Tetravariate point-process model for the continuous characterization of cardiovascular-respiratory dynamics during passive postural changes

In this study, we present a new methodology for time-varying characterization of cardiovascular (CV) control, which includes RR interval (RRI), systolic arterial pressure (SAP), respiration (RSP) and pulse transit time (PTT). Within a multivariate model, CV dynamics are represented as stochastic point processes whose means has a tetravariate autoregressive structure. Such framework provides the simultaneous time-frequency assessment of: (i) both arms of the SAP-RRI loop, along baroreflex and mechanical feedforward pathways; (ii) Respiratory sinus arrhythmia (RSA), through the direct evaluation of the interactions between RSP and the RRI; (iii) the coupling between cardio-respiratory activity and vascular tone through quantification of the interactions between PTT and the other CV variables. We validated the model by characterizing CV control in 16 healthy subjects during a tilt table test, and we were able to confirm a satisfactory model's goodness-of-ft. We further estimated transfer function gains, instantaneous powers and directed coherences, and observed that RSP strongly drove respiratory-related oscillations in all the other CV variables, and that PTT depended on RRI dynamics rather than blood pressure variations. During head-up tilt, baroreflex sensitivity and RSA decreased, while the gain from RRI to SAP increased, thus confirming previous physiological characterizations.