HEART RATE ANALYSIS HEART RATE ANALYSIS DURING SLEEP STAGES USING DURING SLEEP STAGES USING POINCARE

PLOTS POINCARE PLOTS

Giedrius Varoneckas and Danguol emaityt Giedrius Varoneckas and Danguol emaityt

Institute Psychophysiology and Rehabilitation, Vydno Str. 4, Palanga, Lithuania, E-mail: giedvar@ktl.mii.lt

Background Background
Evaluation of autonomic heart rate (HR) control, measured by Evaluation of autonomic heart rate (HR) control, measured by means of HR variability, might be important characteristic of means of HR variability, might be important characteristic of cardiovascular function. HR Poincare plots might be seen as cardiovascular function. HR Poincare plots might be seen as an easy and an informative method for visual presentation of an easy and an informative method for visual presentation of HR variability changes and assessment of autonomic control. HR variability changes and assessment of autonomic control.
Bonaduce et al., 1999; Silke et al., 1991 Bonaduce et al., 1999; Silke et al., 1991

There was starting a development and introduction of some There was starting a development and introduction of some simple characteristics for quantification of the Poincare plot. simple characteristics for quantification of the Poincare plot.
Copie et al., 1996; Kamen et al., 1996; Hnatkova et al., 1995 Copie et al., 1996; Kamen et al., 1996; Hnatkova et al., 1995

The goal The goal

was quantitative evaluation of HR variability by means of was quantitative evaluation of HR variability by means of quantification of Poincare plots during all night sleep as quantification of Poincare plots during all night sleep as well as during individual sleep stages in parallel to its well as during individual sleep stages in parallel to its evaluation by means of standard methodology of HR power evaluation by means of standard methodology of HR power spectrum for both, healthy subjects and cardiac patients. spectrum for both, healthy subjects and cardiac patients.

Contingent Contingent

32 healthy subjects 32 healthy subjects

17 and 40 yrs in average (29.0 0.78 yrs) 17 and 40 yrs in average (29.0 0.78 yrs)

161 coronary artery disease patients 161 coronary artery disease patients
34 and 79 yrs in average (52.0 0.89 yrs) 34 and 79 yrs in average (52.0 0.89 yrs)

Methods Methods
Polysomnography (Alice 4 system) Polysomnography (Alice 4 system) Rhythmography (a sequence of successive RR intervals of ECG) Rhythmography (a sequence of successive RR intervals of ECG) Heart rate analysis using spectral analysis Heart rate analysis using spectral analysis
(for assessment of autonomic HR control) (for assessment of autonomic HR control)

Heart rate analysis using Poincare plots Heart rate analysis using Poincare plots
(for assessment of autonomic HR control) (for assessment of autonomic HR control)

Comparison of the results obtained from HR Poincare plot Comparison of the results obtained from HR Poincare plot and power spectrum analysis has been performed. and power spectrum analysis has been performed.

Heart rate analysis using Poincare plot Heart rate analysis using Poincare plot

RRr, difference on plot diagonal

r RR

between minimal (RRmin) and maximal (RRmax) RR values

R rt R

RRt, maximal HR variability as

maximal width-difference between of two points at parallel tangential lines determining plot
RRmin RRmax

RRmin, maximal HR frequency RRmax, HR frequency at its

minimal level

P, square of the plot, representing

overall HR variability

HR analysis using power spectrum HR analysis using power spectrum

Three main frequency components Three main frequency components were measured: were measured:
very low frequency component (VLFC), very low frequency component (VLFC), low frequency component (LFC), low frequency component (LFC), high frequency component (HFC) high frequency component (HFC) in absolute (ms) and relative (percent) in absolute (ms) and relative (percent) values for evaluation of autonomic humoral, values for evaluation of autonomic humoral, sympathetic-parasympathetic and sympathetic-parasympathetic and parasympathetic control, correspondingly.. parasympathetic control, correspondingly

Poincare plots of RR intervals during individual sleep stages Poincare plots of RR intervals during individual sleep stages
W before Sleep Stages 1-2 Stages 3-4 REM Sleep Total night

Healthy Subject

CAD Patients

Typical HRSP

Reduced HRSP

Poincare plots of RR intervals in healthy subject under Poincare plots of RR intervals in healthy subject under different conditions of autonomic HR control different conditions of autonomic HR control
Baseline Wakefulness Propranolol Atropine Propranolol & Atropine

Stage 2

Stage 3

REM Sleep

Correlation between of individual parameters of Poincare Correlation between of individual parameters of Poincare plot and parameters of heart rate power spectrum plot and parameters of heart rate power spectrum
RR; ms RR; ms RR; ms RRmin; ms RRmax; ms RRr; ms RRt; ms P; ms2 r S, % 0.99* 0.48* 0.66* 0.82* 0.55* 0.37* 0.44* -0.21 0.26* RR; ms 0.59* 0.95* 0.03 0.82* 0.85* 0.81* 0.85* -0.59* 0.69* RR; ms 0.55* 0.92* -0.03 0.77* 0.83* 0.74* 0.78* -0.53* 0.61* ULFC; ms 0.34* 0.86* -0.15 0.59* 0.69* 0.63* 0.66* -0.42* 0.53* VLFC; ms 0.57* 0.77* 0.03 0.71* 0.75* 0.62* 0.66* -0.46 0.49* LFC; ms 0.28* 0.84* -0.19* 0.66* 0.79* 0.88* 0.89* -0.68* 0.78* HFC; ms 0.43* 0.78* -0.05 0.68* 0.68* 0.84* 0.83* -0.73* 0.79* NULFC; % -0.32* -0.30* -0.10 -0.47* -0.46* -0.48* -0.47* 0.50* -0.46* NVLFC; % 0.06 -0.41* 0.10 -0.21* -0.24* -0.49* -0.44 0.29* -0.52* NLFC; % -0.02 0.44* -0.26* 0.36* 0.51* 0.58* 0.56* -0.38* 0.53* NHFC; % 0.28* 0.33* 0.21 0.39* 0.28* 0.48* 0.44* -0.43* 0.52*

Conclusions Conclusions
Evaluation of autonomic HR control changes during sleep stages Evaluation of autonomic HR control changes during sleep stages showed principally similar results ifif measured by means of HR power showed principally similar results measured by means of HR power spectrum components or parameters drawn from Poincare plot. spectrum components or parameters drawn from Poincare plot. Poincare plot analysis was less precise in evaluation of sympatheticPoincare plot analysis was less precise in evaluation of sympatheticparasympathetic components of tonic HR control, as compared to HR parasympathetic components of tonic HR control, as compared to HR power spectrum analysis, although better for evaluation of reflex HR power spectrum analysis, although better for evaluation of reflex HR control, as well as, for an overall quantitative and qualitative evaluation. control, as well as, for an overall quantitative and qualitative evaluation. Quantification of HR autonomic control evaluation using RR Quantification of HR autonomic control evaluation using RR parameters of Poincare plot might be seen as informative method for an parameters of Poincare plot might be seen as informative method for an analysis of HR control. analysis of HR control.