenge on the MSE of heart rate and blood pressure variability (HRV, BPV) and the correlation between MSE (complexity measures) and traditional linear (time and frequency domain) measures. MSE analysis of HRV and BPV was performed in 28 healthy young subjects on 1000 consecutive heart beats in the supine and standing positions. S le entropy values were assessed on scales of 1-10. We found that MSE of heart rate and blood pressure signals is sensitive to changes in autonomic balance caused by postural change from the supine to the standing position. The effect of orthostatic challenge on heart rate and blood pressure complexity depended on the time scale under investigation. Entropy values did not correlate with the mean values of heart rate and blood pressure and showed only weak correlations with linear HRV and BPV measures. In conclusion, the MSE analysis of heart rate and blood pressure provides a sensitive tool to detect changes in autonomic balance as induced by postural change.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 11-2016
Publisher: American Thoracic Society
Date: 15-11-2014
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.CLINPH.2010.12.046
Abstract: The aim of this study was to test whether a new heart rate variability (HRV) complexity measure, the Point Correlation Dimension (PD2i), provides diagnostic information regarding early subclinical autonomic dysfunction in diabetes mellitus (DM). We tested the ability of PD2i to detect diabetic autonomic neuropathy (DAN) in asymptomatic young DM patients without overt neuropathy and compared them to age- and gender-matched controls. HRV in DM type 1 patients (n=17, 10 female, 7 male) aged 12.9-31.5 years (duration of DM 12.4±1.2 years) was compared to that in a control group of 17 healthy matched probands. The R-R intervals were measured over 1h using a telemetric ECG system. PD2i was able to detect ANS dysfunction with p=0.0006, similar to the best discriminating MSE scale, with p=0.0002. The performance of PD2i to detect DAN in asymptomatic DM patients is similar to the best discriminative power of previously published complexity measures. The PD2i algorithm may prove to be an easy to perform and clinically useful tool for the early detection of autonomic neuropathy in DM type 1 patients, especially given its minimal data requirements.
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.NEUROSCIENCE.2013.05.012
Abstract: There are a limited number of biological indices for assessing pro-emetic states in laboratory rodents as they do not possess the vomiting response. In the present study we tested the hypothesis that in rats, pro-emetic intervention would affect the respiratory pattern. To this end, using whole-body plethysmography, in adult male Wistar rats we recorded respiration after i.p. administration of either the emetic agent LiCl or Ringer. Quantification of respiratory signals (from 5 to 35 min post-injection) revealed that post-LiCl, mean respiratory rate was significantly lower (126 ± 9 vs. 178 ± 10 cpm, p < 0.005) and less variable (Kvar 59 ± 8% vs. 73 ± 3% p 200 cpm) from 25 ± 3% to 9 ± 2% (p = 0.004). Thus, reduction of the mean respiratory rate by LiCl was predominantly due to reduced contribution of high-frequency breathing that is normally associated with motor activity and/or arousal. Non-linear multifractal analysis of respiratory signals revealed that post-LiCl, respiration becomes less random and more orderly. 5-HT3 antagonist ondansetron prevented respiratory changes elicited by LiCl. We conclude that the observed changes likely reflect effects of LiCl on animals' motion, and that this effect is mediated via 5-HT3 receptors. Providing that the effects observed in our study were quite robust, we suggest that simple and non-invasive respiratory monitoring may be a promising approach for studying emesis in rodents.
Publisher: Japanese Society of Hypertension
Date: 2005
Abstract: In the US, it is currently estimated that 3% of pregnant women have chronic hypertension, or more than 100,000 pregnant women each year. The aim of our study was to investigate the adaptation of autonomic control during pregnancy based on heart rate variability analysis and to determine whether chronic hypertension during pregnancy has an impact on this adaptation. Sixteen pregnant women with chronic hypertension (CH group mean age, 30 years range, 25-33 years) and 35 healthy pregnant women serving as controls (CON group mean age, 28 years range, 24-30 years) were recruited for this longitudinal study. Beginning at the 20th week of pregnancy, the women were monitored every 4th week until delivery. For the analysis of heart rate variability, Portapres signals (200 Hz) were recorded for 30 min under resting conditions. Women in the CH group had significantly elevated blood pressure compared to controls (CON, 111 mmHg [105-132] CH, 140 mmHg [132-148] p<0.001). An increased heart rate was found in both groups during the second half of pregnancy. Consequently, decreased heart rate variability was observed, but was more pronounced in the CON group. There was a shift in the frequency bands indicated by an elevation of the low-to-high frequency ratio (LF/HF) in both groups due to a decrease in HF, and thus a significant increase in LFn (LF power in normalized units). However, VLF (power of very low frequency range) increased exclusively in the CON pregnancies. Our data showed no significant difference in heart rate variability between the subjects of the CH and CON groups. Longitudinal variations were detectable in normal pregnancies and also, albeit to a lesser degree, in chronic hypertensive pregnant women. Thus, our data indicate that patients with long-term hypertension are still able to respond to the physiological changes occurring during pregnancy.
Publisher: Walter de Gruyter GmbH
Date: 04-01-2004
DOI: 10.1515/JPM.2004.124
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2018
Publisher: Springer Science and Business Media LLC
Date: 11-06-2019
DOI: 10.1007/S11517-019-01998-9
Abstract: The fraction of repolarization variability independent of RR interval variability is of clinical interest. It has been linked to direct autonomic nervous system (ANS) regulation of the ventricles in healthy subjects and seems to reflect the instability of the ventricular repolarization process in heart disease. In this study, we sought to identify repolarization measures that best reflect the sympathetic influences on the ventricles independent of the RR interval. ECG was recorded in 46 young subjects during supine and then following 45 degrees head-up tilt. RR intervals and five repolarization features (QTend, QTpeak, RTend, RTpeak, and TpTe) were extracted from the ECG recordings. Repolarization variability was separated into RR-dependent and RR-independent variability using parametric spectral analysis. Results show that LF power of TpTe is independent of RR in both supine and tilt, while the LF power of QTend and RTend independent of RR and respiration increases following tilt. We conclude that TpTe is independent of RR and is highly affected by respiration. QTend and RTend LF power might reflect the sympathetic influences on the ventricles elicited by tilt. Graphical abstract.
Publisher: Springer Science and Business Media LLC
Date: 29-04-2004
Publisher: IEEE
Date: 08-2010
Publisher: Frontiers Media SA
Date: 07-06-2016
Publisher: Springer Science and Business Media LLC
Date: 27-05-2011
DOI: 10.1007/S10439-011-0332-3
Abstract: Cardiac and respiratory rhythms are highly nonlinear and nonstationary. As a result traditional time-domain techniques are often inadequate to characterize their complex dynamics. In this article, we introduce a novel technique to investigate the interactions between R-R intervals and respiratory phases based on their joint symbolic dynamics. To evaluate the technique, electrocardiograms (ECG) and respiratory signals were recorded in 13 healthy subjects in different body postures during spontaneous and controlled breathing. Herein, the R-R time series were extracted from ECG and respiratory phases were obtained from abdomen impedance belts using the Hilbert transform. Both time series were transformed into ternary symbol vectors based on the changes between two successive R-R intervals or respiratory phases. Subsequently, words of different symbol lengths were formed and the correspondence between the two series of words was determined to quantify the interaction between cardiac and respiratory cycles. To validate our results, respiratory sinus arrhythmia (RSA) was further studied using the phase-averaged characterization of the RSA pattern. The percentage of similarity of the sequence of symbols, between the respective words of the two series determined by joint symbolic dynamics, was significantly reduced in the upright position compared to the supine position (26.4 ± 4.7 vs. 20.5 ± 5.4%, p < 0.01). Similarly, RSA was also reduced during upright posture, but the difference was less significant (0.11 ± 0.02 vs. 0.08 ± 0.01 s, p < 0.05). In conclusion, joint symbolic dynamics provides a new efficient technique for the analysis of cardiorespiratory interaction that is highly sensitive to the effects of orthostatic challenge.
Publisher: Springer Science and Business Media LLC
Date: 12-03-2010
DOI: 10.1038/HR.2010.30
Abstract: The maternal heart significantly adapts to the circulatory needs of pregnancy, but the effect of pregnancy on ventricular repolarization is poorly understood. The aim of this study was to quantify longitudinal changes in ventricular repolarization during pregnancy. Monthly electrocardiographs (ECGs) were recorded in 32 pregnant women with normal uterine perfusion and 32 pregnant women with abnormal perfusion, starting from the 20th week of gestation until 3 days postpartum. Ventricular repolarization was assessed through various QT interval variability and heart rate adaptation measures. The pregnancy outcomes of all women with normal perfusion were normal. Among pregnancies with abnormal uterine perfusion, 15 pregnancy outcomes were normal, but 17 pregnancies developed preecl sia and/or small-for-gestational-age infants. In pregnancies with normal perfusion, the QT(c) interval was unaltered, but the QT interval-heart rate hysteresis lag was shorter and the QT interval-heart rate regression residual was higher compared with those of a control group of 10 healthy non-pregnant women. Pregnancies with abnormal uterine perfusion that developed pathological outcomes showed significantly smaller QT interval-heart rate regression residuals and a trend towards shorter QT(c) intervals compared with pregnant women with normal perfusion. In conclusion, pregnancy has a significant effect on ventricular repolarization. Pregnancies with abnormal uterine perfusion and subsequent pathological outcomes are paralleled by changes in ventricular repolarization that precede clinical symptoms.
Publisher: IEEE
Date: 08-2014
Publisher: The Royal Society
Date: 31-10-2008
Abstract: Methods from nonlinear dynamics (NLD) have shown new insights into heart rate (HR) variability changes under various physiological and pathological conditions, providing additional prognostic information and complementing traditional time- and frequency-domain analyses. In this review, some of the most prominent indices of nonlinear and fractal dynamics are summarized and their algorithmic implementations and applications in clinical trials are discussed. Several of those indices have been proven to be of diagnostic relevance or have contributed to risk stratification. In particular, techniques based on mono- and multifractal analyses and symbolic dynamics have been successfully applied to clinical studies. Further advances in HR variability analysis are expected through multidimensional and multivariate assessments. Today, the question is no longer about whether or not methods from NLD should be applied however, it is relevant to ask which of the methods should be selected and under which basic and standardized conditions should they be applied.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 12-2022
Publisher: SPIE
Date: 26-12-2008
DOI: 10.1117/12.810681
Publisher: Wiley
Date: 04-10-2023
DOI: 10.1002/EHF2.14556
Publisher: IEEE
Date: 2005
Publisher: IEEE
Date: 09-2007
Publisher: IEEE
Date: 2002
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 11-2014
Publisher: Springer International Publishing
Date: 2022
Publisher: American Physiological Society
Date: 15-11-2012
DOI: 10.1152/JAPPLPHYSIOL.00756.2012
Abstract: Sleep-disordered breathing (SDB) in children is assessed by quantification of hypopnea and apnea events. Little is known, however, about respiratory timing and breath-to-breath variability during sleep. The aim of this study was to investigate respiratory parameters across sleep stages in children with SDB before and after treatment compared with healthy children. Overnight polysomnography (PSG) was conducted in 40 children with SDB prior to and 6 mo following adenotonsillectomy. For comparison, a control group of 40 healthy sex- and age-matched children underwent two PSGs at equivalent time points but without intervention. The following variables were measured breath by breath during obstruction-free periods in stage 2 nonrapid eye movement (NREM), stage 4 NREM, and REM sleep: inspiratory time (Ti), expiratory time (Te), total time (Ttotal), inspiratory duty cycle (DC =Ti/Ttotal), respiratory frequency (fR), and SD of the parameters Ti, Te, fR, and DC. Variability in waveform morphology was also computed using the residue of respiratory patterns. The severity of SDB was relatively mild in the study cohort (obstructive apnea hypopnea index: baseline, 5.1 ± 9.4 vs. 0.1 ± 0.2, P 0.001 follow-up, 0.3 ± 0.3 vs. 0.8 ± 1.0, P 0.01). Compared with healthy controls, children with SDB showed significantly longer Ti and Te and a lower fR at the baseline study. These differences were not significant after adenotonsillectomy. Sleep stages were associated with significant differences in all of the respiratory measures in both groups of children. In conclusion, children with relatively mild SDB showed prolonged inspiration and expiration indicative of chronic narrowing of the upper airway. Treatment of SDB normalizes respiratory timing. Documentation of these parameters may aid in both understanding and management of children with SDB.
Publisher: MDPI AG
Date: 03-12-2014
DOI: 10.3390/E16126384
Publisher: Oxford University Press (OUP)
Date: 02-2013
DOI: 10.5665/SLEEP.2380
Publisher: IOP Publishing
Date: 27-11-2008
DOI: 10.1088/0967-3334/30/1/003
Abstract: The purpose of this paper is to investigate the effect of orthostatic challenge on recurrence plot based complexity measures of heart rate and blood pressure variability (HRV and BPV). HRV and BPV complexities were assessed in 28 healthy subjects over 15 min in the supine and standing positions. The complexity of HRV and BPV was assessed based on recurrence quantification analysis. HRV complexity was reduced along with the HRV magnitude after changing from the supine to the standing position. In contrast, the BPV magnitude increased and BPV complexity decreased upon standing. Recurrence quantification analysis (RQA) of HRV and BPV is sensitive to orthostatic challenge and might therefore be suited to assess changes in autonomic neural outflow to the cardiovascular system.
Publisher: Elsevier BV
Date: 11-2020
Publisher: IEEE
Date: 08-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2013
DOI: 10.1161/CIRCEP.112.976654
Abstract: The pivot is critical to rotors postulated to maintain atrial fibrillation (AF). We reasoned that wavefronts circling the pivot should broaden the litude distribution of bipolar electrograms because of directional information encoded in these signals. We aimed to determine whether Shannon entropy (ShEn), a measure of signal litude distribution, could differentiate the pivot from surrounding peripheral regions and thereby assist clinical rotor mapping. Bipolar electrogram recordings were studied in 4 systems: (1) computer simulations of rotors in a 2-dimensional atrial sheet (2) isolated rat atria recorded with a multi-electrode array (n=12) (3) epicardial plaque recordings of induced AF in hypertensive sheep (n=11) and (4) persistent AF patients (n=10). In the model systems, rotation episodes were identified, and ShEn calculated as an index of litude distribution. In humans, ShEn distribution was analyzed at AF termination sites and with respect to complex fractionated electrogram mean. We analyzed rotation episodes in simulations (4 cycles) and animals (rats: 14 rotors, duration 80±81 cycles sheep: 13 rotors, 4.2±1.5 cycles). The maximum ShEn bipole was consistently colocated with the pivot zone. ShEn was negatively associated with distance from the pivot zone in simulated spiral waves, rats, and sheep. ShEn was modestly inversely associated with complex fractionated electrogram however, there was no relationship at the sites of highest ShEn. ShEn is a mechanistically based tool that may assist AF rotor mapping.
Publisher: Oxford University Press (OUP)
Date: 05-02-2020
Abstract: To assess the microstructural architecture of non-rapid eye movement (NREM) sleep known as cyclic alternating pattern (CAP) in relation to the age, gender, self-reported sleep quality, and the degree of sleep disruption in large community-based cohort studies of older people. We applied a high-performance automated CAP detection system to characterize CAP in 2,811 men from the Osteoporotic Fractures in Men Sleep Study (MrOS) and 426 women from the Study of Osteoporotic Fractures (SOF). CAP was assessed with respect to age and gender and correlated to obstructive apnea–hypopnea index, arousal index (AI-NREM), and periodic limb movements in sleep index. Further, we evaluated CAP across levels of self-reported sleep quality measures using analysis of covariance. Age was significantly associated with the number of CAP sequences during NREM sleep (MrOS: p = 0.013, SOF = 0.051). CAP correlated significantly with AI-NREM (MrOS: ρ = 0.30, SOF: ρ = 0.29). CAP rate, especially the A2+A3 index, was inversely related to self-reported quality of sleep, independent of age and sleep disturbance measures. Women experienced significantly fewer A1-phases compared to men, in particular, in slow-wave sleep (N3). We demonstrate that automated CAP analysis of large-scale databases can lead to new findings on CAP and its subcomponents. We show that sleep disturbance indices are associated with the CAP rate. Further, the CAP rate is significantly linked to subjectively reported sleep quality, independent from traditionally scored markers of sleep fragmentation. Finally, men and women show differences in the microarchitecture of sleep as identified by CAP, despite similar macro-architecture.
Publisher: IOP Publishing
Date: 26-06-2008
DOI: 10.1088/0967-3334/29/7/010
Abstract: Multiscale entropy (MSE) analysis provides information about complexity on various time scales. The aim of this study was to test whether MSE is able to detect autonomic dysregulation in young patients with diabetes mellitus (DM). We analyzed heart rate (HR) oscillations, systolic (SBP) and diastolic blood pressure (DBP) signals in 14 patients with DM type 1 and 14 age- and sex-matched healthy controls. S En values (scales 1-10) and linear measures were computed. HR: among the linear measures of heart rate variability significant differences between groups were only found for RMSSD (p = 0.043). MSE was significantly reduced on scales 2 and 3 in DM (p = 0.023 and 0.010, respectively). SBP and DBP: no significant differences were detected with linear measures. In contrast, MSE analysis revealed significantly lower S En values in DM on scale 3 (p = 0.039 for SBP p = 0.015 for DBP). No significant correlations were found between MSE and linear measures. In conclusion, MSE analysis of HR, SBP and DBP oscillations is able to detect subtle abnormalities in cardiovascular control in young patients with DM and is independent of standard linear measures.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2006
Publisher: IEEE
Date: 2001
Publisher: Oxford University Press (OUP)
Date: 09-09-2021
Publisher: IOP Publishing
Date: 06-2023
Abstract: Objective. Closed loop cardiovascular (CV) and cerebrovascular (CBV) variability interactions are assessed via transfer entropy (TE) from systolic arterial pressure (SAP) to heart period (HP) and vice versa and from mean arterial pressure (MAP) to mean cerebral blood velocity (MCBv) and vice versa. This analysis is exploited to assess the efficiency of baroreflex and cerebral autoregulation. This study aims at characterizing CV and CBV controls in postural orthostatic tachycardiac syndrome (POTS) subjects experiencing exaggerated sympathetic response during orthostatic challenge via unconditional TE and TE conditioned on respiratory activity ( R ). Approach. In 18 healthy controls (age: 28 ± 13 yrs 5 males, 13 females) and 15 POTS in iduals (age: 29 ± 11 yrs 3 males, 12 females) we acquired beat-to-beat variability of HP, SAP, MAP and MCBv and two R signals, namely respiratory chest movement (RCM) and capnogram (CAP). Recordings were made at sitting rest and during active standing (STAND). TE was computed via vector autoregressive approach. Main results. We found that: (i) when assessing CV interactions, the increase of the TE from SAP to HP during STAND, indicating baroreflex activation, is detected solely when conditioning on RCM (ii) when assessing CBV interactions, the impact of R on the TE computation is negligible (iii) POTS shows baroreflex impairment during STAND (iv) POTS exhibits a normal CBV response to STAND. Significance. TE is useful for detecting the impairment of specific regulatory mechanisms in POTS. Moreover, using different R signals highlights the sensitivity of CV and CBV controls to specific R aspects.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 02-2016
Publisher: MDPI AG
Date: 04-11-2014
DOI: 10.3390/E16115777
Publisher: American Physiological Society
Date: 04-2011
DOI: 10.1152/AJPHEART.01184.2010
Abstract: Elevated QT interval variability is a predictor of malignant ventricular arrhythmia, but the underlying mechanisms are incompletely understood. A recent study in dogs with pacing-induced heart failure suggests that QT variability is linked to cardiac sympathetic nerve activity. The aim of this study was to determine whether increased cardiac sympathetic activity is associated with increased beat-to-beat QT interval variability in patients with essential hypertension. We recorded resting norepinephrine (NE) spillover into the coronary sinus and single-lead, short-term, high-resolution, body-surface ECG in 23 patients with essential hypertension and 9 normotensive control subjects. To assess beat-to-beat QT interval variability, we calculated the overall QT variability (QTVN) as well as the QT variability index (QTVi). Cardiac NE spillover (12.2 ± 6.5 vs. 20.7 ± 14.7, P = 0.03) and QTVi (−1.75 ± 0.36 vs. −1.42 ± 0.50, P = 0.05) were significantly increased in hypertensive patients compared with normotensive subjects. QTVN was significantly correlated with cardiac NE spillover ( r 2 = 0.31, P = 0.001), with RR variability ( r 2 = 0.20, P = 0.008), and with systolic blood pressure ( r 2 = 0.16, P = 0.02). Linear regression analysis identified the former two as independent predictors of QTVN. In conclusion, elevated repolarization lability is directly associated with sympathetic cardiac activation in patients with essential hypertension.
Publisher: IEEE
Date: 07-2013
Publisher: Springer Science and Business Media LLC
Date: 10-08-2011
DOI: 10.1007/S11517-011-0822-3
Abstract: The cardiorespiratory synchrogram, a graphical tool based on the stroboscopic technique, is an established method for evaluating phase-locking between cardiac and respiratory oscillators. In the original method, the phase of the respiratory oscillator is observed at the instants of time when the phase of the cardiac oscillator attains a certain value. In this article, we introduced an additional adaptive delay in the cardiac oscillator based on the maximisation of the cross-correlation or symbolic coupling traces between the phases of respiration and the delayed R-R intervals. We then investigated phase coordination in thirteen normal subjects (five males, eight females age: 19-24 years) for different body postures. Cardiorespiratory coordination was observed to be significantly reduced in the upright position (supine vs. upright: 11.9 ± 5.1 vs. 6.9 ± 3.6, P < 0.05). Compared to the original algorithm we observed an increase in the detection of average cardiorespiratory coordination (supine original vs. delay: 11.9 vs. 18.9%), together with a decrease in standard deviation of the percentage of coordination in all the subjects, after introducing the heart rate delay (supine original vs. delay: 5.1 vs. 4.4%). In conclusion, the performance of the synchrogram technique was improved by including an adaptive delay in the cardiac oscillator.
Publisher: IEEE
Date: 08-2010
Publisher: The Royal Society
Date: 25-10-2021
Abstract: The dynamic interplay between central and autonomic nervous system activities plays a pivotal role in orchestrating sleep. Macrostructural changes such as sleep-stage transitions or phasic, brief cortical events elicit fluctuations in neural outflow to the cardiovascular system, but the causal relationships between cortical and cardiovascular activities underpinning the microstructure of sleep are largely unknown. Here, we investigate cortical–cardiovascular interactions during the cyclic alternating pattern (CAP) of non-rapid eye movement sleep in a erse set of overnight polysomnograms. We determine the Granger causality in both 507 CAP and 507 matched non-CAP sequences to assess the causal relationships between electroencephalography (EEG) frequency bands and respiratory and cardiovascular variables (heart period, respiratory period, pulse arrival time and pulse wave litude) during CAP. We observe a significantly stronger influence of delta activity on vascular variables during CAP sequences where slow, low- litude EEG activation phases (A1) dominate than during non-CAP sequences. We also show that rapid, high- litude EEG activation phases (A3) provoke a more pronounced change in autonomic activity than A1 and A2 phases. Our analysis provides the first evidence on the causal interplay between cortical and cardiovascular activities during CAP. Granger causality analysis may also be useful for probing the level of decoupling in sleep disorders. This article is part of the theme issue ‘Advanced computation in cardiovascular physiology: new challenges and opportunities’.
Publisher: IOP Publishing
Date: 23-03-2015
Publisher: Oxford University Press (OUP)
Date: 10-08-2020
Abstract: To determine in children with obstructive sleep apnea (OSA) the effect of adenotonsillectomy (AT) on the cyclic alternating pattern (CAP) and the relationship between CAP and behavioral, cognitive, and quality-of-life measures. CAP parameters were analyzed in 365 overnight polysomnographic recordings of children with mild-to-moderate OSA enrolled in the Childhood Adenotonsillectomy Trial (CHAT), randomized to either early AT (eAT) or watchful waiting with supportive care (WWSC). We also analyzed CAP in a subgroup of 72 children with moderate OSA (apnea–hypopnea index & 10) that were part of the CHAT s le. Causal mediation analysis was performed to determine the independent effect of changes in CAP on selected outcome measures. At baseline, a higher number of A1 phases per hour of sleep was significantly associated with worse behavioral functioning (caregiver Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC): ρ = 0.24, p = 0.042 caregiver Conners’ Rating Scale Global Index: ρ = 0.25, p = 0.036) and lower quality of life (OSA-18: ρ = 0.27, p = 0.022 PedsQL: ρ = −0.29, p = 0.015) in the subgroup of children with moderate OSA, but not across the entire s le. At 7-months follow-up, changes in CAP parameters were comparable between the eAT and WWSC arms. CAP changes did not account for significant proportions of variations in behavioral, cognitive, and quality-of-life performance measures at follow-up. We show a significant association between the frequency of slow, high- litude waves with behavioral functioning, as well as the quality of life in children with moderate OSA. Early AT in children with mild-to-moderate OSA does not alter the microstructure of nonrapid eye movement sleep compared with watchful waiting after an approximately 7-month period of follow-up. The study “A Randomized Controlled Study of Adenotonsillectomy for Children With Obstructive Sleep Apnea Syndrome” was registered at Clinicaltrials.gov (#NCT00560859).
Publisher: MDPI AG
Date: 20-10-2017
DOI: 10.3390/S17102400
Publisher: IEEE
Date: 08-2014
Publisher: American Physiological Society
Date: 06-2018
DOI: 10.1152/AJPREGU.00430.2017
Abstract: The objective of this study was to determine the response of heart rate and blood pressure variability (respiratory sinus arrhythmia, baroreflex sensitivity) to orthostatic and mental stress, focusing on causality and the mediating effect of respiration. Seventy-seven healthy young volunteers (46 women, 31 men) aged 18.4 ± 2.7 yr underwent an experimental protocol comprising supine rest, 45° head-up tilt, recovery, and a mental arithmetic task. Heart rate variability and blood pressure variability were analyzed in the time and frequency domain and modeled as a multivariate autoregressive process where the respiratory volume signal acted as an external driver. During head-up tilt, tidal volume increased while respiratory rate decreased. During mental stress, breathing rate increased and tidal volume was elevated slightly. Respiratory sinus arrhythmia decreased during both interventions. Baroreflex function was preserved during orthostasis but was decreased during mental stress. While sex differences were not observed during baseline conditions, cardiovascular response to orthostatic stress and respiratory response to mental stress was more prominent in men compared with women. The respiratory response to the mental arithmetic tasks was more prominent in men despite a significantly higher subjectively perceived stress level in women. In conclusion, respiration shows a distinct response to orthostatic versus mental stress, mediating cardiovascular variability it needs to be considered for correct interpretation of heart rate and blood pressure phenomena.
Publisher: IEEE
Date: 12-2012
Publisher: IEEE
Date: 05-2014
Publisher: Public Library of Science (PLoS)
Date: 30-07-2012
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.NEUROSCIENCE.2009.01.038
Abstract: The aim of this study was to determine whether 5-HT2A receptors mediate cardiovascular and thermogenic responses to acute psychological stresses. For this purpose, adult male Wistar hooded rats instrumented for telemetric recordings of either electrocardiogram (ECG) (n=12) or arterial pressure (n=12) were subjected, on different days, to four 15-min episodes of social defeat. Prior to stress, animals received s.c. injection of the selective 5-HT2A receptor antagonist SR-46349B (trans-4-((3Z)3-[(2-dimethylaminoethyl)oxyimino]-3-(2-fluorophenyl)propen-1-yl)-phenol, hemifumarate) (at doses of 0.3, 1.0 and 3.0 mg/kg) or vehicle. The drug had no effect on basal heart rate or heart rate variability indexes, arterial pressure, and core body temperature. Social defeat elicited significant and substantial tachycardic (347+/-7 to 500+/-7 bpm), pressor (77+/-4 to 97+/-4 mm Hg) and hyperthermic (37.0+/-0.3 to 38.5+/-0.1 degrees C) responses. Blockade of 5-HT2A receptors, at all doses of the antagonist, completely prevented stress-induced hyperthermia. In contrast, stress-induced cardiovascular responses were not affected by the blockade (except small reduction of tachycardia by the highest dose of the drug). We conclude that in rats, 5-HT2A receptors mediate stress-induced hyperthermic responses, but are not involved in the genesis of stress-induced rises in heart rate or arterial pressure, and do not participate in cardiovascular control at rest.
Publisher: Wiley
Date: 13-12-2016
Abstract: Hypertrophic cardiomyopathy (HCM) is a common heritable cardiac disorder with erse clinical outcomes including sudden death, heart failure, and stroke. Depressed heart rate variability (HRV), a measure of cardiac autonomic regulation, has been shown to predict mortality in patients with cardiovascular disease. Cardiac autonomic remodelling in animal models of HCM are not well characterised. This study analysed Gly203Ser cardiac troponin-I transgenic (TG) male mice previously demonstrated to develop hallmarks of HCM by age 21 weeks. 33 mice aged 30 and 50 weeks underwent continuous electrocardiogram (ECG) recording for 30 min under anaesthesia. TG mice demonstrated prolonged P-wave duration (P < 0.001) and PR intervals (P < 0.001) compared to controls. Additionally, TG mice demonstrated depressed standard deviation of RR intervals (SDRR P < 0.01), coefficient of variation of RR intervals (CVRR P < 0.001) and standard deviation of heart rate (SDHR P < 0.001) compared to controls. Additionally, total power was significantly reduced in TG mice (P < 0.05). No significant age-related difference in either strain was observed in ECG or HRV parameters. Mice with HCM developed slowed atrial and atrioventricular conduction and depressed HRV. These changes were conserved with increasing age. This finding may be indicative of atrial and ventricular hypertrophy or dysfunction, and perhaps an indication of worse clinical outcome in heart failure progression in HCM patients.
Publisher: IEEE
Date: 04-2013
Publisher: IOP Publishing
Date: 06-09-2011
DOI: 10.1088/0967-3334/32/10/009
Abstract: Hypertensive pregnancy disorders affect 6% to 8% of all pregnancies and can result in severe complications for the mother and the foetus of which pre-ecl sia (PE) has the worst perinatal outcome. Several studies suggested that the autonomic nervous system plays an important role in the process of developing hypertensive pregnancy disorders, especially PE. The aim of this retrospective study was to investigate whether women with PE could be differentiated from women with various other hypertensive pregnancy disorders, by employing an enhanced Poincaré plot analysis (PPA), the segmented Poincaré plot analysis (SPPA), to their beat-to-beat interval and blood pressure signals. Sixty-nine pregnant women with hypertensive disorders (29 PE, 40 with chronic or gestational hypertension) were included. The SPPA as well as the traditional PPA found significant differences between PE and other hypertensive disorders of diastolic blood pressure (p < 0.001 versus p < 0.001) but only the SPPA method revealed significant differences (p < 0.001) also of the systolic blood pressure. Further on, linear discrimination analysis demonstrated that indices derived from SPPA are more suitable for differentiation between chronic and gestational hypertension and PE than those from traditional PPA (area under the ROC curve 0.85 versus 0.69). Therefore this procedure could contribute to the differential diagnosis of hypertensive pregnancy disorders.
Publisher: Elsevier BV
Date: 03-2016
Publisher: Elsevier BV
Date: 05-2018
Publisher: Springer Science and Business Media LLC
Date: 06-03-2015
DOI: 10.1007/S11325-014-0963-3
Abstract: This study aims to investigate the impact of upper airway obstruction (UAO) in children by measuring thoracoabdominal asynchrony (TAA) during periods of sleep apnea/hypopnea and during scored-event-free (SEF) breathing periods. Respiratory inductive plethysmographic signals were extracted from polysomnographic data, recorded before and after adenotonsillectomy in 40 children with UAO and 40 healthy, matched children at equivalent time points. Thoracoabdominal asynchrony was computed using a Hilbert transform-based phase difference estimation method in SEF periods during stage 2, stage 4 non-rapid eye movement (NREM), and rapid eye movement (REM) sleep and compared between the groups. At baseline, in the UAO group, TAA during obstructions were significantly higher than TAA during SEF periods in both stage 2 and REM sleep. Compared to controls, children with UAO had a significantly higher TAA during SEF periods in stage 2, stage 4 sleep, and REM sleep. This between-group difference was not significant post adenotonsillectomy. UAO group showed a significant decrease in TAA compared to their baseline during SEF stage 2 and 4 NREM, but not in REM. Upper airway obstruction in children is associated with increased TAA during SEF periods, indicative of continuous partial obstruction of the upper airway. Adenotonsillectomy decreased this effect significantly in non-REM sleep as evidenced by reduced asynchrony levels post-surgery. TAA assessment during sleep may therefore provide additional diagnostic information.
Start Date: 04-2006
End Date: 04-2009
Amount: $235,020.00
Funder: Australian Research Council
View Funded ActivityStart Date: 2011
End Date: 05-2017
Amount: $576,712.00
Funder: Australian Research Council
View Funded Activity