Ambulatory Monitoring Research Articles

Using machine learning with passive wearable sensors to pilot the detection of eating disorder behaviors in everyday life.

Eating disorders (ED) are serious psychiatric disorders, taking a life every 52 minutes, with high relapse. There are currently no support or effective intervention therapeutics for individuals with an ED in their everyday life. The aim of this study is to build idiographic machine learning (ML) models to evaluate the performance of physiological recordings to detect individual ED behaviors in naturalistic settings. From an ongoing study (Final N = 120), we piloted the ability for ML to detect an individual's ED behavioral episodes (e.g. purging) from physiological data in six individuals diagnosed with an ED, all of whom endorsed purging. Participants wore an ambulatory monitor for 30 days and tapped a button to denote ED behavioral episodes. We built idiographic (N = 1) logistic regression classifiers (LRC) ML trained models to identify onset of episodes (~600 windows) v. baseline (~571 windows) physiology (Heart Rate, Electrodermal Activity, and Temperature). Using physiological data, ML LRC accurately classified on average 91% of cases, with 92% specificity and 90% sensitivity. This evidence suggests the ability to build idiographic ML models that detect ED behaviors from physiological indices within everyday life with a high level of accuracy. The novel use of ML with wearable sensors to detect physiological patterns of ED behavior pre-onset can lead to just-in-time clinical interventions to disrupt problematic behaviors and promote ED recovery.

Is boredom at work bad for your health? Examining the links between job boredom and autonomic nervous system dysfunction.

Job boredom refers to an unpleasant state of passiveness at work that has been found to negatively relate to self-reported health. To date, however, the relation between job boredom and physiological indicators of health has not been examined. The present study investigates whether job boredom relates to dysfunction in autonomic nervous system (ANS) activity as indicated by reduced heart rate variability (HRV) during night sleep. The sample of this study consisted of Finnish public sector workers (n=125). Job boredom was assessed with an electronic questionnaire and HRV with an ambulatory monitoring period of two nights of sleep. The results supported the hypothesis by showing a negative relation between job boredom and HRV, after controlling for demographic and lifestyle factors. The findings extend previous knowledge on the detrimental consequences of job boredom by showing that it is related to dysfunction in ANS activity. Consequently, it is important to acknowledge boredom at work as a threat to occupational health and well-being and pay more attention to how it can be prevented at workplaces.

Prenatal diagnosis of coarctation: Impact on early and late cardiovascular outcome

BackgroundPrenatal diagnosis (PND) of aortic coarctation (AoCo) has been associated with a significant improvement in early results, but there is limited information on the long-term cardiovascular outcome. MethodsWe studied 103 patients with simple AoCo, operated in the neonatal period, with a median follow-up of 8,5 years (2 to 23,7 years), with 47% followed for over 10 years. PND was made in 35%. The primary aim was to determine the short and long-term cardiovascular impact of PND of AoCo. ResultsNeonates with PND had less preoperative neonatal complications, with only 2,8% incidence of a composite preoperative severe morbidity course, compared to 28% in the postnatal group. PND patients underwent surgery 8 days earlier and had a shorter length of stay in ICU. PND did not impact the incidence of post-operative complications.On the long-term, prevalence of hypertension, left ventricular hypertrophy and rate of recoarctation were not influenced by PND. The PND group had mean 24 h diastolic BP 9 mmHg lower and mean daytime diastolic BP 11 mmHg lower. In the final multivariable model, PND was the single independent variable correlating with daytime diastolic BP. ConclusionPND of AoCo effectively leads to a better pre-operative course with less pre-operative morbidity. We found no significant differences in immediate post-operative cardiovascular outcomes.A better initial course of patients with PND does not have a major long-term impact on cardiovascular outcomes, nevertheless, at late follow-up PND patients had lower diastolic BP values on ambulatory monitoring, which may have an impact on long-term cardiovascular risk.

Loss of Otopetrin 1 affects thermoregulation during fasting in mice.

Otopetrin 1 (OTOP1) is a proton channel that is highly expressed in brown adipose tissue. We examined the physiology of Otop1-/- mice, which lack functional OTOP1. Mice were studied by indirect calorimetry and telemetric ambulatory body temperature monitoring. Mitochondrial function was measured as oxygen consumption and extracellular acidification. Otop1-/- mice had similar body temperatures as control mice at baseline and in response to cold and hot ambient temperatures. However, in response to fasting the Otop1-/- mice exhibited an exaggerated hypothermia and hypometabolism. Similarly, in ex vivo tests of Otop1-/- brown adipose tissue mitochondrial function, there was no change in baseline oxygen consumption, but the oxygen consumption was reduced after maximal uncoupling with FCCP and increased upon stimulation with the β3-adrenergic agonist CL316243. Mast cells also express Otop1, and Otop1-/- mice had intact, possibly greater hypothermia in response to mast cell activation by the adenosine A3 receptor agonist MRS5698. No increase in insulin resistance was observed in the Otop1-/- mice. Loss of OTOP1 does not change basal function of brown adipose tissue but affects stimulated responses.

Low-Power Long-Term Ambulatory Electrocardiography Monitor of Three Leads with Beat-to-Beat Heart Rate Measurement in Real Time.

A low-power long-term ambulatory ECG monitor was developed for the acquisition, storage and processing of three simultaneous leads DI, aVF and V2 with a beat-to-beat heart rate measurement in real time. It provides long-term continuous ECG recordings until 84 h. The monitor uses a QRS complex detection algorithm based on the continuous wavelet transform with splines, which automatically selects the scale for the analysis of ECG records with different sampling frequencies. It includes a lead-off detection to continuously monitor the electrode connections and a real-time system of visual and acoustic alarms to alert users of abnormal conditions in its operation. The monitor presented is based in an ADS1294 analogue front end with four channels, 24-bit analog-to-digital converters and programmable gain amplifiers, a low-power dual-core ESP32 microcontroller, a microSD memory for data storage in a range of 4 GB to 32 GB and a 1.4 in thin-film transistor liquid crystal display (LCD) variant with a resolution of 128 × 128 pixels. It has programmable sampling rates of 250, 500 and 1000 Hz; a bandwidth of 0 Hz to 50% of the selected sampling rate; a CMRR of -105 dB; an input margin of ±2.4 V; a resolution of 286 nV; and a current consumption of 50 mA for an average battery life of 84 h. The ambulatory ECG monitor was evaluated with the commercial data-acquisition system BIOPAC MP36 and its module for ECG LABEL SS2LB, simultaneously comparing the morphologies of two ECG records and obtaining a correlation of 91.78%. For the QRS detection in real time, the implemented algorithm had an error less than 5%. The developed ambulatory ECG monitor can be used for the analysis of the dynamics of the heart rate variability in long-term ECG records and for the development of one's own databases of ECG recordings of normal subjects and patients with cardiovascular and noncardiovascular diseases.

Association between non-dipping blood pressure pattern and different glucometabolic profile during oral glucose tolerance test

It is known that, a not physiological blood pressure (BP) circadian pattern has been associated with increased risk of organ damage and cardiovascular (CV) event. The aim of this study was to assess the association between circadian BP pattern and glucometabolic phenotypes occurring after oral glucose tolerance test (OGTT). We recruited 810 hypertensive Caucasian patients. All participants underwent to OGTT, laboratory test and 24-h ambulatory BP monitoring (ABPM). The analysis of collected data allowed classifying patients based on nocturnal BP profiles into four categories: dippers, non-dippers, extreme dippers, and reverse dippers. Considering the dipping pattern, the proportion of non-dippers in normal glucose tolerance patients with 1-h glucose ≥ 155 mg/dL (NGT ≥ 155) (36.4%) was higher than NGT < 155 (29.6%) and impaired glucose tolerance (IGT) (34.8%), but lower than type 2 diabetes group (T2DM) (52.6%) (p = 0.001). The proportion of dippers was lower in NGT ≥ 155 (47%) and T2DM (34.6%), when compared with NGT < 155 (53.8%) and IGT (51.2%) (p = 0.017). From logistic regression analysis, 1-h glucose ≥ 155 increased the risk of a pathological nocturnal drop in BP by 74%, (OR = 1.740, 95% CI 1.254–2.415, p < 0.0001). In addition, the improvement in 1 unit of Matsuda was responsible for a 3.5% risk decrease (OR = 0.965, 95% CI 0.958–0.971, p < 0.0001), while e-GFR determined a 0.9% risk reduction of nocturnal BP drop (OR = 0.991, 95% CI 0.984–0.999, p = 0.020). Our data demonstrated the existence, in newly diagnosed hypertensive patients, of an association between circadian BP profile and altered glycemic response during OGTT, in particular NGT ≥ 155 subjects are associated with a non-dipper BP pattern, this is clinically relevant because may explain, at least in part, the increased CV risk in this setting of patients.

Sleep Variability, Sleep Irregularity, and Nighttime Blood Pressure Dipping.

Circadian rhythm regulates many important biological functions in humans. The goal of this study is to explore the impact of day-to-day deviations in the sleep-wake cycle on nighttime blood pressure (BP) dipping and further examine whether the ethnic difference in day-to-day deviations in sleep patterns can explain the ethnic difference in nighttime BP dipping. Twenty-four-hour ambulatory BP monitoring and 7-day accelerometer data were obtained from 365 adult participants (age range, 18.7-50.1 years; 52.6% Black participants and 47.3% European Americans; 64.1% females). Systolic BP dipping level was used to represent nighttime BP dipping. The SD of sleep duration was calculated as the index of sleep variability, and the SD of sleep midpoint was calculated as the index of sleep irregularity. A 1-hour increase in the SD of sleep midpoint was associated with a 1.16% decrease in nighttime BP dipping (P<0.001). A 1-hour increase in the SD of sleep duration was associated with a 1.39% decrease in nighttime BP dipping (P=0.017). The ethnic difference in the SD of sleep midpoint can explain 29.2% of the ethnicity difference in BP dipping (P=0.008). Sleep variability and sleep irregularity are associated with blunted BP dipping in the general population. In addition, data from the present investigation also demonstrate that the ethnic difference in sleep irregularity could partly explain the ethnic difference in BP dipping, an important finding that may help reduce the health disparity between Black participants and European Americans.

Smartwatch Technology's Diagnostic Use in Atrial Fibrillation Detection – A Literature Review

Introduction: An ECG is the gold standard for detecting various cardiology pathologies including AF. Current ambulatory heart rhythm monitoring technology include Holter monitoring and various implantable event monitors, which provide continuous monitoring but are invasive, uncomfortable and may lack in detecting intermittent arrhythmias, due to their periodic exploratory monitoring strategy. Methods: A systematic search was conducted using the following databases: Cochrane Library, Embase, PubMed, and Google Scholar. The search was conducted using the keywords "atrial fibrillation," "smartwatch," "ECG," "stroke," and "PPG”. Relevant sources between 2018 and 2023 were chosen, and data was analysed to establish clinical utility in early diagnosis of AF. Results: Two studies assessing the diagnostic efficacy of smartwatch technology, two studies investigating the usability of new technology and one study assessing cost-effectiveness were included in our review. The diagnostic efficacy of smartwatches ranges from 93.5-98.25% accurate, 92.45-97.3% sensitive and 88.6-100% specific, with PPV ranging from 91.6-100%, and NPV ranging from 93.85-96.83%. Targeted audiences of AF detection includes a larger proportion of older adults with possible declined technological and/or cognitive function, and may find difficulty using current smartwatch technology. With a simplified user interface, novel software like Pulsewatch promotes user accessibility in smartwatch technology, making AF detection simple to identify, particularly in elderly people. 90 patients used the Pulsewatch system, and more than half reported having a positive experience with the system; only 13% considered it excessively stressful. Discussion: Due to the low 65+ age group representation (6.6%) in studies like Fitbit, Huawei, and Apple heart studies, they overlook potential bias in older adults' adherence to pAF monitoring. Pulsewatch addresses this issue. Smartwatches, being user-friendly and cost-effective, offer real-time, reasonably accurate prospective data for patients. However, further research is required to gauge their clinical utility in early AF detection, diagnostic effectiveness during daily activities, and the heterogeneity of smartwatch devices remains to be fully explored. Conclusion: User-friendly PPG-based smartwatch technology is a medically accurate alternative to standard AF detection techniques that may speed up the diagnosis and treatment of AF, lowering stroke and cardiovascular disease-related morbidity and mortality as well as AF-related healthcare costs.

Monocyte-to-high-density lipoprotein ratio: an independent predictor of reverse dipper pattern in hypertensive patients.

In healthy individuals, blood pressure (BP) levels are expected to decrease by 10-20% during sleep hours, which is defined as the dipping pattern. On the other hand, the presence of a BP rise at night in hypertensive patients is defined as a reverse dipper hypertensive pattern (RDHT). RDHT has been associated with stroke and cardiovascular mortality. Similarly, the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has been associated with the prognosis of cardiovascular disease. We, therefore, aimed to assess the relationship between MHR and RDHT in patients with hypertension. A total of 363 patients were enrolled in the study, all of whom had undergone 24-hour ambulatory BP monitoring. The patients were analyzed in three groups: RDHT (n: 92), dipper hypertensive (DHT) (n: 124), and normotensive controls (n: 147). Univariable and multivariable analyses were performed to identify factors that could be used to predict RDHT presence. The RDHT group was compared with the DHT and normotensive groups. A high MHR (p = 0.014, OR: 1.110, CIs: 1.021-1.206) and low daytime diastolic BP (p = 0.026, OR: 0.951, CIs: 0.910-0.994) were found to be independent factors that differentiated RDHT from DHT. Additionally, high MHR (p < 0.001, OR: 1.244, CIs: 1.140-1.357), body mass index (p = 0.005, OR: 1.143, CIs: 1.042-1.255), and C-reactive protein (p = 0.009, OR: 1.166, CIs: 1.039-1.308) were found to be independent factors that could differentiate patients with RDHT from controls. We demonstrated that MHR, a novel inflammatory marker, independently predicts RDHT. This easily applicable and inexpensive marker can be used to predict RDHT in patients with hypertension.

S583 The Diagnostic Value of Reflux Seen on a Barium Swallow Compared to Ambulatory Reflux Monitoring in Symptomatic Patients

S583 The Diagnostic Value of Reflux Seen on a Barium Swallow Compared to Ambulatory Reflux Monitoring in Symptomatic Patients

S453 Upper GI Endoscopy With Ambulatory Reflux Monitoring and Trialing PPI Discontinuation Optimizes Cost Effectiveness to Manage Heartburn

S453 Upper GI Endoscopy With Ambulatory Reflux Monitoring and Trialing PPI Discontinuation Optimizes Cost Effectiveness to Manage Heartburn

Bladder contractility index changes with short-term antimuscarinic therapy in patients with detrusor overactivity: A placebo controlled randomised study

Aims:Bladder contractility is altered by high doses of anticholinergics. It is unknown if anticholinergics at doses used for treating overactive bladder alter bladder contractility. This is a randomised, double-blind, placebo controlled cross-over multicentre study with two 2-week treatment periods. Patients with a previous diagnosis of detrusor overactivity and reporting urinary frequency of at least seven times a day, one or more episodes of urge urinary incontinence per week and at least seven episodes of urgency per week were included. Methods:After a two-week washout period, subjects were randomised to receive propiverine 20 mg od, propiverine 15 mg tds, oxybutynin 5 mg tds or placebo for 2 weeks. After a second washout period, they were randomised to receive 2 weeks of another treatment not previously used. Ambulatory urodynamic monitoring was performed according to ICS standards for 4 h, using a standardised protocol before and after treatment. The bladder contractility index (BCI) was given by the formula: BCI = PdetQmax+ 5Qmax. The main outcome measure was the average BCI for the first 2 voids for each of the treatment. Results:77 participants were recruited. The average BCI for the first two voids was 143 (range 24–314). The BCI was not statistically different before and after antimuscarinic therapy or placebo although there were reductions in urinary frequency and urgency over placebo indicating efficacy over placebo in the treatment of detrusor overactivity. Conclusions:The bladder contractility index did not change significantly in response to antimuscarinic therapy despite a therapeutic effect. This suggests efficacy is mediated by an effect on another system such as sensory rather than motor function.

The Yield of Ambulatory Video-EEG: Predictors of Successful Event Capture.

The purpose of this study was to assess the likelihood of capturing a patient's typical event in question on ambulatory video-EEG monitoring (AVEM) based on certain baseline patient or event characteristics. We retrospectively reviewed 300 studies that resulted between June 2021 and August 2022 ordered by adult epileptologists. Patients were included in event analysis if the study was ordered for the purpose of capturing an event (and excluded for all other purposes). A total of 149 studies were included in event analysis. Sixty-eight patients (46%) had their typical events captured on AVEM. Diagnosis was an epileptic seizure in 17 patients (25%), psychogenic nonepileptic seizure in 7 (10%), and other nonepileptic events in 44 (65%). Regarding event frequency, for patients who on average had daily events, 84% had events captured, which corresponds to a significantly increased odds ratio (OR 17.90, 95% CI 7.55-42.44, p < 0.001). For those who had events <1 per week to ≥1 per month, only 9% had events captured (OR 0.06, 95% CI 0.02-0.19, p < 0.001). No patients who had events less frequently than once per month had a diagnostic AVEM. Regarding the number of antiseizure medications (ASMs), the odds ratio was increased for those not on ASMs (OR 2.65, 95% CI 1.17 -6.03, p = 0.02) and decreased for those on 1 ASM (OR 0.28, 95% CI 0.13 -0.60, p = 0.001). There was no statistical significance based on event type (motor vs nonmotor), prior seizure diagnosis, history of psychiatric comorbidity, or presence of a focal brain lesion. Certain baseline characteristics can increase or decrease the pretest probability of capturing a typical event on AVEM, particularly the frequency of events and number of ASMs. This can be useful information for clinicians before ordering a study so that resources can be properly allocated.

163 Examining the appropriateness of tilt-testing within a community integrated care hub for older persons services

Abstract Background Tilt-testing has been widely used in acute hospitals for more than 20 years in Ireland. Its use in community settings has been promoted in recent years with the development of the National Integrated Care Programme for Older Persons (NICPOP). In our integrated care hub our focus lies in the assessment of falls and frailty. We propose to examine if the current rational for performing tilt-testing has showed a diagnostic yield. Methods We retrospectively reviewed all tilt reports in the ambulatory care hub from November 2021 to May 2023. We examined the rationale for ordering the test, the number of patients who received a diagnosis of Orthostatic Hypotension (OH) and treatment that was commenced. Results 59 tilt reports were examined between the 18 month period. The average age of the patients were 83 (range 68–93). The male to female ratio was 1:1.3. All patients had an indicator for testing. The 5 indicators that emerged were falls, syncope, orthostatic intolerance, lying and standing blood pressure drop and dizziness. 11/59 (19%) patients had one indicator, 18/59 (31%) patients had two indicators, 15/59 (25%) patients had three indicators and 15/59 (25%) patients had four indicators for performing a tilt. OH was diagnosed in 36/59 (61%) patients of whom 9/36 (25%) had symptomatic OH during both HUT and AS, 8/36 (22%) had symptoms during HUT alone, 6/36 (17%) had symptoms during AS and 9/36 (25%) were asymptomatic throughout testing. 4/36 (11%) had no documentation regarding their symptoms during tilting. De-prescribing was performed in 16/36 (44%) patients and Midodrine was commenced in 18/36 (50%) patients with fludrocortisone being started on 2/36 (6%) patients. Conclusion We demonstrated a high yield from the tilt-test investigations and in combination with Ambulatory BP monitoring had a significant number of medications de-prescribed. The greater preponderance of more than one indicator for tilt-testing was greater than what we perceived.

157 Budget impact analysis of Holter monitors provision in an outpatient clinic

Abstract Background Outpatient clinic attendees (aged &amp;gt;64) commonly present with falls, dizziness, syncope and palpitations. The most common non-invasive investigation ordered includes continuous ambulatory electrocardiography monitoring, namely the Holter monitor. The clinic is outsourcing Holter monitor requests to the Cardiology Department, with a long waiting list. If the patient wishes the test to be done sooner in a private hospital, it costs between 160 to 295 euros, covered by the patient’s private healthcare insurance. Methods A budget analysis was carried out to further evaluate by provisioning 5 Holter monitors in the outpatient clinic to quicken patient turnover and reduce the cardiology department waiting list. The intervention scope was limited to the designated clinic of approximately 450 patients a month. The intervention is not for generating revenue for the clinic. The budget analysis doesn’t include sensitivity analysis from the best-case towards worst-case scenarios of Holter frequency usage and duration of Holter monitoring. The objectives of the proposed change are to lessen the turnaround time by 20% for the patients from being assessed until discharge from the clinic without having delayed investigation of the Holter monitor, to have a timely and accurate diagnosis of suspected arrhythmia and the appropriate management within the new intervention. Results The decision tree, utilising the Decision analytic modelling, resource identification, cost implication, estimated changes including 2-hour staff training, capital, year one to year five costs, potential cost savings year-on-year, cost-per-wear comparison against the private hospital provider, pre and post-intervention scenario analysis were constructed. Conclusion The budget impact analysis designed a simple cost calculator to add additional tests of Holter monitors that rely on the decision model approach. It shows a potential cost saving within a five-year horizon and increases the number of patients’ attendance by optimising patient turnover. Apart from the cost and organisation, there are other positive impacts towards financial and clinical areas, ensuring high-quality service for the population.

A perspective on the clinical relevance of weak or nonacid reflux.

Advances in ambulatory esophageal reflux monitoring that incorporated impedance electrodes to pH catheters have resulted in better characterization of retrograde bolus flow in the esophagus. With pH-impedance monitoring, in addition to acid reflux episodes identified by pH drops below 4.0, weakly acid reflux (WAR, pH 4-7) and nonacid reflux (NAR, pH >7.0) are also recognized, although both may be included under the umbrella term NAR. However, despite identification of ambulatory pH-impedance monitoring, data on clinical relevance and prognostic value of NAR are limited. The Lyon Consensus, an international expert review that defines conclusive metrics for gastroesophageal reflux disease (GERD), identifies NAR as "supportive" but not conclusive for GERD. This review provides perspectives on whether NAR fulfills three criteria for clinical relevance: whether NAR sufficiently explains pathogenesis of symptoms, whether it is associated with meaningful manifestations of GERD, and whether it can predict treatment efficacy.

Pregnancy Zone Protein as an Emerging Biomarker for Cardiovascular Risk in Pediatric Chronic Kidney Disease.

Cardiovascular disease (CVD) is a significant cause of mortality and morbidity among children with chronic kidney disease (CKD). The causes of pediatric CKD differ from those in adults, as congenital anomalies in the kidney and urinary tract (CAKUT) are the leading causes in childhood. Identifying ideal markers of CVD risk early is crucial for CKD children to improve their care. Previously, we screened differentially expressed proteins in CKD children with or without blood pressure (BP) abnormalities and identified pregnancy zone protein (PZP). In 106 children and adolescents with CKD stages G1-G4, we analyzed plasma PZP concentration. The associations between PZP and ambulatory BP monitoring (ABPM) profile, parameters of cardiac and carotid ultrasounds, indices of arterial stiffness, and nitric oxide (NO) parameters were determined. We observed that PZP positively correlated with arterial stiffness indices, beta index, and pulse wave velocity in CAKUT. CKD children with abnormalities in ABPM and night dipping displayed a higher PZP concentration than those without. Additionally, the PZP level was positively correlated with NO bioavailability. In conclusion, our results suggest PZP has differential influences on cardiovascular risk in CAKUT and non-CAKUT children. Identification of this relationship is novel in the pediatric CKD literature.

The Importance of Out-of-Office Blood Pressure Measurement, as Highlighted by the Correlation with Left Ventricular Hypertrophy in an Untreated Hypertensive Population.

Background and Objectives: Hypertensive heart disease, especially left ventricular hypertrophy (LVH), is considered to be one of the main types hypertension-mediated organ damage. Hence, the purpose of this study was to examine which method of measuring BP (office BP measurement (OBPM), 24 h ambulatory BP monitoring (ABPM), or home BP monitoring (HBPM)), can be better correlated with echocardiographic LVH in the untreated hypertensive population. Materials and Methods: This study's population consisted of 202 patients 58 ± 15 years old (40.8% males). All patients reported elevated home BP measurements for at least 3 months, but they had never been treated before for hypertension. Office and out-of-office BP measurements, including ABPM on a usual working day and seven-day HBPM, as well as 2D echocardiography, were performed. Results: In the univariate analysis, LVH was associated (p < 0.05) with a mean 24 h systolic BP (OR: 1.93, CI: 1.29-2.91), a mean 24 h diastolic BP (OR: 1.30, CI: 1.16-1.80), ambulatory daytime systolic (OR: 1.11, CI:1.01-1.82) and diastolic BP (OR: 1.13, CI:1.09-1.17), ambulatory nighttime systolic BP (OR: 2.11, CI: 1.04-4.31), and mean home systolic BP (OR: 1.05, CI:1.01-1.12). Pearson's correlation analysis showed a significant correlation between the LV mass index and the mean 24 h systolic BP (r = 0.58, p < 0.05), daytime systolic BP (r = 0.59, p < 0.05), and nighttime systolic BP (r = 0.57, p < 0.05). Most of the population with confirmed LVH presented confirmed hypertension (based on ABPM, 48.1% or HBPM, 40%). The second most dominant phenotype was masked hypertension (ABPM, 32.7% and HBPM, 23.7%). The majority (59.3%) had non-dipping status, 20.4% had a reverse dipping pattern, 13% had a dipping pattern, and only 7.3% had extreme dipping BP. Conclusions: Out-of-office BP measurement devices seemed to be superior compared to in-office. This advantage is highlighted by better correlations in the identification of LVH as well as the diagnosis of masked hypertension, a condition also highly correlated with LVH.

Nocturnal Bladder Function and Sleep in the Children with Refractory Nocturnal Enuresis: A Prospective Study

To prospectively investigate the nocturnal bladder function and sleep in children with refractory primary monosymptomatic nocturnal enuresis (RPMNE). Fifty-three children diagnosed with RPMNE and 30 controls who had upper urinary tract abnormality but without any voiding problems were included in the study. RPMNE patients underwent a standardized investigation protocol, including the Pittsburgh Sleep Quality Index (PSQI) questionnaire, a 7-day bladder diary, and the simultaneous ambulatory urodynamic monitoring and polysomnography (PSG); controls were evaluated using the PSQI questionnaire and PSG. The children with RPMNE were subdivided into the nocturnal detrusor overactivity (NDO) case group and the non-NDO case group. The children in the NDO case group had a higher percentage of total sleep time in light sleep and a lower percentage in the N3 sleep stage than those in the non-NDO case group and control group (P<.05). The cortical arousal index and PSQI scores of both RPMNE subgroups were higher compared to the control group (P<.05). The incidences of reduced nocturnal bladder capacity (NBC) in the NDO case group were higher than in the non-NDO case group (P<.05). The frequency of involuntary detrusor contractions during sleep was positively correlated with cortical arousal index in the NDO case group (r=0.811, P<.0001). In addition to the reduced NBC, the RPMNE is related to abnormal NDO, increased light sleep period, and cortical arousal dysfunction. Moreover, there is a certain correlation between the abnormal degrees of NDO and cortical arousal dysfunction.

Implementation of Wavelet-Transform-Based Algorithms in an FPGA for Heart Rate and RT Interval Automatic Measurements in Real Time: Application in a Long-Term Ambulatory Electrocardiogram Monitor.

Cardiovascular diseases are currently the leading cause of death worldwide. Thus, there is a need for non-invasive ambulatory (Holter) ECG monitors with automatic measurements of ECG intervals to evaluate electrocardiographic abnormalities of patients with cardiac diseases. This work presents the implementation of algorithms in an FPGA for beat-to-beat heart rate and RT interval measurements based on the continuous wavelet transform (CWT) with splines for a prototype of an ambulatory ECG monitor of three leads. The prototype's main elements are an analog-digital converter ADS1294, an FPGA of Xilinx XC7A35T-ICPG236C of the Artix-7 family of low consumption, immersed in a low-scale Cmod-A7 development card integration, an LCD display and a micro-SD memory of 16 Gb. A main state machine initializes and manages the simultaneous acquisition of three leads from the ADS1294 and filters the signals using a FIR filter. The algorithm based on the CWT with splines detects the QRS complex (R or S wave) and then the T-wave end using a search window. Finally, the heart rate (60/RR interval) and the RT interval (from R peak to T-wave end) are calculated for analysis of its dynamics. The micro-SD memory stores the three leads and the RR and RT intervals, and an LCD screen displays the beat-to-beat values of heart rate, RT interval and the electrode connection. The algorithm implemented on the FPGA achieved satisfactory results in detecting different morphologies of QRS complexes and T wave in real time for the analysis of heart rate and RT interval dynamics.