Reliability Of Heart Rate Variability Research Articles

Test-retest reliability of short- and long-term heart rate variability in individuals with spinal cord injury

Study designCross-sectional.ObjectivesTo investigate test-retest reliability of heart rate variability (HRV) metrics in SCI without restriction of activity over long (24-h) and shorter durations (5-min, 10-min, 1-h, 3-h and 6-h).SettingsUniversity hospital in Khon Kaen, Thailand.MethodsForty-five participants (11 with tetraplegia and 34 with paraplegia) underwent two 24-h recordings of RR-intervals to derive time and frequency HRV metrics. Relative reliability was assessed by intraclass correlation coefficient (ICC) and absolute reliability by coefficient of variation (CV) and Bland–Altman limits of agreement (LoA).ResultsFor 5- and 10-min durations, eight of eleven HRV metrics had moderate to excellent reliability (ICC 0.40–0.76); the remaining three were poor (ICC < 0.4). HRV values from 1-h and 3-h durations showed moderate to excellent reliability (ICC of 0.46–0.81), except for 1-h reliability of ULF and TP (ICC of 0.06 and 0.30, respectively). Relative reliability was excellent (ICC of 0.77–0.92) for 6-h and 24-h durations in all HRV metrics. Absolute reliability improved as recording duration increased (lower CVs and narrower LoAs). Participants with high AD risk (SCI level at or above T6) showed lower test-retest reliability of HF and LF values than participants with low AD risk.ConclusionRelative reliability of HRV was excellent for 6-h and 24-h. The best absolute reliability values were for 24-h duration. Time-domain outcomes were more reliable than frequency domain outcomes. Participants with high risk of AD, particularly those with tetraplegia, showed lower reliability, especially for HF and LF.

Intra- and Interrater Reliability of Short-Term Measurement of Heart Rate Variability on Rest in Individuals Post-COVID-19.

Individuals affected by COVID-19 have an alteration in autonomic balance, associated with impaired cardiac parasympathetic modulation and, consequently, a decrease in heart rate variability (HRV). This study examines the inter- and intrarater reliability of HRV) parameters derived from short-term recordings in individuals post-COVID. Sixty-nine participants of both genders post-COVID were included. The RR interval, the time elapsed between two successive R-waves of the QRS signal on the electrocardiogram (RRi), were recorded during a 10 min period in a supine position using a portable heart rate monitor (Polar® V800 model). The data were transferred into Kubios® HRV standard analysis software and analyzed within the stable sessions containing 256 sequential RRi. The intraclass correlation coefficient (ICC) ranged from 0.920 to 1.000 according to the intrarater analysis by Researcher 01 and 0.959 to 0.999 according to the intrarater by Researcher 02. The interrater ICC ranged from 0.912 to 0.998. The coefficient of variation was up to 9.23 for Researcher 01 intrarater analysis, 6.96 for Researcher 02 intrarater analysis and 8.83 for interrater analysis. The measurement of HRV in post-COVID-19 individuals is reliable and presents a small amount of error inherent to the method, supporting its use in the clinical environment and in scientific research.

0149 Reliability of Heart Rate Variability during Stable and Disrupted Polysomnographic Sleep

Abstract Introduction Heart rate variability (HRV) is a common metric to estimate autonomic activity during sleep. Frequency-domain HRV is quantified as low (LF) and high (HF) frequency, whereas HRV time-domain indices include root mean square of successive R-R interval differences (RMSSD), and percentage of successive R-R intervals differing by more than 50ms (pNN50). Despite high HRV use during sleep, it is unknown whether sleep disturbance changes overall reliability of frequency- and time-domain HRV. The purpose of this present study was to determine whether HRV was reliable across arousal-free and arousal-containing periods of sleep. Methods Twenty-seven participants (11 male, 16 female, 26±1 years, 27±1 kg/m2) were given an 8-hour sleep opportunity, equipped with continuous two-lead electrocardiography (ECG) and overnight polysomnography (PSG). The ECG recordings were analyzed via fast-Fourier transformation for frequency-domain HRV in a custom software as LF (0.04-0.15 Hz) and HF (0.15-0.4 Hz) HRV. Time-domain HRV was quantified as RMSSD and pNN50. Two separate stable sleep periods (range, 5-10min) absent of arousals were recorded, along with two separate disrupted periods of sleep with at least one arousal were selected in stage II sleep (N2), slow wave sleep (SWS), and rapid eye movement (REM) sleep. LF and HF HRV was log10 transformed due to non-normal distribution. Statistical analysis included intraclass correlations (ICC) of HRV across the four stable and disrupted periods of sleep, with separate ICC analyses across sleep stages (α = 0.05). Results Time-domain measures (RRI, RMSSD, pNN50) were reliable across arousal-free and arousal-containing sleep cycles, for all three stages (ICC&amp;gt;0.9, p&amp;lt;0.05). HF HRV exhibited similar reliability patterns across N2 sleep (ICC=0.960, p&amp;lt;0.001), SWS (ICC=0.955, p&amp;lt;0.001), and REM sleep (ICC=0.924, p&amp;lt;0.001). LF HRV was reliable in two stages of stable and disrupted sleep in N2 (ICC=0.903, p&amp;lt;0.001), REM (ICC=0.907, p&amp;lt;0.001) sleep, and trending in SWS (ICC=0.616, p=0.089) sleep. Conclusion Time- and frequency-domain HRV were reliable between stable sleep with and without cortical arousals, with the exception of LF HRV during SWS. Taken together, HRV may provide a reliable, indirect index of autonomic activity across stable and disrupted sleep. Support (If Any) Support: Support is provided by the National Institutes of Health (AA-024892; U54GM115371; P20GM103474).

Reliability of heart rate variability during stable and disrupted polysomnographic sleep.

Heart rate variability (HRV) is commonly used within sleep and cardiovascular research, yet HRV reliability across various sleep stages remains equivocal. The present study examined the reliability of frequency- and time-domain HRV within stage-2 (N2), slow-wave (SWS), and rapid-eye-movement (REM) sleep during both stable and disrupted sleep. We hypothesized that high-frequency (HF) HRV would be reliable in all three sleep stages, low-frequency (LF) HRV would be reliable during N2 and SWS, and that disrupted sleep via spontaneous cortical arousals would decrease HRV reliability. Twenty-seven participants (11 men, 16 women, 26 ± 1 yr) were equipped with laboratory polysomnography for 1 night. Both frequency- and time-domain HRV were analyzed in two 5- to 10-min blocks during multiple stable and disrupted sleep cycles across N2, SWS, and REM sleep. HF HRV was highly correlated across stable N2 (r = 0.839, P < 0.001), SWS (r = 0.765, P < 0.001), and REM (r = 0.881, P < 0.001). LF HRV was moderate-to-highly correlated during stable cycles of N2 sleep (r = 0.694, P < 0.001), SWS, (r = 0.765, P < 0.001), and REM (r = 0.699, P < 0.001) sleep. When stable sleep was compared with disrupted sleep, both time- and frequency-domain HRV were reliable (α > 0.90, P < 0.05) in N2, SWS, and REM, except for LF HRV during SWS (α = 0.62, P = 0.089). In conclusion, time- and frequency-domain HRV demonstrated reliability across stable N2, SWS, and REM sleep, and remained reliable during disrupted sleep. These findings support the use of HRV during sleep as a tool for assessing cardiovascular health and risk stratification.NEW & NOTEWORTHY Heart rate variability (HRV) is a commonly employed indirect estimate of cardiac autonomic activity during sleep with limited reliability studies. Nocturnal frequency-domain HRV was reliable across differing stable sleep cycles of stage-2 (N2), slow-wave (SWS), and rapid-eye-movement (REM) sleep. Moreover, frequency- and time-domain HRV were reliable during stable and disturbed sleep, except SWS low-frequency HRV. Our finding supports nocturnal HRV as a potential tool for cardiovascular risk stratification.

Reliability of Heart Rate Variability during Polysomnographic Sleep

Spectral analysis of heart rate variability (HRV) is often used as a noninvasive index of cardiac sympathetic and/or parasympathetic activity during sleep. During controlled wake recordings, the low frequency (LF) component of HRV can be unreliable within experimental sessions and against other direct sympathetic measurements. In contrast, the high frequency (HF) component of HRV has higher reported reproducibility within controlled wake sessions. It remains unknown if the frequency component of HRV is reliable across sleep cycles within individuals during stable sleep. The purpose of the present study was to determine HRV reliability during stable stage II (N2) sleep, slow wave sleep (SWS) and rapid eye movement (REM) sleep. We hypothesized that both LF and HF components of HRV would be less reliable during REM sleep than during SWS and N2 sleep. Twenty‐seven participants (11 male, 16 female, 26±1 years, 27±1 kg/m2) were enrolled in the present study. Overnight polysomnography (PSG; NATUS, Middleton, WI) and continuous two‐lead electrocardiography (ECG) were recorded during an 8‐hour sleep opportunity. The nocturnal ECG recordings were imported into a custom software (WinCPRS, Absolute Aliens, Finland) for analysis of HRV via fast‐Fourier transformation function. Autonomic cardiac activity was quantified as LF (0.04‐0.15 Hz) and HF (0.15‐0.4 Hz) HRV. Two separate stable periods of sleep (range, 5‐10 min) absent of cortical arousal were selected from each sleep stage for comparison. Raw LF and HF HRV underwent logarithmic transformation due to non‐normal distribution. Statistical analysis included bivariate correlation of HRV across differing sleep stage cycles (α = 0.05). LF HRV was significantly correlated across two independent sleep cycles in N2 (r=0.694, p&lt;0.001, n=26), SWS (r=0.765, p&lt;0.001, n=25), and REM sleep (r=0.699, p&lt;0.001, n=20). Similarly, HF HRV was reliable across two independent sleep cycles in N2 sleep (r=0.839, p&lt;0.001, n=26), SWS (r=0.765, p&lt;0.001, n=25), and REM sleep (r=0.881 p&lt;0.001, n=21). Taken together, both LF and HF HRV measures were reliable across stable N2, SWS, and REM sleep. Our results support the reliability of frequency domain analysis of HRV during key PSG sleep stages within a single night, but further research across nights is warranted.

Fetal respiratory movements improve reliability of heart rate variability and suggest a coupling between fetal respiratory arrhythmia and vagal activity.

Fetal heart rate variability (FHRV) reflects autonomic cardiac regulation. The autonomic nervous system constantly adjusts the heart rate to maintain homeostasis. By providing insight into the fetal autonomic state, FHRV has the potential to become an investigational and clinical instrument. However, the method needs standardization and the influence of fetal movements, including fetal respiratory movements, is not well explored. Therefore, in a highly standardized setting, the aim was to evaluate the association between fetal movements and fetal heart rate variability (FHRV) including their impact on reliability. Fetal heart rate was obtained by noninvasive fetal electrocardiography (NI‐FECG) and fetal movements by simultaneous ultrasound scanning in 30 healthy singleton pregnant women on two occasions with a maximum interval of 7 days. The standard deviation of normal‐to‐normal RR‐intervals (SDNN), root mean square of successive RR‐interval differences (RMDDS), high‐frequency power (HF‐power), low‐frequency power (LF‐power), and LF/HF were measured. A multivariate mixed model was used and reliability was defined as acceptable by a coefficient of variance (CV) ≤15% and an intraclass correlation coefficient (ICC) ≥0.80. During time periods with fetal respiratory movements, the highest reliability was achieved. Intra‐ and inter‐observer reliability measurements were very high (CV: 0–9%; ICC ≧ 0.86). Within the same recording, SDNN and RMSSD achieved acceptable reliability (CV: 14–15%; ICC ≧ 0.80). However, day‐to‐day reliability displayed high CV’s. In time periods with fetal respiratory movements, as compared to periods with quiescence RMSSD and HF‐power were higher (Ratio: 1.33–2.03) and LF/HF power lower (Ratio: 0.54). In periods with fetal body movements SDNN, RMSSD and HF‐power were higher (Ratio: 1.27–1.65). In conclusion, time periods with fetal respiratory movements were associated with high reliability of FHRV analyses and the highest values of parameters supposed to represent vagal activity.

Heart Rate Variability for Classification of Alert Versus Sleep Deprived Drivers in Real Road Driving Conditions

Driver sleepiness is a contributing factor in many road fatalities. A long-standing goal in driver state research has therefore been to develop a robust sleepiness detection system. It has been suggested that various heart rate variability (HRV) metrics can be used for driver sleepiness classification. However, since heart rate is modulated not only by sleepiness but also by several other time-varying intra-individual factors such as posture, distress, boredom and relaxation, it is relevant to highlight not only the possibilities but also the difficulties involved in HRV-based driver sleepiness classification. This paper investigates the reliability of HRV as a standalone feature for driver sleepiness detection in a realistic setting. Data from three real-road driving studies were used, including 86 drivers in both alert and sleep-deprived conditions. Subjective ratings based on the Karolinska sleepiness scale (KSS) were used as ground truth when training four binary classifiers ( k-nearest neighbours, support vector machine, AdaBoost, and random forest). The best performance was achieved with the random forest classifier with an accuracy of 85%. However, the accuracy dropped to 64% for three-class classification and to 44% for subject-independent, leave-one-participant-out classification. The worst results were obtained in the severely sleepy class. The results show that in realistic driving conditions, subject-independent sleepiness classification based on HRV is poor. The conclusion is that more work is needed to control for the many confounding factors that also influence HRV before it can be used as input to a driver sleepiness detection system.

Effect of recording length and posture on the reliability of heart rate variability in horses

Effect of recording length and posture on the reliability of heart rate variability in horses

Inter- and Intra-Day Comparisons of Smartphone-Derived Heart Rate Variability across Resistance Training Overload and Taper Microcycles.

The purposes of this study were: (1) to determine if smartphone-derived heart rate variability (HRV) could detect changes in training load during an overload microcycle and taper, and (2) to determine the reliability of HRV measured in the morning and measured immediately prior to the testing session. Twelve powerlifters (male = 10, female = 2) completed a 3-week resistance training program consisting of an introduction microcycle, overload microcycle, and taper. Using a validated smartphone application, daily measures of resting, ultra-short natural logarithm of root mean square of successive differences were recorded in the morning (LnRMSSDM) and immediately before the test session (LnRMSSDT) following baseline, post-overload, and post-taper testing. LnRMSSDM decreased from baseline (82.9 ± 13.0) to post-overload (75.0 ± 9.9, p = 0.019), while post-taper LnRMSSDM (81.9 ± 7.1) was not different from post-overload (p = 0.056) or baseline (p = 0.998). No differences in LnRMSSDT (p < 0.05) were observed between baseline (78.3 ± 9.0), post-overload (74.4 ± 10.2), and post-taper (78.3 ± 8.0). LnRMSSDM and LnRMSSDT were strongly correlated at baseline (ICC = 0.71, p < 0.001) and post-overload (ICC = 0.65, p = 0.010), whereas there was no relationship at post-taper (ICC = 0.44, p = 0.054). Bland–Altman analyses suggest extremely wide limits of agreement (Bias ± 1.96 SD) between LnRMSSDM and LnRMSSDT at baseline (4.7 ± 15.2), post-overload (0.5 ± 16.9), and post-taper (3.7 ± 15.3). Smartphone-derived HRV, recorded upon waking, was sensitive to resistance training loads across an overload and taper microcycles in competitive strength athletes, whereas the HRV was taken immediately prior to the testing session was not.

Reliability of heart rate variability in futsal players

The main aim the present study was evaluated the reliability of the heart rate variability (HRV) indices in futsal players. Additionally the study verifi ed the reliability of different approaches for 5 min interval selection of recording. Eighteen under-20 futsal players underwent 15 min of pre-training RR interval recordings in two different day. Time and frequency domain and Poincaré Plot indices were tested. The indices were calculated using: 1) fi nal 5 min of recording; 2) 5 min of lower variance of recording, by a mathematical algorithm; 3) 5 min segment of lower variance, by an experienced operator. The HRV indices presented a wide range reliability [e.g. RRmean (ICC=0.96, SEM=3.4ms, CV=2.6%), lnRMSSD (ICC=0.88, SEM=5.9ms, CV=4.3%), lnHF (ICC=0.89, SEM=7.5ms, CV=5.9%), LFnu (ICC=0.84, SEM=13ms, CV=9.4%), LF (ICC=0.47, SEM=65.2ms,CV=38.5%) and LF/HF (ICC=0.63, SEM=83.7ms, CV=54.5%)]. The fi nal 5 min of recording was the most reliable. The results suggest that most of HRV indices presented acceptable reliability, however the RRmean, lnRMSSD, lnHF and LFnu were the most reliable.

Reliability of heart rate variability in futsal players

The main aim the present study was evaluated the reliability of the heart rate variability (HRV) indices in futsal players. Additionally the study verifi ed the reliability of different approaches for 5 min interval selection of recording. Eighteen under-20 futsal players underwent 15 min of pre-training RR interval recordings in two different day. Time and frequency domain and Poincaré Plot indices were tested. The indices were calculated using: 1) fi nal 5 min of recording; 2) 5 min of lower variance of recording, by a mathematical algorithm; 3) 5 min segment of lower variance, by an experienced operator. The HRV indices presented a wide range reliability [e.g. RRmean (ICC=0.96, SEM=3.4ms, CV=2.6%), lnRMSSD (ICC=0.88, SEM=5.9ms, CV=4.3%), lnHF (ICC=0.89, SEM=7.5ms, CV=5.9%), LFnu (ICC=0.84, SEM=13ms, CV=9.4%), LF (ICC=0.47, SEM=65.2ms,CV=38.5%) and LF/HF (ICC=0.63, SEM=83.7ms, CV=54.5%)]. The fi nal 5 min of recording was the most reliable. The results suggest that most of HRV indices presented acceptable reliability, however the RRmean, lnRMSSD, lnHF and LFnu were the most reliable.

The Test-Retest Reliability of Heart Rate Variability and Its Association With Personality Functioning.

Background: Heart rate variability (HRV) is a widely used non-invasive index of emotion regulation ability. The main aim of our study was to investigate the relationship between HRV and level of personality functioning in a clinical sample, most of whom had a personality disorder. Our secondary aim was to examine the test-retest reliability of HRV in our sample as there is a lack of knowledge regarding the test-retest reliability in psychiatric populations. We hypothesized that trait HRV would be negatively associated with impairments of personality functioning.Method: Thirty-two adults (23 females, mean age = 27) with threshold or subthreshold personality disorders were recruited from two psychiatric outpatient clinics in Norway. Impairment of personality functioning was assessed by the first module of the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders (SCID-5-AMPD-I); Level of Personality Functioning Scale (LPFS). HRV was assessed during resting conditions with spontaneous breathing over three separate days. Trait HRV was calculated by averaging all three HRV assessments. The test-retest reliability of HRV was assessed using intraclass correlations.Results: Contrary to expected, a positive association between trait HRV and the LPFS Self-direction domain emerged. This was driven by positive associations between the LPFS and HRV at time point 2. Overall, the test-retest reliability of HRV was comparable to previous studies on healthy subjects. However, the reliability coefficients for the first two time points were considerably lower relative to the second and third time points.Conclusions: We propose that impairment of personality functioning may have increased the proportion of variance in HRV attributed to state relative to trait. This could explain the lower test-retest reliability for the first two time points. The increased test-retest reliability for the last two time points could reflect a habituation to the testing situation and hence, less pronounced influences of state in the second and third time points.

Optimizing Intersession Reliability of Heart Rate Variability-The Effects of Artifact Correction and Breathing Type.

Gisselman, AS, D'Amico, M, and Smoliga, JM. Optimizing intersession reliability of heart rate variability-the effects of artifact correction and breathing type. J Strength Cond Res 34(11): 3199-3207, 2020-This study aimed to comprehensively investigate the reliability of multiple heart rate variability (HRV) parameters and to explore the influence of artifact removal and breathing condition on HRV reliability. Resting HRV was collected using Polar Team monitors on 41 participants (age: 19.9 ± 1.2 years; 28 females and 13 males) during 2 separate days. Within each session, participants performed 10 minutes each of spontaneous and controlled breathing (randomized order). Kubios HRV analysis software was used to analyze 180-second data epochs using "low" or "strong" artifact removal. Relative reliability was assessed using intraclass correlation coefficient (ICC2,1), and absolute reliability was quantified using mean-normalized SEM%. Time-domain and nonlinear parameters produced poor to good intersession agreement (ICC = 0.34-0.68; SEM% = 11.0-39.0) with "low" artifact removal, regardless of breathing condition. Frequency-domain parameters demonstrated fair intersession agreement during controlled breathing (ICC = 0.40-0.45; SEM% = 26.0-70.0) but poor agreement during spontaneous breathing (ICC = 0.07-0.13; SEM% = 32.0-81.0). Minimal differences in ICCs were observed between "low" and "strong" artifact removal. Thus, this study provides 3 practical applications: (a) HRV monitoring is most reliable when using time-domain and nonlinear parameters, regardless of breathing or filtering condition, but no single parameter is especially reliable. The large variation and poor intersession reliability of frequency indices during spontaneous breathing are improved by controlling breathing rate; (b) "Low" artifact removal seems superior to more aggressive artifact removal; and (c) intersession differences in HRV measurements <30% may be indicative of normal daily variation rather than true physiologic changes.

A Pilot Study of the Reliability and Agreement of Heart Rate, Respiratory Rate and Short-Term Heart Rate Variability in Elite Modern Pentathlon Athletes.

Research on reliability of heart rate variability (HRV) parameters in athletes has received increasing attention. The aims of this study were to examine the inter-day reliability of short-term (5 min) and ultra-short-term (1 min) heart rate (HR), respiratory rate (RespRate) and HRV parameters, agreement between short-term and ultra-short-term parameters, and association between differences in HR, RespRate and HRV parameters in elite modern pentathletes. Electrocardiographic recordings were performed in stable measurement conditions with a week interval between tests. Relative reliability was evaluated by intra-class correlation coefficients, absolute reliability was evaluated by within-subject coefficient of variation, and agreement was evaluated using Bland–Altman (BA) plot with limits of agreement and defined a priori maximum acceptable difference. Short-term HR, RespRate, log transformed (ln) root mean square of successive normal-to-normal interval differences (lnRMSSD), ln high frequency (lnHF) and SD2/SD1 HRV indices and ultra-short-term HR, RespRate and lnRMSSD presented acceptable, satisfactory inter-day reliability. Although there were no significant differences between short-term and ultra-short-term HR, RespRate and lnRMSSD, no parameter showed acceptable differences with BA plots. Differences in time-domain and non-linear HRV parameters were more correlated with differences in HR than with differences in RespRate. Inverse results were observed for frequency-domain parameters. Short-term HR, RespRate, lnRMSSD, lnHF, and SD2/SD1 and ultra-short-term HR, RespRate and lnRMSSD could be used as reliable parameters in endurance athletes. However, practitioners should interpret changes in HRV parameters with regard to concomitant differences in HR and RespRate and caution should be taken before considering 5 min and 1 min parameters as interchangeable.

Impact of heart rate on reproducibility of heart rate variability analysis in the supine and standing positions in healthy men

OBJECTIVE:The reliability of heart rate variability (HRV) analysis is not yet fully understood, especially considering different body positions and the mathematical influence of heart rate. The aim of this study was to evaluate the reliability of HRV in supine and standing positions, with and without mathematical adjustment of HRV by the average R-R interval (iRR).METHODS:We evaluated 37 young males (23.1±4 years; 25.1±3 kg/m2). A 5-min segment of the iRR was collected in the supine and standing positions on three occasions separated by 48-hour intervals. Absolute and relative reliability of temporal and spectral indices were assessed by the coefficient of variation (CV) and the intraclass correlation coefficient (ICC), respectively.RESULTS:We did not observe differences in HRV indices in the three occasions in the supine or standing position (p>0.05). Moderate to good reproducibility was observed for temporal and spectral indices of HRV in the supine position (ICC: 0.65-0.89; CV: 0.9-19.8). In the orthostatic position, low to good reproducibility was observed (ICC: 0.35-0.89; CV: 1.1-34.8), with higher ICCs for temporal indices. After mathematical adjustment, only a small modification in HRV reliability was observed in both positions.CONCLUSIONS:In young adult males, the mathematical adjustment of HRV by the average iRR led to a nonsignificant effect on HRV reliability. Additionally, HRV reliability is dependent on body position and the index analyzed. Promising measures in both supine and standing positions include r-MSSD and the HF band (parasympathetic indices).

Are ultra-short heart rate variability features good surrogates of short-term ones? State-of-the-art review and recommendations.

Ultra-short heart rate variability (HRV) analysis refers to the study of HRV features in excerpts of length <5 min. Ultra-short HRV is widely growing in many healthcare applications for monitoring individual's health and well-being status, especially in combination with wearable sensors, mobile phones, and smart-watches. Long-term (nominally 24 h) and short-term (nominally 5 min) HRV features have been widely investigated, physiologically justified and clear guidelines for analysing HRV in 5 min or 24 h are available. Conversely, the reliability of ultra-short HRV features remains unclear and many investigations have adopted ultra-short HRV analysis without questioning its validity. This is partially due to the lack of accepted algorithms guiding investigators to systematically assess ultra-short HRV reliability. This Letter critically reviewed the existing literature, aiming to identify the most suitable algorithms, and harmonise them to suggest a standard protocol that scholars may use as a reference in future studies. The results of the literature review were surprising, because, among the 29 reviewed papers, only one paper used a rigorous method, whereas the others employed methods that were partially or completely unreliable due to the incorrect use of statistical tests. This Letter provides recommendations on how to assess ultra-short HRV features reliably and proposes an inclusive algorithm that summarises the state-of-the-art knowledge in this area.

Diagnostic Accuracy of Random ECG in Primary Care for Early, Asymptomatic Cardiac Autonomic Neuropathy.

Cardiac autonomic reflex tests (CARTs) are time consuming and require patient cooperation for detecting cardiac autonomic neuropathy (CAN). Heart rate variability (HRV) analysis requires less patient cooperation and is quicker to complete. However the reliability of HRV results as a clinical tool, with respect to length of recording and accuracy of diagnosis is inconclusive. The current study investigated the reproducibility associated with varying length of recording for early CAN (eCAN) assessment. Participants were 68 males, 72 females with average age of 55 for controls and 63 for early CAN. Inclusion criteria were that participants were medication free and presented with no comorbidities. ECGs of control and eCAN were recorded and heart rate changes analyzed with the fast Fourier transform (FFT) and Lomb-Scargle periodogram (LSP). Ten-second to 5-minute recordings were extracted from a 15-minute lead-II ECG and accuracy in assessment of eCAN determined. The eCAN group was older ( P < .001) and systolic blood pressure was higher ( P < .01). HDL-cholesterol was also higher in the eCAN group ( P < .05). HRV analysis showed that both FFT and LSP results were significantly different between eCAN and control down to a 10-second ECG length for low frequency (LSP: P = .013, FFT: P = .024) and high frequency (HF-LSP: P = .002, FFT: P = .002) power. eCAN assessment was optimal down to 90-second recordings with a sensitivity of 100% and specificity of 29.49%. HRV is suitable for clinical practice from ECG recordings of more than 90 seconds with high accuracy and repeatability within a session for each participant.

Reliability of Heart Rate Variability as an Assessment of Cardiac Sympathetic Activity in Humans

Spectral analysis of heart rate variability (HRV) has been widely used as an indirect, non‐invasive method for assessing cardiac autonomic function in numerous psychophysiological and clinical research studies. However, there is debate whether or not the low‐frequency (LF) component of the analysis provides accurate insight into cardiac sympathetic activity in humans. The purpose of this study was to evaluate the reliability of the LF component of HRV compared to that of peripheral muscle sympathetic nerve activity (MSNA), which remains the only direct method to assess sympathetic neural outflow in humans and has been consistently shown to have high intra‐individual reproducibility. Sixteen adults (9 men and 7 women, 21 ± 1 years, body mass index of 23 ± 1 kg/m2) were examined, and completed three experimental sessions across two laboratory visits. Experimental sessions one and two were conducted during the first laboratory visit and separated by 45 minutes of supine rest, while the third session was completed approximately one month after the first laboratory visit. Each session included a five‐minute supine baseline that included recordings of MSNA via microneurography and R‐R intervals using a three‐lead electrocardiogram. Intraclass correlation analyses (Cronbach's α coefficient) were performed to determine the consistency of HRV and MSNA across the three sessions. The spectral analysis revealed that the high‐frequency (HF) component, which is primarily associated with cardiac parasympathetic activity, was highly reliable (Cronbach's α = 0.90, P &lt; 0.001). In contrast, the LF component, which is often utilized as a noninvasive estimate of cardiac sympathetic activity, was not significantly consistent across the three sessions (Cronbach's α = 0.45, P = 0.078). As previously reported (Fonkoue &amp; Carter, Am J Physiol Regul Integr Comp Physiol, 2015), MSNA was highly consistent across the three sessions (Cronbach's α = 0.84, P &lt; 0.001). In summary, our findings demonstrate that unlike MSNA, which has been consistently shown to be a stable and reliable measurement of peripheral sympathetic activity, the LF component of HRV is not a stable and reliable measurement of cardiac sympathetic activity in humans.

Repeatability and Reliability of Heart Rate Variability in Healthy, Adult Pony Mares

Heart rate variability (HRV) is an important noninvasive method to quantify stress by measuring sympathetic and parasympathetic activity of the autonomic nervous system. Few studies exist on the repeatability and reliability of HRV in equids. The objectives of this study were to (1) compare the effect of different correction factors (CF) available in HRV analysis software on HRV indicator values and (2) to determine the repeatability and reliability of HRV indicators in an unrestricted (pasture) and a restricted movement (equine examination stocks) environment. Data were recorded on five consecutive days from six adult pony mares. Short-term tachograms were compared with regard to software CF by graphical and statistical (Friedman's and Wilcoxon signed rank test) comparison. The results showed that the specific CF influences the HRV indicator values. The strong CF was able to balance the elimination of artefacts without removing the variability of RR intervals and was subsequently used to determine repeatability and reliability. HRV indicators showed good repeatability over the 5 days using Friedman test (pasture, P = .162–.898; examination stocks, P = .29–.865), indicating that there were no significant differences between HRV indicator values. The reliability, represented by intraclass correlation coefficient (ICC) and coefficient of variation (CV), was poor-to-good for pasture data (ICC = 0.44–0.79; CV = 10–68.10) and examination stocks data (ICC = 0.22–0.83; CV = 16.07–62.29). Measurements obtained from the examination stocks were less reliable than those from pasture. Using normalized low-frequency and normalized high-frequency components improved reliability. Free-movement environment-based HRV recordings could ensure better reliability but may require the use of a stronger CF.

Within-Session Stability of Short-Term Heart Rate Variability Measurement.

The primary aim of this study was to assess the retest stability of the short-term heart rate variability (HRV) measurement performed within one session and without the use of any intervention. Additionally, a precise investigation of the possible impact of intrinsic biological variation on HRV reliability was also performed. First, a single test-retest HRV measurement was conducted with 20-30 min apart from one another. Second, the HRV measurement was repeated in ten non-interrupted consecutive intervals. The lowest typical error (CV = 21.1%) was found for the square root of the mean squared differences of successive RR intervals (rMSSD) and the highest for the low frequency power (PLF) (CV = 93.9%). The standardized changes in the mean were trivial to small. The correlation analysis revealed the highest level for ln rMSSD (ICC = 0.87), while ln PLF represented the worst case (ICC = 0.59). The reliability indices for ln rMSSD in 10 consecutive intervals improved (CV = 9.9%; trivial standardized changes in the mean; ICC = 0.96). In conclusion, major differences were found in the reliability level between the HRV indices. The rMSSD demonstrated the highest reliability level. No substantial influence of intrinsic biological variation on the HRV reliability was observed.