Abstract
Background: Heart rate variability (HRV) analysis is a clinical tool frequently used to characterize cardiac autonomic status. The aim of this study was to establish normative values for short-term HRV parameters by considering their main determinants in school-aged children.Methods: Five-minute electrocardiograms were taken from 312 non-athlete children (153 boys) at age of 6 to 13 years for computation of conventional time- and frequency-domain HRV parameters. Heart rate (HR), respiratory rate, age, body mass index, and sex were considered as their potential determinants. Multiple regression analysis revealed that HR was the principal predictor of all standard HRV indices. To develop their universal normative limits, standard HRV parameters were corrected for prevailing HR.Results: The HRV correction for HR yielded the parameters which became independent on both sex and HR, and only poorly dependent on age (with small effect size). Normal ranges were calculated for both time- and frequency-domain indices (the latter computed with either fast Fourier transform and autoregressive method). To facilitate recalculation of standard HRV parameters into corrected ones, a calculator was created and attached as a Supplementary Material that can be downloaded and used for both research and clinical purposes.Conclusion: This study provides HRV normative values for school-aged children which have been developed independently of their major determinants. The calculator accessible in the Supplementary Material can considerably simplify determination if HRV parameters accommodate within normal limits.
Highlights
Since the early 1970s, when power spectral analysis was applied to explore the physiological basis of intermittent variations in heart rate (HR) (Hyndman et al, 1971; Chess et al, 1975; Akselrod et al, 1981; Billman, 2011; Ernst, 2017b), a large number of studies addressing heart rate variability (HRV) have been published (Xhyheri et al, 2012)
Only a limited number of studies reported such normative/reference HRV values in pediatric populations (Goto et al, 1997; Massin and von Bernuth, 1997; Umetani et al, 1998; Silvetti et al, 2001; Rêkawek et al, 2003; Longin et al, 2009; Michels et al, 2013; Seppälä et al, 2014; Jarrin et al, 2015; Sharma et al, 2015; Bobkowski et al, 2017). Authors presented their normal values for children by categorizing them according to age and/or sex (Massin and von Bernuth, 1997; Silvetti et al, 2001; Rêkawek et al, 2003; Sharma et al, 2015), HRV parameters are significantly associated with other factors, like HR (Goto et al, 1997; Massin and von Bernuth, 1997; Jarrin et al, 2015), respiration (Grossman and Taylor, 2007; Beda et al, 2014; Quintana et al, 2016a,b; Shader et al, 2017; Shaffer and Ginsberg, 2017), physical activity (Oliveira et al, 2017), or weight status (Eyre et al, 2014)
RespRate, age, Body Mass Index (BMI) and sex were initially chosen as potential determinants of standard HRV parameters (Table 1 presents their correlations with HRV)
Summary
Since the early 1970s, when power spectral analysis was applied to explore the physiological basis of intermittent variations in heart rate (HR) (Hyndman et al, 1971; Chess et al, 1975; Akselrod et al, 1981; Billman, 2011; Ernst, 2017b), a large number of studies addressing heart rate variability (HRV) have been published (Xhyheri et al, 2012). Only a limited number of studies reported such normative/reference HRV values in pediatric populations (Goto et al, 1997; Massin and von Bernuth, 1997; Umetani et al, 1998; Silvetti et al, 2001; Rêkawek et al, 2003; Longin et al, 2009; Michels et al, 2013; Seppälä et al, 2014; Jarrin et al, 2015; Sharma et al, 2015; Bobkowski et al, 2017). The aim of this study was to establish normative values for short-term HRV parameters by considering their main determinants in schoolaged children
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