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During an ECG-training course, a case of extreme respiratory sinus arrhythmia (RSA) was found in a 19-year-old slender, female student who was not active in sports. The heart rate (HR) fluctuated from above 100 to below 60 beats per minute (bpm), often from one beat to the next. The pattern was repetitive and appeared to be linked to respiration, representing an extreme form of RSA. The initial recording of the HR and blood pressure (BP) by finger blood pressure showed concomitant drops in diastolic BP of up to 25 mmHg. The student agreed to participate in a short follow-up study, during which HR, BP, and respiration (measured by temperature and pCO2 of the airflow at the nose) were recorded in the supine and upright tilted positions. Measurements were taken during 5 min of rest, during paced breathing (1 min each at 6, 10, and 15 breaths per min), and during end-expiratory breath-hold. This study presents a beat-by-beat analysis of the observed interrelations between respiration, HR, and BP. Her respiratory rate with maximal RSA was found to be only slightly lower than the spontaneous rate, at 10 versus 12 breaths per min. From the combined observations, it was concluded that, in this case, the baroreflex relationship between spontaneous BP and HR changes was overridden by near on/off gating of (possibly massive) cardiac vagal outflow. This is due to a central, respiration-coupled gating mechanism, with the vagus nerve being "on" during expiration and "off" during inspiration. Such a system will destabilize blood pressure. It shows an evolutionary remnant of optimizing lung perfusion during air inflation, regardless of the consequences for systemic blood pressure. [ABSTRACT FROM AUTHOR]

During an ECG-training course, a case of extreme respiratory sinus arrhythmia (RSA) was found in a 19-year-old slender, female student who was not active in sports. The heart rate (HR) fluctuated from above 100 to below 60 beats per minute (bpm), often from one beat to the next. The pattern was repetitive and appeared to be linked to respiration, representing an extreme form of RSA. The initial recording of the HR and blood pressure (BP) by finger blood pressure showed concomitant drops in diastolic BP of up to 25 mmHg. The student agreed to participate in a short follow-up study, during which HR, BP, and respiration (measured by temperature and pCO2 of the airflow at the nose) were recorded in the supine and upright tilted positions. Measurements were taken during 5 min of rest, during paced breathing (1 min each at 6, 10, and 15 breaths per min), and during end-expiratory breath-hold. This study presents a beat-by-beat analysis of the observed interrelations between respiration, HR, and BP. Her respiratory rate with maximal RSA was found to be only slightly lower than the spontaneous rate, at 10 versus 12 breaths per min. From the combined observations, it was concluded that, in this case, the baroreflex relationship between spontaneous BP and HR changes was overridden by near on/off gating of (possibly massive) cardiac vagal outflow. This is due to a central, respiration-coupled gating mechanism, with the vagus nerve being “on” during expiration and “off” during inspiration. Such a system will destabilize blood pressure. It shows an evolutionary remnant of optimizing lung perfusion during air inflation, regardless of the consequences for systemic blood pressure.

We propose for the first time a method for extracting the instantaneous phases of respiration from the signal of a photoplethysmogram (PPG). In addition to the instantaneous phases of respiration, this method allows for more accurately extracting the instantaneous frequencies of respiration from a PPG than other methods. The proposed method is based on a calculation of the element-wise product of the wavelet spectrum of a PPG and the sequence of intervals between the heartbeats extracted from a PPG, and a calculation of the skeleton of the resulting spectrum in the respiratory frequency range. It is shown that such an element-wise product makes it possible to extract the instantaneous phases and instantaneous frequencies of respiration more accurately than using the wavelet transform of a PPG signal or the sequence of the heartbeat intervals. The proposed method was verified by analyzing the signals from healthy subjects recorded during stress-inducing cognitive tasks. This method can be used in wearable devices for signal processing. [ABSTRACT FROM AUTHOR]

Ballistocardiography (BCG) and seismocardiography (SCG) are non-invasive techniques used to record the micromovements induced by cardiovascular activity at the body's center of mass and on the chest, respectively. Since their inception, their potential for evaluating cardiovascular health has been studied. However, both BCG and SCG are impacted by respiration, leading to a periodic modulation of these signals. As a result, data processing algorithms have been developed to exclude the respiratory signals, or recording protocols have been designed to limit the respiratory bias. Reviewing the present status of the literature reveals an increasing interest in applying these techniques to extract respiratory information, as well as cardiac information. The possibility of simultaneous monitoring of respiratory and cardiovascular signals via BCG or SCG enables the monitoring of vital signs during activities that require considerable mental concentration, in extreme environments, or during sleep, where data acquisition must occur without introducing recording bias due to irritating monitoring equipment. This work aims to provide a theoretical and practical overview of cardiopulmonary interaction based on BCG and SCG signals. It covers the recent improvements in extracting respiratory signals, computing markers of the cardiorespiratory interaction with practical applications, and investigating sleep breathing disorders, as well as a comparison of different sensors used for these applications. According to the results of this review, recent studies have mainly concentrated on a few domains, especially sleep studies and heart rate variability computation. Even in those instances, the study population is not always large or diversified. Furthermore, BCG and SCG are prone to movement artifacts and are relatively subject dependent. However, the growing tendency toward artificial intelligence may help achieve a more accurate and efficient diagnosis. These encouraging results bring hope that, in the near future, such compact, lightweight BCG and SCG devices will offer a good proxy for the gold standard methods for assessing cardiorespiratory function, with the added benefit of being able to perform measurements in real-world situations, outside of the clinic, and thus decrease costs and time. [ABSTRACT FROM AUTHOR]

Purpose: The SERVE-HF study revealed no benefit of adaptive servoventilation (ASV) versus guideline-based medical treatment in patients with symptomatic heart failure, an ejection fraction (EF) ≤45% and a predominance of central events (apnoea-hypopnea Index [AHI] > 15/h). Because both all-cause and cardiovascular mortality were higher in the ASV group, an EF ≤ 45% in combination with AHI 15/h, central apnoea-hyponoea index [CAHI/AHI] > 50% and central apnoea index [CAI] > 10/h were subsequently listed as contraindications for ASV. The intention of our study was to analyse the clinical relevance of this limitation. Methods: Data were analysed retrospectively for patients treated with ASV who received follow-up echocardiography to identify contraindications for ASV. Results: Echocardiography was conducted in 23 patients. The echocardiogram was normal in 10 cases, a left ventricular hypertrophy with normal EF was found in 8 patients, there was an EF 45–50% in 2 cases and a valvular aortic stenosis (grade II) with normal EF was found in 1 case. EF <45% was present in just 2 cases, and only 1 of these patients also had more than 50% central events in the diagnostic night. Conclusion: The population typically treated with ASV is entirely different from the study population in SERVE-HF, as nearly half of the patients treated with ASV showed a normal echocardiogram. Thus, the modified indication for ASV has little impact on the majority of treated patients. The current pathomechanistic hypothesis of central apnoea must be reviewed. [ABSTRACT FROM AUTHOR]

Cardiorespiratory interaction (CRI) has been intensively studied in adult sleep, yet not in preterm infants, in particular across different sleep states including wake (W), active sleep (AS), and quiet sleep (QS). The aim of this study was to quantify the interaction between cardiac and respiratory activities in different sleep states of preterm infants. The postmenstrual age (PMA) of preterm infants was also taken into consideration. The CRI during sleep was analyzed using a visibility graph (VG) method, enabling the nonlinear analysis of CRI in a complex network. For each sleep state, parameters quantifying various aspects of the CRI characteristics from constructed VG network including mean degree (Dm) and its variability (Dsd), clustering coefficient (CCm) and its variability (CCsd), assortativity coefficient (AC), and complexity (DSE) were extracted from the CRI networks. The interaction effect of sleep state and PMA was found to be statistically significant on all CRI parameters except for AC and DSE. The main effect between sleep state and CRI parameters was statistically significant except for CCm, and that between PMA and CRI parameters was statistically significant except for DSE. In conclusion, the CRI of preterm infants is associated with sleep states and PMA in general. For preterm infants with a larger PMA, CRI has a more clustered pattern during different sleep states, where QS shows a more regular, stratified, and stronger CRI than other states. In the future, these parameters can be potentially used to separate sleep states in preterm infants. NEW & NOTEWORTHY The interaction between cardiac and respiratory activities is investigated in preterm infant sleep using an advanced nonlinear method (visibility graph) and some important characteristics are shown to be significantly different across sleep states, which has not been studied before. [ABSTRACT FROM AUTHOR]

The pulse-respiration quotient (heart rate divided by the respiration rate, PRQ = HR/RR) is a parameter capturing the complex state of cardiorespiratory interactions. We analysed 482 single PRQ values obtained from measurement on 134 healthy adult subjects (49 men, 85 women, age: 24.7 ± 3.4, range: 20-46 years) during rest. We found that the distribution of PRQ values (i) has a global maximum at around a value of 4 (median: 4.19) and (ii) follows a lognormal distribution function. A multimodality of the distribution, associated with several PRQ attractor states was not detected by our group-level based analysis. In summary, our analysis shows that in healthy humans the resting-state PRQ is around 4 and lognormally distributed. This finding supports claims about the special role of the 4 to 1 cardiorespiratory coupling in particular and the PRQ in general for physiological and medical views and applications. To the best of our knowledge, our study is the largest conducted so far in healthy adult humans about reference values of the PRQ during a resting-state at day. [ABSTRACT FROM AUTHOR]

ECG recordings were obtained using an implanted telemetry device from the South American rattlesnake, Crotalus durissus, held under stable conditions without restraining cables or interaction with researchers. Mean heart rate (fH) recovered rapidly (<24 h) from anaesthesia and operative procedures. This preceded a more gradual development of heart rate variability (HRV), with instantaneous fH increasing during each lung ventilation cycle. Atropine injection increased mean fH and abolished HRV. Complete autonomic blockade revealed a cholinergic tonus on the heart of 55% and an adrenergic tonus of 37%. Power spectral analysis of HRV identified a peak at the same frequency as ventilation. This correlation was sustained after temperature changes and it was more evident, marked by a more prominent power spectrum peak, when ventilation is less episodic. This HRV component is homologous to that observed in mammals, termed respiratory sinus arrhythmia (RSA). Evidence for instantaneous control of fH indicated rapid conduction of activity in the cardiac efferent nervous supply, as supported by the description of myelinated fibres in the cardiac vagus. Establishment of HRV 10 days after surgical intervention seems a reliable indicator of the reestablishment of control of integrative functions by the autonomic nervous system.We suggest that this criterion could be applied to other animals exposed to natural or imposed trauma, thus improving protocols involving animal handling, including veterinarian procedures. [ABSTRACT FROM AUTHOR]

We used the chicken embryo at the internal pipping phase (just after the onset of pulmonary ventilation) as a model to quantify the changes in heart rate (fH), breathing frequency (fB) and their variabilities (heart rate variability and breathing rate variability) during air breathing (21% O2) and successive 20-min periods of 15%, 10% and 5% O2 and posthypoxic recovery. For each condition, and for both fH and fB, variability was quantified by time-domain analysis with five standard criteria; these produced qualitatively similar results, which were combined into a single variability index. In normoxia, breathing rate variability was about five times higher than heart rate variability. With 10% O2, the embryo's oxygen consumption (...O2 ) and breathing rate variability decreased while heart rate variability increased. In normoxia, respiratory sinus arrhythmia was recognisable in a minority of embryos; its average value was low (~2%) and decreased further with hypoxia. With very severe hypoxia (5% O2), in some cases, breathing stopped; when it did not, breathing rate variability was high. Within the 20-min post-hypoxia, all embryos recovered, and almost all parameters (fH, heart rate variability, fB, respiratory sinus arrhythmia and ...O2 ) were at the pre-hypoxic values; only breathing rate variability remained low. The possibility of simultaneous measurements of fB and fH makes the avian embryo, close to hatching, a suitable model for the investigations of heart rate variability and breathing rate variability in response to hypoxia during the transition from prenatal to postnatal life. [ABSTRACT FROM AUTHOR]

Investigation of the nonlinear dynamics of the heart rate is crucial for understanding the physiological mechanisms of various functional states and understanding the adaptation capacity of the human body. The purpose of this study was to evaluate some quantitative parameters of the nonlinear parameters of resonance in the heart rate variability. The study included 70 healthy students who underwent paced breath training. The heart rate was recorded during breathing at different respiratory rates (spontaneous breathing, 4.5, 5, 5.5, 6, and 6.5 breaths/min). The resonant frequency was determined using heart-rate spectral analysis. Nonlinear analysis of HRV was performed using entropy measures (ApEn, SampEn, and MSE), Correlation dimension, Detrended Fluctuation Analysis (DFA), Recurrence Plot (REC, DET, Lmean, Lmax, and ShanEn), the Poincaré plot (SD1 and SD2), and time asymmetry (GI and P). We observed a decrease in the level of complexity, an increase in the self-similarity of the RR intervals, a decrease in the chaotic component, and an increase in rhythm asymmetry during breathing at resonant frequency. [ABSTRACT FROM AUTHOR]

Investigation of the interaction between cardiovascular variables and respiration provides a quantitative and noninvasive approach to assess the autonomic control of cardiovascular function. The aim of this paper is to investigate the changes of cardiopulmonary coupling (CPC), blood pressure (BP) and pulse transit time (PTT) during a stepwise-paced breathing (SPB) procedure (spontaneous breathing followed by paced breathing at 14, 12.5, 11, 9.5, 8 and 7 breaths per minute, 3 min each) and gain insights into the characteristics of slow breathing exercises. RR interval, respiration, BP and PTT are collected during the SPB procedure (48 healthy subjects, 27 ± 6 years). CPC is assessed through investigating both the phase and amplitude dynamics between the respiration-induced components from RR interval and respiration by the approach of ensemble empirical mode decomposition. It was found that even though the phase synchronization and amplitude oscillation of CPC were both enhanced by the SPB procedure, phase coupling does not increase monotonically along with the amplitude oscillation during the whole procedure. Meanwhile, BP was reduced significantly by the SPB procedure (SBP: from 122.0 ± 13.4 to 114.2 ± 14.9 mmHg, p < 0.001, DBP: from 82.2 ± 8.6 to 77.0 ± 9.8 mmHg, p < 0.001, PTT: from 172.8 ± 20.1 to 176.8 ± 19.2 ms, p < 0.001). Our results demonstrate that the SPB procedure can reduce BP and lengthen PTT significantly. Compared with amplitude dynamics, phase dynamics is a different marker for CPC analysis in reflecting cardiorespiratory coherence during slow breathing exercise. Our study provides a methodology to practice slow breathing exercise, including the setting of target breathing rate, change of CPC and the importance of regular breathing. The applications and usability of the study results have also been discussed. [ABSTRACT FROM AUTHOR]

The article titled "Variation in End Tidal CO2 as a Predictor of Fluid Responsiveness in Anesthetized and Ventilated Pigs" presents a prospective study conducted on anesthetized and ventilated pigs to evaluate the predictive capacity of changes in the value of End Tidal CO2 (EtCO2) to predict fluid responsiveness. Eleven pigs were used, and it was found that the change in EtCO2 (ΔEtCO2) showed a high predictive capacity to discriminate between fluid responders and non-responders. The results suggest that ΔEtCO2 can be used as an indicator to evaluate fluid responsiveness in anesthetized and ventilated pigs. [Extracted from the article]

Cardiac and respiratory rhythms are known to exhibit a modest degree of phase synchronization, which is affected by age, diseases, and other factors. We study the fine temporal structure of this synchrony in healthy young, healthy elderly, and elderly subjects with coronary artery disease. We employ novel time-series analysis to explore how phases of oscillations go in and out of the phase-locked state at each cycle of oscillations. For the first time we show that cardiorespiratory system is engaged in weakly synchronized dynamics with a very specific temporal pattern of synchrony: the oscillations go out of synchrony frequently, but return to the synchronous state very quickly (usually within just 1 cycle of oscillations). Properties of synchrony depended on the age and disease status. Healthy subjects exhibited more synchrony at the higher (1:4) frequency-locking ratio between respiratory and cardiac rhythms, whereas subjects with coronary artery disease exhibited relatively more 1:2 synchrony. However, multiple short desynchronization episodes prevailed regardless of the age and disease status. The same average synchrony level could be alternatively achieved with few long desynchronizations, but this was not observed in the data. This implies functional importance of short desynchronization dynamics. These dynamics suggest that a synchronous state is easy to create if needed but is also easy to break. Short desynchronization dynamics may facilitate the mutual coordination of cardiac and respiratory rhythms by creating intermittent synchronous episodes. It may be an efficient background dynamics to promote adaptation of cardiorespiratory coordination to various external and internal factors. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the dynamic behavior of the high-frequency component (HF > 0.15 Hz) of heart rate variability (HRV) and the respiratory frequency in relation to the anaerobic threshold (AT). Twenty-two healthy subjects [mean (SD) age: 24 (6) years, height: 175 (10) cm, body mass: 65 (11) kg] completed a ramp load, with increments of 20 W · min-1, on a cycle ergometer. The AT was determined by the V-slope-method. Respiratory movements of the thorax, and the electrocardiogram were monitored. The instantaneous frequency of the HF component of HRV and of the respiratory signal were obtained by the Hilbert transformation. Both frequencies were closely related, the cross correlation coefficient being between 0.84 and 0.99. Various patterns of HRV and respiration were observed during the protocol. Remarkably, however, in over 90% of these cases, a shift in the instantaneous frequency of the HF component occurred during the transition from aerobic to anaerobic work. The difference between the AT determined by gas analysis and the AT evaluated as the power output (ATf), calculated using the approximation of the curve of the instantaneous frequency of HF by hyperbolic tangent functions, varied between 2 and 14%. In conclusion, the present study demonstrates significant changes in the behavior of the instantaneous frequency of HF in the region of the AT. [ABSTRACT FROM AUTHOR]

Respiratory variations in blood flow are initiated by the changing pressures within the intrathoracic and abdominal cavities, thereby altering the pressure gradients for blood flow into and out of the thoracic cavity. The respiratory venous return variations alter the right ventricular volume which directly affects left ventricular function through ventricular interdependence. Variations in right ventricular output affect, after transmission through the pulmonary circulation, left atrial inflow and hence left ventricular (LV) output. LV output is also directly affected by respiratory variations in the pressure gradient between the left ventricle and the systemic circulation. Any respiration-induced variations in the haemodynamic impedance to blood flow (collapse of the great veins, variations in pulmonary vascular impedance) will also contrib ute to flow variations. The heart rate changes with respiration affecting heart chamber filling and output.The wide variety of factors contributing to respira tory blood flow variations complicates its analysis. However, by enabling the individual factors to be separately considered, model studies provide a convenient method of analysing the effects of the different factors involved. [ABSTRACT FROM PUBLISHER]

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Cardiorespiratory interaction (CRI) has been intensively studied in adult sleep, yet not in preterm infants, in particular across different sleep states including wake (W), active sleep (AS), and quiet sleep (QS). The aim of this study was to quantify the interaction between cardiac and respiratory activities in different sleep states of preterm infants. The postmenstrual age (PMA) of preterm infants was also taken into consideration. The CRI during sleep was analyzed using a visibility graph (VG) method, enabling the nonlinear analysis of CRI in a complex network. For each sleep state, parameters quantifying various aspects of the CRI characteristics from constructed VG network including mean degree ( D m ) and its variability ( D sd ), clustering coefficient (CC m ) and its variability (CC sd ), assortativity coefficient (AC), and complexity ( D SE ) were extracted from the CRI networks. The interaction effect of sleep state and PMA was found to be statistically significant on all CRI parameters except for AC and D SE . The main effect between sleep state and CRI parameters was statistically significant except for CC m , and that between PMA and CRI parameters was statistically significant except for D SE . In conclusion, the CRI of preterm infants is associated with sleep states and PMA in general. For preterm infants with a larger PMA, CRI has a more clustered pattern during different sleep states, where QS shows a more regular, stratified, and stronger CRI than other states. In the future, these parameters can be potentially used to separate sleep states in preterm infants. NEW & NOTEWORTHY The interaction between cardiac and respiratory activities is investigated in preterm infant sleep using an advanced nonlinear method (visibility graph) and some important characteristics are shown to be significantly different across sleep states, which has not been studied before.

Addicted drugs like nicotine affect autonomic nervous system that results in arrhythmia and other cardiovascular diseases. Notable effects of Zen meditation on autonomic nervous system have been reported during the past decade. Holistic Detox Association (HDA) in Taiwan offered Zen-meditation program to drug addicts as the core scheme among a variety of drug addiction treatments. This paper reports the results of quantifying the cardiorespiratory interactions and autonomic nervous system function to evaluate the on-site effect of Zen meditation on drug rehab. Methods and schemes for quantifying time-domain heart rate variability were employed to electrocardiograph and respiratory signals. Peak-valley method was developed to quantify the respiratory sinus arrhythmia (RSA) behavior. Poincaré Plot Analysis was adopted to evaluate the cardiorespiratory functioning. Among 18 voluntary drug addicts during the 10-minute Zen meditation session, about two-third subjects have significant improvement in autonomic nervous system function characterized by heart rate variability (SDNN, RMSSD and pNN50). Group average of RSA increases from 33.43 ms(Rest) to 69.14 ms(AR Zen meditation). Poincaré-plot analysis reveals the improvement of SD1, SD2 and SD2/SD1 by respectively 14.7%, 19.8% and 8.8%. The group averages of all the parameters exhibit significantly positive changes in the 10-minute session of abdominal-respiration Zen meditation. Even the subject with heart transplant showed the improvement of all the quantitative indicators during the AR Zen meditation.

Heart rate in vertebrates is controlled by activity in the autonomic nervous system. In spontaneously active or experimentally prepared animals, inhibitory parasympathetic control is predominant and is responsible for instantaneous changes in heart rate, such as occur at the first air breath following a period of apnoea in discontinuous breathers like inactive reptiles or species that surface to air breathe after a period of submersion. Parasympathetic control, exerted via fast-conducting, myelinated efferent fibres in the vagus nerve, is also responsible for beat-to-beat changes in heart rate such as the high frequency components observed in spectral analysis of heart rate variability. These include respiratory modulation of the heartbeat that can generate cardiorespiratory synchrony in fish and respiratory sinus arrhythmia in mammals. Both may increase the effectiveness of respiratory gas exchange. Although the central interactions generating respiratory modulation of the heartbeat seem to be highly conserved through vertebrate phylogeny, they are different in kind and location, and in most species are as yet little understood. The heart in vertebrate embryos possesses both muscarinic cholinergic and β-adrenergic receptors very early in development. Adrenergic control by circulating catecholamines seems important throughout development. However, innervation of the cardiac receptors is delayed and first evidence of a functional cholinergic tonus on the heart, exerted via the vagus nerve, is often seen shortly before or immediately after hatching or birth, suggesting that it may be coordinated with the onset of central respiratory rhythmicity and subsequent breathing.

Cardiac and respiratory rhythms are known to exhibit a modest degree of phase synchronization, which is affected by age, diseases, and other factors. We study the fine temporal structure of this synchrony in healthy young, healthy elderly, and elderly subjects with coronary artery disease. We employ novel time-series analysis to explore how phases of oscillations go in and out of the phase-locked state at each cycle of oscillations. For the first time we show that cardiorespiratory system is engaged in weakly synchronized dynamics with a very specific temporal pattern of synchrony: the oscillations go out of synchrony frequently, but return to the synchronous state very quickly (usually within just 1 cycle of oscillations). Properties of synchrony depended on the age and disease status. Healthy subjects exhibited more synchrony at the higher (1:4) frequency-locking ratio between respiratory and cardiac rhythms, whereas subjects with coronary artery disease exhibited relatively more 1:2 synchrony. However, multiple short desynchronization episodes prevailed regardless of the age and disease status. The same average synchrony level could be alternatively achieved with few long desynchronizations, but this was not observed in the data. This implies functional importance of short desynchronization dynamics. These dynamics suggest that a synchronous state is easy to create if needed but is also easy to break. Short desynchronization dynamics may facilitate the mutual coordination of cardiac and respiratory rhythms by creating intermittent synchronous episodes. It may be an efficient background dynamics to promote adaptation of cardiorespiratory coordination to various external and internal factors.