Validity of the Empatica E4 Wristband to Measure Heart Rate Variability (HRV) Parameters: a Comparison to Electrocardiography (ECG)

Angela A T Schuurmans, Peter de Looff, Karin S Nijhof, Catarina Rosada, Ron H J Scholte, Arne Popma, Roy Otten, Angela A T Schuurmans, Peter de Looff, Karin S Nijhof, Catarina Rosada, Ron H J Scholte, Arne Popma, Roy Otten

Abstract

Wearable monitoring devices are an innovative way to measure heart rate (HR) and heart rate variability (HRV), however, there is still debate about the validity of these wearables. This study aimed to validate the accuracy and predictive value of the Empatica E4 wristband against the VU University Ambulatory Monitoring System (VU-AMS) in a clinical population of traumatized adolescents in residential care. A sample of 345 recordings of both the Empatica E4 wristband and the VU-AMS was derived from a feasibility study that included fifteen participants. They wore both devices during two experimental testing and twelve intervention sessions. We used correlations, cross-correlations, Mann-Whitney tests, difference factors, Bland-Altman plots, and Limits of Agreement to evaluate differences in outcomes between devices. Significant correlations were found between Empatica E4 and VU-AMS recordings for HR, SDNN, RMSSD, and HF recordings. There was a significant difference between the devices for all parameters but HR, although effect sizes were small for SDNN, LF, and HF. For all parameters but RMSSD, testing outcomes of the two devices led to the same conclusions regarding significance. The Empatica E4 wristband provides a new opportunity to measure HRV in an unobtrusive way. Results of this study indicate the potential of the Empatica E4 as a practical and valid tool for research on HR and HRV under non-movement conditions. While more research needs to be conducted, this study could be considered as a first step to support the use of HRV recordings provided by wearables.

Keywords: Autonomic nervous system; Electrocardiography; Empatica; Heart rate variability; Validation; Wearables.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Block diagram for the Empatica E4 wristband. Note. BVP = blood volume pulse, EDA = electrodermal activity, HF = high frequency, HR = heart rate, IBI = inter beat interval, LF = low frequency, LF/HF = ratio between low and high frequency, RMSSD = root mean squared differences of successive difference of intervals, SDNN = standard deviation of the normal to normal interval
Fig. 2
Fig. 2
a to d: Bland-Altman Plots: Time-domain parameters. Note. HR = heart rate, RMSSD = root mean squared differences of successive difference of intervals, SDNN = standard deviation of the NN interval
Fig. 3
Fig. 3
a to c: Bland-Altman Plots: Frequency-domain parameters. Note. HF = high frequency, LF = low frequency, LF/HF = ratio between low and high frequency

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