Correntropy-Based Pulse Rate Variability Analysis in Children with Sleep Disordered Breathing

Pulse rate variability (PRV), an alternative measure of heart rate variability (HRV), is altered during obstructive sleep apnea. Correntropy spectral density (CSD) is a novel spectral analysis that includes nonlinear information. We recruited 160 children and recorded SpO2 and photoplethysmography (PPG), alongside standard polysomnography. PPG signals were divided into 1-min epochs and apnea/hypoapnea (A/H) epochs labeled. CSD was applied to the pulse-to-pulse interval time series (PPIs) and five features extracted: the total spectral power (TP: 0.01–0.6 Hz), the power in the very low frequency band (VLF: 0.01–0.04 Hz), the normalized power in the low and high frequency bands (LFn: 0.04–0.15 Hz, HFn: 0.15–0.6 Hz), and the LF/HF ratio. Nonlinearity was assessed with the surrogate data technique. Multivariate logistic regression models were developed for CSD and power spectral density (PSD) analysis to detect epochs with A/H events. The CSD-based features and model identified epochs with and without A/H events more accurately relative to PSD-based analysis (area under the curve (AUC) 0.72 vs. 0.67) due to the nonlinearity of the data. In conclusion, CSD-based PRV analysis provided enhanced performance in detecting A/H epochs, however, a combination with overnight SpO2 analysis is suggested for optimal results.

[1]  W. Karlen,et al.  Development of a Screening Tool for Sleep Disordered Breathing in Children Using the Phone Oximeter™ , 2014, PloS one.

[2]  A. Goldberger Is the normal heartbeat chaotic or homeostatic? , 1991, News in physiological sciences : an international journal of physiology produced jointly by the International Union of Physiological Sciences and the American Physiological Society.

[3]  Ainara Garde,et al.  Correntropy-based analysis of respiratory patterns in patients with chronic heart failure , 2009, 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[4]  A. Chesson,et al.  The American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications , 2007 .

[5]  Guy A. Dumont,et al.  Identifying individual sleep apnea/hypoapnea epochs using smartphone-based pulse oximetry , 2016, 2016 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[6]  N. Montano,et al.  Complexity and Nonlinearity in Short-Term Heart Period Variability: Comparison of Methods Based on Local Nonlinear Prediction , 2007, IEEE Transactions on Biomedical Engineering.

[7]  Lino Nobili,et al.  Heart rate variability in normal and pathological sleep , 2013, Front. Physiol..

[8]  H. Krum,et al.  Sleep apnea in heart failure increases heart rate variability and sympathetic dominance. , 2007, Sleep.

[9]  Walter Karlen,et al.  Oxygen saturation in children with and without obstructive sleep apnea using the phone-oximeter , 2013, 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[10]  Raimon Jané,et al.  Correntropy-Based Spectral Characterization of Respiratory Patterns in Patients With Chronic Heart Failure , 2010, IEEE Transactions on Biomedical Engineering.

[11]  T. Schreiber,et al.  Surrogate time series , 1999, chao-dyn/9909037.

[12]  Hsien-Tsai Wu,et al.  Multiscale Entropy Analysis of Heart Rate Variability for Assessing the Severity of Sleep Disordered Breathing , 2015, Entropy.

[13]  Niels Wessel,et al.  Is the normal heart rate "chaotic" due to respiration? , 2009, Chaos.

[14]  Eduardo Gil,et al.  PTT Variability for Discrimination of Sleep Apnea Related Decreases in the Amplitude Fluctuations of PPG Signal in Children , 2010, IEEE Transactions on Biomedical Engineering.

[15]  W Karlen,et al.  Photoplethysmogram signal quality estimation using repeated Gaussian filters and cross-correlation , 2012, Physiological measurement.

[16]  J. Habbema,et al.  Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. , 2001, Journal of clinical epidemiology.

[17]  Javier Gomez-Pilar,et al.  Assessment of Time and Frequency Domain Entropies to Detect Sleep Apnoea in Heart Rate Variability Recordings from Men and Women , 2015, Entropy.

[18]  Walter Karlen,et al.  Pulse rate variability compared with heart rate variability in children with and without sleep disordered breathing , 2013, 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[19]  Alan V. Sahakian,et al.  Use of Sample Entropy Approach to Study Heart Rate Variability in Obstructive Sleep Apnea Syndrome , 2007, IEEE Transactions on Biomedical Engineering.

[20]  José Carlos Príncipe,et al.  Generalized correlation function: definition, properties, and application to blind equalization , 2006, IEEE Transactions on Signal Processing.

[21]  H. Akaike,et al.  Information Theory and an Extension of the Maximum Likelihood Principle , 1973 .

[22]  M. Villa,et al.  Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management , 2015, European Respiratory Journal.

[23]  Ainara Garde,et al.  Correntropy-based nonlinearity test applied to patients with chronic heart failure , 2010, 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology.

[24]  W. Karlen,et al.  Evaluation of cardiac modulation in children in response to apnea/hypopnea using the Phone Oximeter™ , 2016, Physiological measurement.

[25]  A. Halbower,et al.  Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome , 2012, Pediatrics.

[26]  P. Laguna,et al.  Photoplethysmography pulse rate variability as a surrogate measurement of heart rate variability during non-stationary conditions , 2010, Physiological measurement.

[27]  Schreiber,et al.  Improved Surrogate Data for Nonlinearity Tests. , 1996, Physical review letters.

[28]  Michael C. K. Khoo,et al.  Sleep-related changes in autonomic control in obstructive sleep apnea: A model-based perspective , 2013, Respiratory Physiology & Neurobiology.

[29]  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.

[30]  Thomas Penzel,et al.  Comparison of detrended fluctuation analysis and spectral analysis for heart rate variability in sleep and sleep apnea , 2003, IEEE Transactions on Biomedical Engineering.

[31]  J. Knottnerus,et al.  Clinical prediction models are not being validated. , 2015, Journal of clinical epidemiology.

[32]  J. Perkiömäki Heart Rate Variability and Non-Linear Dynamics in Risk Stratification , 2011, Front. Physio..

[33]  José Carlos Príncipe,et al.  Correntropy as a Novel Measure for Nonlinearity Tests , 2006, The 2006 IEEE International Joint Conference on Neural Network Proceedings.

[34]  Jesús Lázaro,et al.  Pulse Rate Variability Analysis for Discrimination of Sleep-Apnea-Related Decreases in the Amplitude Fluctuations of Pulse Photoplethysmographic Signal in Children , 2014, IEEE Journal of Biomedical and Health Informatics.