Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Mar 17, 2020
Date Accepted: Jun 13, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A novel smartphone app Pulse Express PRO is a valid and reliable surrogate for ultra-short-term and short-term heart rate variability
ABSTRACT
Background:
Smartphone application of heart rate variability (HRV) measurement has been extensively developed in this decade. However, this implementation to ultra-short-term HRV records with wearable devices has not been examined
Objective:
The purposes of this study were 1) to compare the validity and reliability of ultra-short-term and short-term HRV of time-domain and frequency-domain variables in a novel smartphone application, Pulse Express Pro (PEP); and 2) to determine the agreement of HRV assessments between electrocardiographic (ECG) and PEP.
Methods:
Thirty healthy male adults were recruited to participate in this study (age: 23.40 ± 3.60 yrs, height: 174.81 ± 4.71 cm, body weight: 71.53 ± 9.82 kg). A 5-min resting HRV was assessed via ECG and PEP in a sitting position. Standard deviation of normal R-R interval (SDNN), root mean square of successive R-R interval, (RMSSD), normalised low-frequency power (LF), and normalised high-frequency power (HF) were analysed within nine time segments of HRV records: 0-1 min, 1-2 min, 2-3 min, 3-4 min, 4-5 min, 0-2 min, 0-3 min, 0-4 min, and 0-5 min (standard). Standardized differences (ES), interclass correlation coefficients (ICC), and Spearman’s product-moment correlation were used to compare the validity and reliability of each time segment to 0-5 min standard measures. Limits of agreement were assessed by using Bland-Altman plot analysis.
Results:
Compared to standard measures in both ECG and PEP, the SDNN and RMSSD variables showed trivial ES (< 0.2) and nearly perfect ICC and Spearman correlation coefficient in all time segments (> 0.9). The LF and HF variables demonstrated a variation of ES (from trivial to moderate effects, 0.07-0.53), ICC (from large to nearly perfect, 0.54-0.97), and Spearman correlation coefficient (from moderate to nearly perfect, 0.38-0.95). Furthermore, the Bland-Altman plots showed relatively narrow values of mean difference between ECG and PEP after consecutive 1-min records for SDNN and RMSSD and after consecutive 3-min records for LF and HF.
Conclusions:
Using PEP app to facilitate 1-min ultra-short-term HRV during stabilization is suggested as preferred measure when SDNN and RMSSD were computed. Consecutive record for at least 3-min during stabilization is suggested for accurate measurement of LF and HF indices via PEP.
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