The vagus nerve is strategically located in the body, and has multiple homeostatic and health-promoting effects. Low vagal activity predicts onset and progression of diseases. These are the reasons to activate this nerve. This study examined the effects of transcutaneous vagus nerve stimulation (t-VNS) on a main index of vagal activity, namely heart rate variability (HRV). In Study 1, we compared short (10min) left versus right ear t-VNS versus sham (no stimulation) in a within-subjects experimental design. Results revealed significant increases in only one HRV parameter (standard deviation of the RR intervals (SDNN)) following right-ear t-VNS. Study 2 examined the prolonged effects of t-VNS (1h) in the right ear. Compared to baseline, right-t-VNS significantly increased the LF and LF/HF components of HRV, and SDNN in women, but not in men. These results show limited effects of t-VNS on HRV, and are discussed in light of neuroanatomical and statistical considerations and future directions are proposed.

An analysis of cardiorespiratory dynamics during mental arithmetic, which induces stress, and sustained attention was conducted using information theory. The information storage and internal information of heart rate variability (HRV) were determined respectively as the self-entropy of the tachogram, and the self-entropy of the tachogram conditioned to the knowledge of respiration. The information transfer and cross information from respiration to HRV were assessed as the transfer and cross-entropy, both measures of cardiorespiratory coupling. These information-theoretic measures identified significant nonlinearities in the cardiorespiratory time series. Additionally, it was shown that, although mental stress is related to a reduction in vagal activity, no difference in cardiorespiratory coupling was found when several mental states (rest, mental stress, sustained attention) are compared. However, the self-entropy of HRV conditioned to respiration was very informative to study the predictability of RR interval series during mental tasks, and showed higher predictability during mental arithmetic compared to sustained attention or rest.

Purpose Weightlessness has a well-known effect on the autonomic control of the cardiovascular system. With future missions to Mars in mind, it is important to know what the effect of partial gravity is on the human body. We aim to study the autonomic response of the cardiovascular system to partial gravity levels, as present on the Moon and on Mars, during parabolic flight. Methods ECG and blood pressure were continuously recorded during parabolic flight. A temporal analysis of blood pressure and heart rate to changing gravity was conducted to study the dynamic response. In addition, cardiovascular autonomic control was quantified by means of heart rate (HR) and blood pressure (BP) variability measures. Results Zero and lunar gravity presented a biphasic cardiovascular response, while a triphasic response was noted during martian gravity. Heart rate and blood pressure are positively correlated with gravity, while the general variability of HR and BP, as well as vagal indices showed negative correlations with increasing gravity. However, the increase in vagal modulation during weightlessness is not in proportion when compared to the increase during partial gravity. Conclusions Correlations were found between the gravity level and modulations in the autonomic nervous system during parabolic flight. Nevertheless, with future Mars missions in mind, more studies are needed to use these findings to develop appropriate countermeasures.

Accurate R peak detection in the electrocardiogram (ECG) is a well-known and highly explored problem in biomedical signal processing. Although a lot of progress has been made in this area, current methods are still insufficient in the presence of extreme noise and/or artifacts such as loose electrodes. Often, however, not only the ECG is recorded, but multiple signals are simultaneously acquired from the patient. Several of these signals, such as blood pressure, can help to improve the heart beat detection. These signals of interest can be detected automatically by analyzing their power spectral density or by using the available signal type identifiers. Individual peaks from the signals of interest are combined using majority voting, heart beat location estimation and Hjorth's mobility of the resulting RR intervals. Both multimodal algorithms showed significant increases in performance of up to 8.65% for noisy multimodal datasets compared to when only the ECG signal is used. A maximal performance of 90.02% was obtained on the hidden test set of the Physionet/Computing in Cardiology Challenge 2014: Robust Detection of Heart Beats in Multimodal Data.

Altered stress responsiveness is a risk factor for mental and physical illness. In non-pregnant populations, it is well-known that anxiety can alter the physiological regulation of stress reactivity. Characterization of corresponding risks for pregnant women and their offspring requires greater understanding of how stress reactivity and recovery are influenced by pregnancy and women's anxiety feelings. In the current study, women were presented repeatedly with mental arithmetic stress tasks in the first and third pregnancy trimester and reported their trait anxiety using the state trait anxiety inventory. Cardiovascular stress reactivity in late pregnancy was lower than reactivity in the first pregnancy trimester (heart rate (HR): t(197) = 4.98, p < .001; high frequency heart rate variability (HF HRV): t(196)= -2.09, p = .04). Less attenuation of stress reactivity occurred in more anxious women (HR: b = 0.15, SE = 0.06, p = .008; HF HRV: b = -10.97, SE = 4.79, p = 02). The study design did not allow the influence of habituation to repeated stress task exposure to be assessed separately from the influence of pregnancy progression. Although this is a limitation, the clear differences between anxious and non-anxious pregnant women are important, regardless of the extent to which differing habituation between the groups is responsible. Less dampened stress reactivity through pregnancy may pose long-term risks for anxious women and their offspring. Follow-up studies are required to determine these risks. (C) 2015 Elsevier B.V. All rights reserved.

This study was aimed at comparing two alternative information-theoretic approaches for the combined analysis of heart rate variability (HRV) and respiration variability (RV). The approaches decompose the predictive information about HRV in two terms, quantifying respectively the information stored into HRV and that transferred to HRV from RV. Storage and transfer were assessed by the popular self entropy (SE) and transfer entropy (TE) measures, as well as by the alternative conditional SE (cSE) and cross entropy (CE) measures. The comparison was performed at a theoretical level, computing the exact values of the four measures for simulated cardiorespiratory dynamics, and on real data, estimating the measures from RV and HRV time series taken from healthy subjects during head-up tilt and paced breathing protocols. Both analyses suggested that, for the study of cardiorespiratory interactions which are mostly unidirectional from RV to HRV, the decomposition evidencing cSE and CE is more suitable to describe respiratory sinus arrhythmia and its modifications related to changes in cardiorespiratory interactions.

In this study, we assessed the information dynamics of respiration and heart rate variability during mental stress testing by means of the cross-entropy, a measure of cardiorespiratory coupling, and the self-entropy of the tachogram conditioned to the knowledge of respiration. Although stress is related to a reduction in vagal activity, no difference in cardiorespiratory coupling was found when 5 minutes of rest and stress were compared. The conditional self-entropy, on the other hand, showed significantly higher values during stress, indicating a higher predictability of the tachogram. These results show that entropy analyses of cardiorespiratory data reveal new information that could not be obtained with traditional heart rate variability studies.

Voluntary adjustment of the breathing pattern is widely used to deal with stress-related conditions. In this study, effects of slow and fast breathing with a low and high inspiratory to expiratory time on heart rate variability (HRV) are evaluated by means of information dynamics. Information transfer is quantified both as the traditional transfer entropy as well as the cross entropy, where the latter does not condition on the past of HRV, thereby taking the highly unidirectional relation between respiration and heart rate into account. The results show that the cross entropy is more suited to quantify cardiorespiratory information transfer as this measure increases during slow breathing, indicating the increased cardiorespiratory coupling and suggesting the shift towards vagal activation during slow breathing. Additionally we found that controlled breathing, either slow or fast, results as well in an increase in cardiorespiratory coupling, compared to spontaneous breathing, which demonstrates the beneficial effects of instructed breathing.

The variability of the heart rate (HRV) is widely studied as it contains information about the activity of the autonomic nervous system (ANS). However, HRV is influenced by breathing, independently of ANS activity. It is therefore important to include respiratory information in HRV analyses in order to correctly interpret the results. In this paper, we propose to record respiratory activity and use this information to separate the tachogram in two components: one which is related to breathing and one which contains all heart rate variations that are unrelated to respiration. Several algorithms to achieve this have been suggested in the literature, but no comparison between the methods has been performed yet. In this paper, we conduct two studies to evaluate the methods' performances to accurately decompose the tachogram in two components and to assess the robustness of the algorithms. The results show that orthogonal subspace projection and an ARMAX model yield the best performances over the two comparison studies. In addition, a real-life example of stress classification is presented to demonstrate that this approach to separate respiratory information in HRV studies can reveal changes in the heart rate variations that are otherwise masked by differing respiratory patterns.

The tachogram is typically constructed by detecting the R peaks in the electrocardiogram (ECG). Sometimes the ECG is however very noisy, which makes it hard to find the R peaks in these cases by using only the ECG. Information from other signals can then be used in order to find the R peaks. In this paper, a method is suggested that is able to automatically detect signals with the same periodic behavior as the ECG. Heart beat labels of the detected signals are combined by using majority voting, heart beat location estimation and Hjorth's mobility parameter. The average performance was 99.95% for the training set and 85.62% for the last phase of the 2014 Computing in Cardiology challenge. If the available labels for the signals are used, the performance on the hidden test set was 86.61%.

Slow breathing is widely applied to improve symptoms of hyperarousal, but it is unknown whether its beneficial effects relate to the reduction in respiration rate per se, or, to a lower inhalation/exhalation (i/e) ratio. The present study examined the effects of four ventilatory patterns on heart rate variability and self-reported dimensions of relaxation. Thirty participants were instructed to breathe at 6 or 12 breaths/min, and with an i/e ratio of 0.42 or 2.33. Participants reported increased relaxation, stress reduction, mindfulness and positive energy when breathing with the low compared to the high i/e ratio. A lower compared to a higher respiration rate was associated only with an increased score on positive energy. A low i/e ratio was also associated with more power in the high frequency component of heart rate variability, but only for the slow breathing pattern. Our results show that i/e ratio is an important modulator for the autonomic and subjective effects of instructed ventilatory patterns.

Respiration is one of the main modulators causing heart rate variability (HRV). However, when interpreting studies of HRV, the effect of respiration is largely ignored. We, therefore, previously proposed to take respiratory influences into account by separating the tachogram in a component that is related to respiration and one that contains all residual variations. In this study, we aim to investigate the sensitivity of two of such separation methods, i.e. one based on an ARMAX model and another one based on orthogonal subspace projection (OSP), towards different respiratory signal types, such as nasal airflow (the reference), thoracic and abdominal efforts, and three ECG-derived respiratory (EDR) signals. The sensitivity of both separation methods to the type of respiratory signal is evaluated by assessing the information transfer from the reference respiratory signal to the residual tachogram, where the latter is obtained using each time a different type of respiratory signal. The results show that OSP is the least sensitive to the different types of respiratory signals. Even when an EDR signal obtained using kernel principal component analysis is used, OSP yields a correct separation in 13 out of 18 recordings, demonstrating that in many cases, the separation of the tachogram can successfully be conducted even if only the ECG is available.

Aim: Heart Rate Variability (HRV) is determined by the autonomic nervous system (ANS) and a low value of this parameter is related to neurological pathologies and infants mortality. This study aims to assess the utility and the advantages of HRV analysis by means of phase-rectified signal averaging (PRSA), a technique that obtains curves that are useful to determine the development of the ANS in preterm infants, with less obtrusive monitoring compared to electroencephalography. Methods: For a preliminary study, 24-hour ECGs were taken in NICU at the University Hospital in Leuven, from 12 babies: 4 were term, 4 were born preterm but reached a term postmenstrual age, and 4 were preterm. Heart rate tracks of segments of 27 minutes were extracted and analyzed with the PRSA technique. The curves obtained were quantified by the slope and by an acceleration/deceleration related parameter (AC/DC). Two independent analyses on acceleration and deceleration were carried out to visualize the effects of the sympathetic and parasympathetic system separately. Moreover, the immediate response and the response after 5 seconds were taken into account. Results and Conclusion: All the results were compared and validated with traditional HRV parameters. The results of slope and AD/DC in both types of analysis are promising in providing a simple parameter to assess neurological development deficiency in order to allow faster and preventive intervention. Further studies are needed in a larger population.

Background Spaceflight causes changes in the cardiovascular control system. The aim of this study was to evaluate postflight recovery of linear and nonlinear neural markers of heart rate modulation, with a special focus on day-night variations. Material/Methods Twenty-four-hour Holter ECG recordings were obtained in 8 astronauts participating in space missions aboard the International Space Station (ISS). Data recording was performed 1 month before launch, and 5 and 30 days after return to Earth from short- and long-term flights. Cardiovascular control was inferred from linear and nonlinear heart rate variability (HRV) parameters, separately during 2-hour day and 2-hour night recordings. Results No remarkable differences were found in the postflight recovery between astronauts from short- and long-duration spaceflights. Five days after return to Earth, vagal modulation was significantly decreased compared to the preflight condition (day: p=0.001; night: p=0.019), while the sympathovagal balance was strongly increased, but only at night (p=0.017). A few nonlinear parameters were reduced early postflight compared to preflight values, but these were not always statistically significant. No significant differences remained after 30 days of postflight recovery. Conclusions Our results show that 5 days after return from both short- and long-duration space missions, neural mechanisms of heart rate regulation are still disturbed. After 1 month, autonomic control of heart rate recovered almost completely.

Mental stress is a growing problem in our society. In order to deal with this, it is important to understand the underlying stress mechanisms. In this study, we aim to determine how the cardiorespiratory interactions are affected by mental arithmetic stress and attention. We conduct cross time-frequency (TF) analyses to assess the cardiorespiratory coupling. In addition, we introduce partial TF spectra to separate variations in the RR interval series that are linearly related to respiration from RR interval variations (RRV) that are not related to respiration. The performance of partial spectra is evaluated in two simulation studies. Time-varying parameters, such as instantaneous powers and frequencies, are derived from the computed spectra. Statistical analysis is carried out continuously in time to evaluate the dynamic response to mental stress and attention. The results show an increased heart and respiratory rate during stress and attention, compared to a resting condition. Also a fast reduction in vagal activity is noted. The partial TF analysis reveals a faster reduction of RRV power related to (3 s) than unrelated to (30 s) respiration, demonstrating that the autonomic response to mental stress is driven by mechanisms characterized by different temporal scales.

Mental stress is a major problem in today's society. It is therefore important to determine the mechanisms underlying stress. In this paper, we aim at studying the cardio-respiratory response to mental stress using a nonparametric multivariate time-frequency approach. In addition, partial spectra are considered to separate RR interval variations (RRV) that can be related to respiration from RRV that are unrelated to respiration. The results confirm vagal withdrawal during mental stress and also reveal that the autonomic response to stress is driven by mechanisms both related and unrelated to respiration that are characterized by different response times.

Gravity changes during partial-G parabolic flights (0g 0.16g 0.38g) lead to changes in modulation of the autonomic nervous system (ANS), studied via the heart rate variability (HRV) and blood pressure variability (BPV). HRV and BPV were assessed via classical time and frequency domain measures. Mean systolic and diastolic blood pressure show both increasing trends towards higher gravity levels. The parasympathetic and sympathetic modulation show both an increasing trend with decreasing gravity, although the modulation is sympathetic predominant during reduced gravity. For the mean heart rate, a non-monotonic relation was found, which can be explained by the increased influence of stress on the heart rate. This study shows that there is a relation between changes in gravity and modulations in the ANS. With this in mind, countermeasures can be developed to reduce postflight orthostatic intolerance.

In neonatal intensive care units, there is a need for continuous monitoring of sick newborns with perinatal hypoxic ischemic brain injury (HIE). We assessed the utility of heart rate variability (HRV) in newborns with acute HIE undergoing simultaneous continuous EEG (cEEG) and ECG monitoring. HIE was classified using clinical criteria as well as visual grading of cEEG. Newborns were divided into two groups depending on the severity of the hypoxic injury and outcome. Various HRV parameters were compared between these groups, and significantly decreased HRV was found in neonates with severe HIE. As HRV is affected by many factors, it is difficult to attribute this difference solely to HIE. However, this study suggests that further investigation of HRV as a monitoring tool for acute neonatal hypoxic injury is warranted.