Skip to main content
Log in

Long-Term Tracking of a Patient’s Health Condition Based on Pulse Rate Dynamics During Sleep

  • Published:
Annals of Biomedical Engineering Aims and scope Submit manuscript

Abstract

This article proposed a method to track the changes in health condition of a patient after coronary stenting over seven successive seasons based on daily pulse rate (PR). The pulse signal was recorded by an unconstrained monitoring system during sleep. Seasonal PR dynamics were evaluated by both linear measures, including time domain and frequency domain indexes, and nonlinear measures such as noise limit (NL), detection rate (DR), sample entropy (SampEn), and Poincaré plots. NL and DR were derived using the noise titration method. Significant changes in seasonal indexes of the patient were evaluated statistically. The results show that an overall downward trend of the PR dynamics corresponds to changes in the patient’s health condition that began in winter and developed in spring and worsened most seriously in the following summer. The monthly and seasonal orbits of PR nonlinearity of the patient were plotted and observed to follow different trajectory compared with a healthy subject. These results indicate the feasibility of applying dynamics of PR as a potential prognostic tool for detecting early changes in a patient’s health condition and also for understanding the temporal transition of health condition over a long-term period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9

Similar content being viewed by others

Abbreviations

AECG:

Ambulatory electrocardiogram

ANS:

Autonomic nervous system

DR:

Detection rate

HF:

High frequency

HRV:

Heart rate variability

LF:

Low frequency

NL:

Noise limit

NT:

Noise titration

PI:

Pulse interval

PRV:

Pulse rate variability

PSD:

Power spectral density

SampEn:

Sample entropy

SDNN:

The mean of the 5-min standard deviation of the NN (normal RR) intervals over 24 h

References

  1. Arzeno, N. M., M. T. Kearney, D. L. Eckberg, J. Nolan, and C. S. Poon. Heart rate chaos as a mortality predictor in mild to moderate heart failure. Conf. Proc. IEEE Eng. Med. Biol. Soc. 2007:5051–5054, 2007.

    PubMed  Google Scholar 

  2. Barahona, M., and C.-S. Poon. Detection of nonlinear dynamics in short, noisy time series. Nature 381:215–217, 1996.

    Article  CAS  Google Scholar 

  3. Batchinsky, A. I., J. E. Skinner, C. Necsoiu, B. S. Jordan, D. Weiss, and L. C. Cancio. New measures of heart-rate complexity: Effect of chest trauma and hemorrhage. J. Trauma 68:1178–1185, 2010.

    Article  PubMed  Google Scholar 

  4. Bigger, Jr., J. T., J. L. Fleiss, R. C. Steinman, L. M. Rolnitzky, R. E. Kleiger, and J. N. Rottman. Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation 85:164–171, 1992.

    PubMed  Google Scholar 

  5. Brennan, M., M. Palaniswami, and P. Kamen. Do existing measures of Poincare plot geometry reflect nonlinear features of heart rate variability? IEEE Trans. Biomed. Eng. 48:1342–1347, 2001.

    Article  PubMed  CAS  Google Scholar 

  6. Chen, W. Discovery of biorhythmic stories behind daily vital signs and its application. In: Recent Advances in Biomedical Engineering, edited by G. R. Naik. Vienna: InTech, 2009, pp. 453–492.

    Google Scholar 

  7. Chen, W. Health care—an everlasting challenge in temporal and spatial domains. J Multidiscip Healthc 3:189–199, 2010.

    Article  PubMed  Google Scholar 

  8. Chen, Y., and W. Chen. Seasonal chaotic features of pulse rate in a healthy subject and a patient after coronary stenting. Conf. Proc. IEEE Eng. Med. Biol. Soc. 2010:2549–2552, 2010.

    PubMed  Google Scholar 

  9. Chen, W., X. Zhu, and T. Nemoto. A new sensory device and optimal position for monitoring HR/RR during sleep. In: World Congress on Medical Physics and Biomedical Engineering, Vol. 25/7, edited by R. Magjarevic. Munich: Springer Berlin Heidelberg, 2009, pp. 126–129.

    Google Scholar 

  10. Daubechies, I. Ten lectures on wavelets. Philadelphia: SIAM, 279 pp, 1993.

  11. Delyukov, A., Y. Gorgo, G. Cornelissen, K. Otsuka, and F. Halberg. Natural environmental associations in a 50-day human electrocardiogram. Int. J. Biometeorol. 45:90–99, 2001.

    Article  PubMed  CAS  Google Scholar 

  12. Fujimoto, Y., and T. Iokibe. Evaluation of deterministic property of time series by the method of surrogate data and the trajectory parallel measure method. IEICE Trans. Fundam. E83-A:343–349, 2000.

    Google Scholar 

  13. Goldberger, A. L. Non-linear dynamics for clinicians: Chaos theory, fractals, and complexity at the bedside. Lancet 347:1312–1314, 1996.

    Article  PubMed  CAS  Google Scholar 

  14. Gomes, M. E., A. V. Souza, H. N. Guimaraes, and L. A. Aguirre. Investigation of determinism in heart rate variability. Chaos 10:398–410, 2000.

    Article  PubMed  Google Scholar 

  15. Hagerman, I., M. Berglund, M. Lorin, J. Nowak, and C. Sylven. Chaos-related deterministic regulation of heart rate variability in time- and frequency domains: Effects of autonomic blockade and exercise. Cardiovasc. Res. 31:410–418, 1996.

    PubMed  CAS  Google Scholar 

  16. Janse, M. J. Chaos in the prediction of sudden death. Eur. Heart J. 16:299–301, 1995.

    PubMed  CAS  Google Scholar 

  17. Kaisina, I. G., E. N. Sizova, V. I. Tsirkin, and S. I. Trukhina. Seasonal changes in heart rate variability in 11 to 13-year-old girls. Fiziol. Cheloveka 31:43–49, 2005.

    PubMed  CAS  Google Scholar 

  18. Kazuma, N., and K. Otsuka. Seasonal variation in 1/f fluctuations of heart rate in asthmatic children. Biomed. Pharmacother. 55(Suppl 1):102–105, 2001.

    Google Scholar 

  19. Kazuma, N., K. Otsuka, M. Miyakawa, E. Shirase, I. Matsuoka, and M. Murata. Seasonal variation in heart rate variability in asthmatic children. Chronobiol. Int. 17:503–511, 2000.

    Article  PubMed  CAS  Google Scholar 

  20. Kim, K. K., H. J. Baek, Y. G. Lim, and K. S. Park. Effect of missing RR-interval data on nonlinear heart rate variability analysis. Comput. Methods Programs Biomed. 2010.

  21. Kim, K. K., J. S. Kim, Y. G. Lim, and K. S. Park. The effect of missing RR-interval data on heart rate variability analysis in the frequency domain. Physiol. Meas. 30:1039–1050, 2009.

    Article  PubMed  Google Scholar 

  22. Kim, K. K., Y. G. Lim, J. S. Kim, and K. S. Park. Effect of missing RR-interval data on heart rate variability analysis in the time domain. Physiol. Meas. 28:1485–1494, 2007.

    Article  PubMed  Google Scholar 

  23. Kleiger, R. E., J. P. Miller, J. T. Bigger, Jr., and A. J. Moss. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am. J. Cardiol. 59:256–262, 1987.

    Article  PubMed  CAS  Google Scholar 

  24. Kristiansen, J., A. Olsen, J. H. Skotte, and A. H. Garde. Reproducibility and seasonal variation of ambulatory short-term heart rate variability in healthy subjects during a self-selected rest period and during sleep. Scand. J. Clin. Lab. Invest. 69:651–661, 2009.

    PubMed  Google Scholar 

  25. La Rovere, M. T., J. T. Bigger, Jr., F. I. Marcus, A. Mortara, and P. J. Schwartz. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. Atrami (autonomic tone and reflexes after myocardial infarction) investigators. Lancet 351:478–484, 1998.

    Article  PubMed  CAS  Google Scholar 

  26. Lombardi, F. Chaos theory, heart rate variability, and arrhythmic mortality. Circulation 101:8–10, 2000.

    PubMed  CAS  Google Scholar 

  27. Makikallio, T. H., P. Barthel, R. Schneider, A. Bauer, J. M. Tapanainen, M. P. Tulppo, G. Schmidt, and H. V. Huikuri. Prediction of sudden cardiac death after acute myocardial infarction: Role of Holter monitoring in the modern treatment era. Eur. Heart J. 26:762–769, 2005.

    Article  PubMed  Google Scholar 

  28. Makikallio, T. H., H. V. Huikuri, A. Makikallio, L. B. Sourander, R. D. Mitrani, A. Castellanos, and R. J. Myerburg. Prediction of sudden cardiac death by fractal analysis of heart rate variability in elderly subjects. J. Am. Coll. Cardiol. 37:1395–1402, 2001.

    Article  PubMed  CAS  Google Scholar 

  29. Malik, M., T. Farrell, T. Cripps, and A. J. Camm. Heart rate variability in relation to prognosis after myocardial infarction: Selection of optimal processing techniques. Eur. Heart J. 10:1060–1074, 1989.

    PubMed  CAS  Google Scholar 

  30. Mallat, S., and S. Zhong. Characterization of signals from multiscale edges. IEEE Trans. Pattern Anal. Mach. Intell. 14:710–732, 1992.

    Article  Google Scholar 

  31. Mozaffarian, D., P. W. Wilson, and W. B. Kannel. Beyond established and novel risk factors: Lifestyle risk factors for cardiovascular disease. Circulation 117:3031–3038, 2008.

    Article  PubMed  Google Scholar 

  32. Otsuka, K., R. Izumi, N. Ishioka, H. Ohshima, and C. Mukai. Chronomics of heart rate variability on earth and in space. Respir. Physiol. Neurobiol. 169(Suppl 1):S69–S72, 2009.

    Article  PubMed  Google Scholar 

  33. Pagani, M., F. Lombardi, S. Guzzetti, O. Rimoldi, R. Furlan, P. Pizzinelli, G. Sandrone, G. Malfatto, S. Dell’Orto, E. Piccaluga, et al. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ. Res. 59:178–193, 1986.

    PubMed  CAS  Google Scholar 

  34. Peng, C. K., S. Havlin, H. E. Stanley, and A. L. Goldberger. Quantification of scaling exponents and crossover phenomena in nonstationary heartbeat time series. Chaos 5:82–87, 1995.

    Article  PubMed  CAS  Google Scholar 

  35. Poon, C. S., and M. Barahona. Titration of chaos with added noise. Proc. Natl. Acad. Sci. USA 98:7107–7112, 2001.

    Article  PubMed  CAS  Google Scholar 

  36. Richman, J. S., and J. R. Moorman. Physiological time-series analysis using approximate entropy and sample entropy. Am. J. Physiol. Heart Circ. Physiol. 278:H2039–H2049, 2000.

    PubMed  CAS  Google Scholar 

  37. Shensa, M. J. The discrete wavelet transform: Wedding the a trous and mallat algorithms. IEEE Trans. Signal Process. 40:2464–2482, 1992.

    Article  Google Scholar 

  38. Sturmer, T., P. Hasselbach, and M. Amelang. Personality, lifestyle, and risk of cardiovascular disease and cancer: Follow-up of population based cohort. BMJ 332:1359–1365, 2006.

    Article  PubMed  Google Scholar 

  39. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Circulation 93:1043–1065, 1996.

    Article  Google Scholar 

  40. Theiler, J., S. Eubank, A. Longtin, B. Galdrikian, and J. Doyne Farmer. Testing for nonlinearity in time series: The method of surrogate data. Phys. D 58:77–94, 1992.

    Article  Google Scholar 

  41. Voss, A., J. Kurths, H. J. Kleiner, A. Witt, N. Wessel, P. Saparin, K. J. Osterziel, R. Schurath, and R. Dietz. The application of methods of non-linear dynamics for the improved and predictive recognition of patients threatened by sudden cardiac death. Cardiovasc. Res. 31:419–433, 1996.

    PubMed  CAS  Google Scholar 

  42. Wolf, A., J. B. Swift, H. L. Swinney, and J. A. Vastano. Determining Lyapunov exponents from a time series. Phys. D 16:285–317, 1985.

    Article  Google Scholar 

  43. Zhu, X., W. Chen, T. Nemoto, Y. Kanemitsu, K. Kitamura, K. Yamakoshi, and D. Wei. Real-time monitoring of respiration rhythm and pulse rate during sleep. IEEE Trans. Biomed. Eng. 53:2553–2563, 2006.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the volunteers for their endurance in daily data collection and colleagues in the research project. Authors would like also to thank Prof. Chi-Sang Poon for sharing with the source code of noise titration method.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wenxi Chen.

Additional information

Associate Editor Ioannis A. Kakadiaris oversaw the review of this article.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chen, Y., Chen, W. Long-Term Tracking of a Patient’s Health Condition Based on Pulse Rate Dynamics During Sleep. Ann Biomed Eng 39, 2922–2934 (2011). https://doi.org/10.1007/s10439-011-0397-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10439-011-0397-z

Keywords

Navigation