Comparison of pulse rate variability with heart rate variability during obstructive sleep apnea.

We investigate whether pulse rate variability (PRV) extracted from finger photo-plethysmography (Pleth) waveforms can be the substitute of heart rate variability (HRV) from RR intervals of ECG signals during obstructive sleep apnea (OSA). Simultaneous measurements (ECG and Pleth) were taken from 29 healthy subjects during normal (undisturbed sleep) breathing and 22 patients with OSA during OSA events. Highly significant (p<0.01) correlations (1.0>r>0.95) were found between heart rate (HR) and pulse rate (PR). Bland-Altman plot of HR and PR shows good agreement (<5% difference). Comparison of 2 min recording epochs demonstrated significant differences (p<0.01) in time, frequency domains and complexity analysis, between normal and OSA events using PRV as well as HRV measures. Results suggest that both HRV and PRV indices could be used to distinguish OSA events from normal breathing during sleep. However, several variability measures (SDNN, RMSSD, HF power, LF/HF and sample entropy) of PR and HR were found to be significantly (p<0.01) different during OSA events. Therefore, we conclude that PRV provides accurate inter-pulse variability to measure heart rate variability under normal breathing in sleep but does not precisely reflect HRV in sleep disordered breathing.

[1]  J. Richman,et al.  Physiological time-series analysis using approximate entropy and sample entropy. , 2000, American journal of physiology. Heart and circulatory physiology.

[2]  A P Wheeler,et al.  Use of pulse oximetry to recognize severity of airflow obstruction in obstructive airway disease: correlation with pulsus paradoxus. , 1999, Chest.

[3]  S. Connolly,et al.  CYCLICAL VARIATION OF THE HEART RATE IN SLEEP APNOEA SYNDROME Mechanisms, and Usefulness of 24 h Electrocardiography as a Screening Technique , 1984, The Lancet.

[4]  I. Constant,et al.  Pulse rate variability is not a surrogate for heart rate variability. , 1999, Clinical science.

[5]  Willis J. Tompkins,et al.  A Real-Time QRS Detection Algorithm , 1985, IEEE Transactions on Biomedical Engineering.

[6]  V Pichot,et al.  Screening of obstructive sleep apnea syndrome by heart rate variability analysis. , 1999, Circulation.

[7]  J. Skatrud,et al.  Influence of Respiration on Autonomic Control of Heart Rate and Blood Pressure , 2000 .

[8]  P. Welch.  The use of fast Fourier transform for the estimation of power spectra: A method based on time averaging over short, modified periodograms , 1967 .

[9]  P. Gosse,et al.  Assessment of arterial distensibility by monitoring the timing of Korotkoff sounds. , 1994, American journal of hypertension.

[10]  M. Nitzan,et al.  The variability of the photoplethysmographic signal - a potential method for the evaluation of the autonomic nervous system , 1998, Physiological measurement.

[11]  Eduardo Gil,et al.  Detection of decreases in the amplitude fluctuation of pulse photoplethysmography signal as indication of obstructive sleep apnea syndrome in children , 2008, Biomed. Signal Process. Control..

[12]  G. Santarelli.  Screening of obstructive sleep apnea syndrome by heart rate variability analysis , 2000 .

[13]  R. Akiyama,et al.  Non-invasive determination of instantaneous heart rate in developing avian embryos by means of acoustocardiogram , 2006, Medical and Biological Engineering and Computing.

[14]  Daniel J Buysse,et al.  Sleep–Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research , 2000 .

[15]  S. Pincus.  Approximate entropy (ApEn) as a complexity measure. , 1995, Chaos.

[16]  P. Taggart.  Mechano-electric feedback in the human heart. , 1996, Cardiovascular research.

[17]  T Penzel,et al.  MESAM: a heart rate and snoring recorder for detection of obstructive sleep apnea. , 1990, Sleep.

[18]  G. Breithardt,et al.  Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. , 1996 .

[19]  A Malliani,et al.  Sympathovagal balance: a reappraisal. , 1998, Circulation.

[20]  Gordon R. Williams,et al.  Variability in time delay between two models of pulse oximeters for deriving the photoplethysmographic signals , 2005, Physiological measurement.

[21]  José Haba-Rubio,et al.  Obstructive sleep apnea syndrome: effect of respiratory events and arousal on pulse wave amplitude measured by photoplethysmography in NREM sleep , 2005, Sleep and Breathing.

[22]  H. Nazeran,et al.  Comparison of Heart Rate Variability Signal Features Derived from Electrocardiography and Photoplethysmography in Healthy Individuals , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[23]  K. Chon,et al.  Can Photoplethysmography Variability Serve as an Alternative Approach to Obtain Heart Rate Variability Information? , 2008, Journal of Clinical Monitoring and Computing.

[24]  Shepard Jw,et al.  Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. , 1992 .

[25]  A. Katz.  Physiology of the heart , 1977 .

[26]  N. Montano,et al.  Altered cardiovascular variability in obstructive sleep apnea. , 1998, Circulation.

[27]  C.K. Chang,et al.  Variations of HRV analysis in different approaches , 2007, 2007 Computers in Cardiology.

[28]  Eduardo Gil,et al.  Discrimination of Sleep-Apnea-Related Decreases in the Amplitude Fluctuations of PPG Signal in Children by HRV Analysis , 2009, IEEE Transactions on Biomedical Engineering.

[29]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .