Towards heart rate variability tools in p-health

Heart rate variability (HRV) has received much attention lately, and several techniques for the analysis of HRV using time and frequency domains and non-linear methods have been developed. It has been shown that HRV can be used to monitor the autonomic nervous system (ANS) and to detect autonomic dysfunction, especially vagal dysfunction. Reduced HRV is associated with several diseases, e.g., diabetes, rheumatoid arthritis, depression, and chronic heart disease, and has also been suggested as a predictor of poor outcomes and sudden cardiac death. HRV is, however, not yet widely accepted as a clinical tool and is mostly used for research. Advances in neuroimmunity with an improved understanding of the link between the nervous and immune systems have opened a new potential arena for HRV applications. An example of a new potential arena is when systemic inflammation and autoimmune disease are primarily caused by low vagal activity; it can be detected and prognosticated by reduced HRV.

This thesis is the result of several technical development steps and exploratory research where HRV is applied as a prognostic diagnostic tool with preventive potential. The main objectives were 1) to develop an affordable tool for the effective analysis of HRV, 2) to study the correlation between HRV and pro-inflammatory markers and the potential degree of activity in the cholinergic anti-inflammatory pathway (CAP), and 3) to develop a biofeedback application intended for support of personal capability to increase the vagal activity as reflected in increased HRV. Written as a compilation thesis, the methodology and the results of each study are presented in each appended paper. In the thesis frame/summary chapter, a summary of each of the included papers is presented, grouped by topic and with their connections.

The summary of the results shows that the developed tools may accurately register and properly analyse and potentially influence HRV through the designed biofeedback game. HRV can be used as a prognostic tool, not just in traditional healthcare with a focus on illness but also in wellness. By using these tools for the early detection of decreased HRV, prompt intervention may be possible, enabling the prevention of disease. Gamification and serious gaming is a potential platform to motivate people to follow a routine of exercise that might, through biofeedback, improve HRV and thereby health.

List of scientific papers

I. Abtahi, F.; Snäll, J.; Aslamy, B.; Abtahi, S.; Seoane, F.; Lindecrantz, K. Biosignal PI, an affordable open-source ECG and respiration measurement system. Sensors. 2014 Dec 23;15(1):93-109.
https://doi.org/10.3390/s150100093

II. Hilderman, M.; Qureshi, A.R.; Al-Abed, Y.; Abtahi, F.; Lindecrantz, K.; Anderstam, B.; Bruchfeld, A. Cholinergic anti-inflammatory pathway activity in dialysis patients: A role for neuroimmunomodulation? Clin Kidney J. 2015 Oct;8(5):599-605.
https://doi.org/10.1093/ckj/sfv074

III. Abtahi, F.; Hilderman, M.; Bruchfeld, A.; Seoane, F.; Janerot-Sjoberg, B.; Lindecrantz, K. Proinflammatory Blood Markers and Heart Rate Variability in Apnoea as a Reflection of Basal Vagal Tone. [Manuscript]

IV. Abtahi, F.; Berndtsson, A.; Abtahi, S.; Seoane, F.; Lindecrantz, K. Development and preliminary evaluation of an android-based heart rate variability biofeedback system. Annu Int Conf IEEE Eng Med Biol Soc. 2014;2014:3382-3385.
https://doi.org/10.1109/EMBC.2014.6944348

V. Abtahi, F.; Ji, G.; Lu, K.; Rodby, K.; Seoane, F. A knitted garment using intarsia technique for heart rate variability biofeedback: Evaluation of initial prototype. Annu Int Conf IEEE Eng Med Biol Soc. 2015;2015:3121-3124.
https://doi.org/10.1109/EMBC.2015.7319053

VI. Wollmann, T.; Abtahi, F.; Eghdama, A.; Seoane, F.; Lindecrantz, K.; Haag, M.; Koch, S. UserCentred Design and Usability Evaluation of a Heart Rate Variability Biofeedback Game. IEEE Access. [Accepted]
https://doi.org/10.1109/ACCESS.2016.2601882