Evaluation of a wrist-worn photoplethysmography monitor for heart rate variability estimation in patients recovering from laparoscopic colon resection

Juha K A Rinne, Seyedsadra Miri, Niku Oksala, Antti Vehkaoja, Jyrki Kössi, Juha K A Rinne, Seyedsadra Miri, Niku Oksala, Antti Vehkaoja, Jyrki Kössi

Abstract

To evaluate the accuracy of heart rate variability (HRV) parameters obtained with a wrist-worn photoplethysmography (PPG) monitor in patients recovering from minimally invasive colon resection to investigate whether PPG has potential in postoperative patient monitoring. 31 patients were monitored for three days or until discharge or reoperation using a wrist-worn PPG monitor (PulseOn, Finland) with a Holter monitor (Faros 360, Bittium Biosignals, Finland) as a reference measurement device. Beat-to-beat intervals (BBI) and HRV information collected by PPG were compared with RR intervals (RRI) and HRV obtained from the ECG reference after removing artefacts and ectopic beats. The beat-to-beat mean error (ME) and mean absolute error (MAE) of good quality heartbeat intervals obtained by wrist PPG were estimated as - 1.34 ms and 10.4 ms respectively. A significant variation in the accuracy of the HRV parameters was found. In the time domain, SDNN (9.11%), TRI (11.4%) and TINN (11.1%) were estimated with low relative MAE, while RMSSD (34.3%), pNN50 (139%) and NN50 (188%) had higher errors. The logarithmic parameters in the frequency domain (VLF Log, LF Log and HF Log) exhibited the lowest relative error, and for non-linear parameters, SD2 (7.5%), DFA α1 (8.25%) and DFA α2 (4.71%) were calculated much more accurately than SD1 (34.3%). The wrist PPG shows some potential for use in a clinical setting. The accuracy of several HRV parameters analyzed post hoc was found sufficient to be used in further studies concerning postoperative recovery of patients undergoing laparoscopic colon resection, although there were large errors in many common HRV parameters such as RMSSD, pNN50 and NN50, rendering them unusable.ClinicalTrials.gov Identifier: NCT04996511, August 9, 2021, retrospectively registered.

Keywords: Heart rate variability; Holter monitor; Inter-beat-intervals; PPG; Photoplethysmography; Postoperative recovery; RR intervals.

Conflict of interest statement

Antti Vehkaoja is an employee of PulseOn Ltd., the company that provided the PPG monitors for the study. The other authors declare no financial or other competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
The distribution of the average relative MAE for all subjects. Each datapoint in the bar chart represents one subject. Time domain, frequency domain and non-linear parameters are separated by dashed lines. The bottom and upper part of boxplots, the red dashes and crosses represent 25th and 75th percentiles, median values and outliers respectively. The right bar represents the percentage of accepted windows for each subject, the median which is around 35%, which means that the condition that was set at the beginning led to the acceptance of around 35% of windows on average
Fig. 2
Fig. 2
Bland–Altman plot for the SDNN parameter. The mean of bias and limits of agreements (LoA) together with their confidence intervals (CI) are presented. The dashed line with a negative slope is the trend in the datapoints
Fig. 3
Fig. 3
Scatter plot for the RMSSD parameter

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