Methods Inf Med 2016; 55(03): 250-257
DOI: 10.3414/ME15-01-0088
Original Articles
Schattauer GmbH

Comparison of Pulse Rate Variability and Heart Rate Variability for Hypoglycemia Syndrome

Şükrü Okkesim
1   Fatih University, Institute of Biomedical Engineering, Istanbul, Turkey
,
Gamze Çelik
1   Fatih University, Institute of Biomedical Engineering, Istanbul, Turkey
,
Mustafa S. Yıldırım
1   Fatih University, Institute of Biomedical Engineering, Istanbul, Turkey
,
Mahmut M. Ilhan
2   Bezmialem Vakif University, Faculty of Medicine, Department of Endocrinology and Metabolism Diseases, Istanbul, Turkey
,
Özcan Karaman
2   Bezmialem Vakif University, Faculty of Medicine, Department of Endocrinology and Metabolism Diseases, Istanbul, Turkey
,
Ertuğrul Taşan
2   Bezmialem Vakif University, Faculty of Medicine, Department of Endocrinology and Metabolism Diseases, Istanbul, Turkey
,
Sadık Kara
1   Fatih University, Institute of Biomedical Engineering, Istanbul, Turkey
› Author Affiliations
Further Information

Publication History

received: 19 July 2015

accepted: 01 February 2016

Publication Date:
08 January 2018 (online)

Summary

Background: Heart rate variability (HRV) is a signal obtained from RR intervals of electro -cardiography (ECG) signals to evaluate the balance between the sympathetic nervous system and the parasympathetic nervous system; not only HRV but also pulse rate va -riability (PRV) extracted from finger pulse plethysmography (PPG) can reflect irregularities that may occur in heart rate and control procedures.

Objectives: The purpose of this study is to compare the HRV and PRV during hypogly -cemia in order to evaluate the features that computed from PRV that can be used in detection of hypoglycemia.

Methods: To this end, PRV and HRV of 10 patients who required testing with insulininduced hypoglycemia (IIHT) in Clinics of Endocrinology and Metabolism Diseases of Bezm-i Alem University (Istanbul, Turkey), were obtained. The recordings were done at three stages: prior to IIHT, during the IIHT, and after the IIHT. We used Bland-Altman analysis for comparing the parameters and to evaluate the correlation between HRV and PRV if exists.

Results: Significant correlation (r > 0.90, p < 0.05) and close agreement were found between HRV and PRV for mean intervals, the root-mean square of the difference of successive intervals, standard deviation of successive intervals and the ratio of the low-to-high frequency power.

Conclusions: In conclusion, all the features computed from PRV and HRV have close agreement and correlation according to Bland-Altman analyses’ results and features computed from PRV can be used in detection of hypoglycemia.

 
  • References

  • 1 Golightly LK. et al. Management of Diabetes Mellitus in Hospitalized Patients: Efficiency and Effectiveness of Sliding Scale Insulin Therapy. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 2006; 26 (Suppl. 10) 1421-1432.
  • 2 Freeman R. Hypoglycemia and the Autonomic Nervous System. Diabetic Neuropathy Clinical Diabetes. 2007 pp 379-388.
  • 3 Briscoe V, Davis S. Hypoglycemia in Type 1 Diabetes. Type 1 diabetes in adults: principles and practice. 2007 p 195.
  • 4 Snogdal LS. et al. Detection of hypoglycemia associated EEG changes during sleep in type 1 diabetes mellitus. Diabetes research and clinical practice 2012; 98 (Suppl. 01) 91-97.
  • 5 Tu E, Twigg SM, Semsarian C. Sudden death in type 1 diabetes: the mystery of the ‘dead in bed’ syndrome. International journal of cardiology 2010; 138 (Suppl. 01) 91-93.
  • 6 Nguyen HT, IEEE SM, Ghevondian N, Jones TW. Real-time Detection of Nocturnal Hypoglycemic Episodes using a Novel Non-invasive Hypoglycemia Monitor. 31st Annual International Conference of the IEEE EMBS Minneapolis, Minnesota, USA: September 2–6 2009
  • 7 Dagogo-Jack S, Cryer PE. Seminal Contributions to the Understanding of Hypoglycemia and Glucose Counterregulation and the Discovery of HAAF (Cryer Syndrome). Diabetes Care 2015; 38 (Suppl. 12) 2193-2199.
  • 8 Gill GV. et al. Cardiac arrhythmia and nocturnal hypoglycaemia in type 1 diabetes – the ‘dead in bed’ syndrome revisited. Diabetologia 2009; 52 (Suppl. 01) 42-45.
  • 9 Straus SM. et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. Journal of the American College of Cardiology 2006; 47 (Suppl. 02) 362-367.
  • 10 Koivikko ML. et al. Autonomic cardiac regulation during spontaneous nocturnal hypoglycemia in patients with type 1 diabetes. Diabetes Care 2012; 35 (Suppl. 07) 1585-1590.
  • 11 Vlcek M. et al. Heart rate variability and catecholamines during hypoglycemia and orthostasis. Auton Neurosci 2008; 143 1–2 53-57.
  • 12 Saito IHS, Maruyama K. et al. Heart Rate Variability, Insulin Resistance, and Insulin Sensitivity in Japanese Adults: The Toon Health Study. Journal of Epidemiology 2015; 25 (Suppl. 09) 583-591.
  • 13 Tarvainen MP. et al. Kubios HRV–heart rate variability analysis software. Computer methods and programs in biomedicine 2014; 113 (Suppl. 01) 210-220.
  • 14 Okkesim, et al. Analysis of coronary angiography related psychophysiological responses. Biomedical engineering online 2011; 10 (Suppl. 01) 1-19.
  • 15 Lu G, Yang F, Taylor JA, Stein JF. A comparison of photoplethysmography and ECG recording to analyse heart rate variability in healthy subjects. Journal of Medical Engineering & Technology 2009; 33: 634-641.
  • 16 Xhyheri B. et al. Heart rate variability today. Progress in cardiovascular diseases 2012; 55 (Suppl. 03) 321-331.
  • 17 Allen J. Photoplethysmography and its application in clinical physiological measurement. Physiological measurement 2007; 28 (Suppl. 03) R1.
  • 18 Javed F. et al. Frequency spectrum analysis of finger photoplethysmographic waveform variability during haemodialysis. Physiological measurement 2010; 31 (Suppl. 09) 1203.
  • 19 Selvaraj N, Lee J, Chon KH. Time-varying methods for characterizing nonstationary dynamics of physiological systems. Methods Inf Med 2010; 49 (Suppl. 05) 435-442.
  • 20 Diab MK, Weber WM, Al-Ali A. Method and apparatus for demodulating signals in a pulse oximetry system. 2014 Google Patents.
  • 21 Schäfer A, Vagedes J. How accurate is pulse rate variability as an estimate of heart rate variability? A review on studies comparing photoplethysmographic technology with an electrocardiogram. International journal of cardiology 2013; 166 (Suppl. 01) 15-29.
  • 22 Selvaraj N. et al. Assessment of heart rate variability derived from finger-tip photoplethysmography as compared to electrocardiography. Journal of medical engineering & technology 2008; 32 (Suppl. 06) 479-484.
  • 23 Saime A, Akar SK, Latifoğlu F, Bilgiç V. Time and Frequency Domain Measures of Heart Rate Variability in Schizophrenia. In: The First International Conference on Global Health Challenges. GLOBAL HEALTH 2012. Oct. 2012 Venice/Italy.:
  • 24 Laulkar R, Daimiwal N. Applications of finger photoplethysmography. International Journal of Engineering Research and Applications (IJERA) 2012; 2 (Suppl. 01) 877-880.
  • 25 Kristensen PL. et al. Influence of erythropoietin on cognitive performance during experimental hypoglycemia in patients with type 1 diabetes mellitus: a randomized cross-over trial. PloS one 2013; 8 (Suppl. 04) e59672.
  • 26 Janssen M, Snoek FJ, Heine RJ. Assessing impaired hypoglycemia awareness in type 1 diabetes: agreement of self-report but not of field study data with the autonomic symptom threshold during experimental hypoglycemia. Diabetes Care 2000; 23 (Suppl. 04) 529-532.
  • 27 Lee S. et al. Effect of atenolol on QTc interval lengthening during hypoglycaemia in type 1 diabetes. Diabetologia 2005; 48 (Suppl. 07) 1269-1272.
  • 28 Frier BM, Schernthaner G, Heller SR. Hypoglycemia and cardiovascular risks. Diabetes care 2011; 34 (Suppl. 02) S132-S137.
  • 29 Zhang Q. et al. An algorithm for robust and efficient location of T-wave ends in electrocardiograms. IEEE Transactions on Biomedical Engineering 2006; 53 (Suppl. 12) 2544-2552.
  • 30 Citi L, Brown EN, Barbieri R. A real-time automated point-process method for the detection and correction of erroneous and ectopic heartbeats. IEEE Transactions on Biomedical Engineering 2012; 59 (Suppl. 10) 2828-2837.
  • 31 Barbour AJ, Parker RL. psd: Adaptive, sine multi-taper power spectral density estimation for R. Computers & Geosciences 2014; 63: 1-8.
  • 32 Elliott DF. Handbook of digital signal processing: engineering applications. Academic press; 2013
  • 33 Parastoo Dehkordi AG, Member, IEEE, Karlen W, Member, IEEE, Wensley D, a.G.A.D. J. Mark Ansermino, Fellow IEEE. Pulse rate variability compared with heart rate variability in children with and without sleep disordered breathing. 35th Annual International Conference of the IEEE EMBS Osaka, Japan, July 3–7 2013
  • 34 Zaki R, Bulgiba A, Ismail NA. Testing the agreement of medical instruments: Overestimation of bias in the Bland-Altman analysis. Preventive medicine 2013; 57: S80-S82.
  • 35 Bland JM, Altman DG. Agreed statistics. Measurement method comparison. Anesthesiology 2012; 116: 182-185.
  • 36 Han H, Kim J. Artifacts in wearable photoplethysmographs during daily life motions and their reduction with least mean square based active noise cancellation method. Computers in biology and medicine 2012; 42 (Suppl. 04) 387-393.
  • 37 Foo JYA. Comparison of wavelet transformation and adaptive filtering in restoring artefact-induced time-related measurement. Biomedical signal processing and control 2006; 1 (Suppl. 01) 93-98.
  • 38 Wijshoff RW. et al. Reducing motion artifacts in photoplethysmograms by using relative sensor motion: phantom study. Journal of biomedical optics 2012; 17 (Suppl. 11) 117007.