Change of Pulse Transit Time During Stepwise Paced Breathing_Journal of Biomedical Engineering

Authors：

CHAIXiaoke ¹ , WANGBuqing ² ,  ZHANGZhengbo ² , WANGGuojing ² , WANGWeidong ²

1. Chinese PLA Postgraduate Medical School, Chinese PLA General Hospital, Beijing 100853, China;
2. The Medical Engineering Support Center, Chinese PLA General Hospital, Beijing 100853, China;

Corresponding?author：

ZHANGZhengbo, Email: zhengbozhang@126.com

Keywords：

paced breathing; cardiopulmonary interaction; pulse transit time; baseline; blood pressure

DOI：

10.7507/1001-5515.20140251

Video：

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To investigate the effect of stepwise paced breathing (PB) on pulse transit time (PTT), we collected physiological signals of electrocardiogram (ECG), respiration and arterial pulse wave during a procedure of stepwise PB, which consists of 6 different breathing rates changing in a protocol of 14.0-12.5-11.0-9.5-8.0-7.0 breath per minute (BPM), with each breathing rate lasting 3 minutes. Twenty two healthy adults involved in this experiment and the change of PTT was analyzed during the stepwise PB procedure. In our study, the PTT was measured by calculating the time interval from the R-spike of the ECG to the peaks of the second derivative of the arterial pulse wave. Ensemble empirical mode decomposition (EEMD) was applied to PTT to decompose the signal into different intrinsic mode function, and respiratory oscillation and trend component (baseline) in PTT were further extracted. It was found that the respiratory oscillations in the PTT increased with decreasing of the PB rate, and many of the subjects (14 out of 22) showed the phenomena of PTT baseline increasing during the stepwise PB procedure. The results indicated that the stepwise PB procedure induced a high level of cardiovascular oscillation and produced an accumulative effect of PTT baseline increase. As PTT is capable of predicting changes in BP over a short period of time, increase of PTT baseline indicates the decrease of blood pressure. The experiments showed that the stepwise PB procedure could reduce blood pressure for most subjects. For future work, it is necessary to develop certain indices differentiating the effectiveness of the stepwise PB procedure on the PTT baseline change, and to test the effectiveness of this stepwise PB procedure on blood pressure reduction for patients with essential hypertension.

Citation： CHAIXiaoke, WANGBuqing, ZHANGZhengbo, WANGGuojing, WANGWeidong. Change of Pulse Transit Time During Stepwise Paced Breathing. Journal of Biomedical Engineering, 2014, 31(6): 1325-1331,1341. doi: 10.7507/1001-5515.20140251 Copy

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6.	GROSSMAN E, GROSSMAN A, SCHEIN M H, et al. Breathing-control lowers blood pressure[J]. J Hum Hypertens, 2001,15(4):263-269.
7.	BERNARDI L, SPADACINI G, BELLWON J, et al. Effect of breathing rate on oxygen saturation and exercise performance in chronic heart failure[J]. Lancet, 1998, 351(9112):1308-1311.
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14.	LOGTENBERG S J, KLEEFSTRA N, HOUWELING S T, et al. Effect of device-guided breathing exercises on blood pressure in hypertensive patients with type 2 diabetes mellitus:a randomized controlled trial[J]. J Hypertens, 2007,25(1):241-246.
15.	張政波,王步青,王衛東, 等.心肺交互作用綜合測試系統[J].生物醫學工程學雜志,2013, 30(2):395-402.
16.	王步青,張政波,王衛東.引導呼吸下的呼吸性竇性心律不齊的研究[J].生物醫學工程學雜志,2012, 29(1):45-50.
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18.	SMITH R P, ARGOD J, PèPIN J L, et al. Pulse transit time:an appraisal of potential clinical applications[J]. Thorax, 1999,54(5):452-457.
19.	ZHANG Z B, WANG W D, WANG B Q, et al. A prototype of wearable respiration biofeedback platform and its preliminary evaluation on cardiovascular variabilities[C]//3rd International Conference on Bioinformatics and Biomedical Engineering. Beijing:2009:1-4.
20.	張政波,王衛東,李開元,等.交互式呼吸引導技術[J].中國醫療器械雜志,2008, 32(2):86-88,119.
21.	張政波,俞夢孫,李若新,等.背心式呼吸感應體積描記系統設計[J].航天醫學與醫學工程,2006,19(5):377-381.
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23.	ZHANG Z B, SHEN Y H, WANG W D, et al. Design and implementation of sensing shirt for ambulatory cardiopulmonary monitoring[J]. J Med Biol Eng, 2010,31(3):207-216.
24.	向海燕. 無創傷人體逐拍動脈血壓測量技術[D].西安:第四軍醫大學, 2005:48-65.
25.	王步青, 王衛東. 基于LabVIEW的虛擬心電分析儀中的R波檢測算法研究[J].科學技術與工程,2006,6(21):3401-3404.
26.	HUANG N E, SHEN Z, LONG S R, et al. The empirical mode decomposition and the Hilbert spectrum for nonlinear and non-stationary time series analysis[J]. Proc R Soc Lond A, 1998, 454(1971):903-993.
27.	HUANG N E,WU Z H. Ensemble empirical mode decomposition:a noise-assisted data analysis method[J]. Adv Adapt Data Anal, 2009,1(1):1-41.
28.	臺灣國立中央大學數據分析方法研究中心.Hilbert-Huang Transform[EB/OL]. (2013-9-10) http://rcada.ncu.edu.tw/research1.htm.
29.	LOPES T C, BEDA A, GRANJA-FILHO P C, et al. Cardio-respiratory interactions and relocation of heartbeats within the respiratory cycle during spontaneous and paced breathing[J]. Physiol Meas,2011, 32(9):1389-1401.
30.	DRINNAN M J, ALLEN J, MURRAY A. Relation between heart rate and pulse transit time during paced respiration[J]. Physiol Meas, 2001,22(3):425-432.
31.	KOBAYASHI H. Does paced breathing improve the reproducibility of heart rate variability measurements?[J]. J Physiol Anthropol, 2009,28(5):225-230.
32.	郎曉華,俞夢孫.容積脈搏波在吸相和呼相間的變異性[J].中國生物醫學工程學報,2011,30(1):17-21.
33.	蒲曉雯,梁宗安,雷飛,等.Hypno PTT監測儀對阻塞性睡眠呼吸暫停低通氣綜合征的診斷價值[J].中國呼吸與危重監護雜志,2005, 4(3):214-217.

1. YASUMA F, HAYANO J. Respiratory sinus arrhythmia:why does the heartbeat synchronize with respiratory rhythm?[J]. Chest, 2004, 125(2):683-690.
2. PINNA G D, MAESTRI R, LA ROVERE M T, et al. Effect of paced breathing on ventilatory and cardiovascular variability parameters during short-term investigations of autonomicfunction[J]. Am J Physiol Heart Circ Physiol,2006,290(1):H424-H433.
3. PORTH C J, BAMRAH V S, TRISTANI F E, et al. The Valsalva maneuver:mechanisms and clinical implications[J]. Heart Lung, 1984,13(5):507-518.
4. SHIELDS R W JR. Heart rate variability with deep breathing as a clinical test of cardiovagal function[J]. Cleve Clin J Med, 2009,76(Suppl 2):S37-S40.
5. PITZALIS M V, MASTROPASQUA F, MASSARI F, et al. Effect of respiratory rate on the relationships between RR interval and systolic blood pressure fluctuations:a frequency-dependent phenomenon[J]. Cardiovasc Res, 1998, 38(2):332-339.
6. GROSSMAN E, GROSSMAN A, SCHEIN M H, et al. Breathing-control lowers blood pressure[J]. J Hum Hypertens, 2001,15(4):263-269.
7. BERNARDI L, SPADACINI G, BELLWON J, et al. Effect of breathing rate on oxygen saturation and exercise performance in chronic heart failure[J]. Lancet, 1998, 351(9112):1308-1311.
8. BERNARDI L, PORTA C, SPICUZZA L, et al. Slow breathing increases arterial baroreflex sensitivity in patients with chronic heart failure[J]. Circulation, 2002, 105(2):143-145.
9. CYSARZ D, BUSSING A. Cardiorespiratory synchronization during Zen meditation[J]. Eur J Appl Physiol, 2005, 95(1):88-95.
10. SHARMA M, FRISHMAN W H, GANDHI K. RESPeRATE:nonpharmacological treatment of hypertension[J]. Cardiol Rev, 2011,19(2):47-51.
11. SCHEIN M H, GAVISH B, HERZ M, et al. Treating hypertension with a device that slows and regularises breathing:a randomised, double-blind controlled study[J].J Hum Hypertens, 2001,15(4):271-278.
12. MAHTANI K R, NUNAN D, HENEGHAN C J. Device-guided breathing exercises in the control of human blood pressure:systematic review and meta-analysis[J].J Hypertens, 2012,30(5):852-860.
13. ALTENA M R, KLEEFSTRA N, LOGTENBERG S J, et al. Effect of device-guided breathing exercises on blood pressure in patients with hypertension:a randomized controlled trial[J]. Blood Press, 2009,18(5):273-279.
14. LOGTENBERG S J, KLEEFSTRA N, HOUWELING S T, et al. Effect of device-guided breathing exercises on blood pressure in hypertensive patients with type 2 diabetes mellitus:a randomized controlled trial[J]. J Hypertens, 2007,25(1):241-246.
15. 張政波,王步青,王衛東, 等.心肺交互作用綜合測試系統[J].生物醫學工程學雜志,2013, 30(2):395-402.
16. 王步青,張政波,王衛東.引導呼吸下的呼吸性竇性心律不齊的研究[J].生物醫學工程學雜志,2012, 29(1):45-50.
17. GESCHE H, GROSSKURTH D, KVCHLER G, et al.Continuous blood pressure measurement by using the pulse transit time:comparison to a cuff-based method[J]. Eur J Appl Physiol, 2012, 112(1):309-315.
18. SMITH R P, ARGOD J, PèPIN J L, et al. Pulse transit time:an appraisal of potential clinical applications[J]. Thorax, 1999,54(5):452-457.
19. ZHANG Z B, WANG W D, WANG B Q, et al. A prototype of wearable respiration biofeedback platform and its preliminary evaluation on cardiovascular variabilities[C]//3rd International Conference on Bioinformatics and Biomedical Engineering. Beijing:2009:1-4.
20. 張政波,王衛東,李開元,等.交互式呼吸引導技術[J].中國醫療器械雜志,2008, 32(2):86-88,119.
21. 張政波,俞夢孫,李若新,等.背心式呼吸感應體積描記系統設計[J].航天醫學與醫學工程,2006,19(5):377-381.
22. 張政波,俞夢孫,趙顯亮,等.穿戴式、多參數協同監測系統設計[J]. 航天醫學與醫學工程,2008,21(1):66-69.
23. ZHANG Z B, SHEN Y H, WANG W D, et al. Design and implementation of sensing shirt for ambulatory cardiopulmonary monitoring[J]. J Med Biol Eng, 2010,31(3):207-216.
24. 向海燕. 無創傷人體逐拍動脈血壓測量技術[D].西安:第四軍醫大學, 2005:48-65.
25. 王步青, 王衛東. 基于LabVIEW的虛擬心電分析儀中的R波檢測算法研究[J].科學技術與工程,2006,6(21):3401-3404.
26. HUANG N E, SHEN Z, LONG S R, et al. The empirical mode decomposition and the Hilbert spectrum for nonlinear and non-stationary time series analysis[J]. Proc R Soc Lond A, 1998, 454(1971):903-993.
27. HUANG N E,WU Z H. Ensemble empirical mode decomposition:a noise-assisted data analysis method[J]. Adv Adapt Data Anal, 2009,1(1):1-41.
28. 臺灣國立中央大學數據分析方法研究中心.Hilbert-Huang Transform[EB/OL]. (2013-9-10) http://rcada.ncu.edu.tw/research1.htm.
29. LOPES T C, BEDA A, GRANJA-FILHO P C, et al. Cardio-respiratory interactions and relocation of heartbeats within the respiratory cycle during spontaneous and paced breathing[J]. Physiol Meas,2011, 32(9):1389-1401.
30. DRINNAN M J, ALLEN J, MURRAY A. Relation between heart rate and pulse transit time during paced respiration[J]. Physiol Meas, 2001,22(3):425-432.
31. KOBAYASHI H. Does paced breathing improve the reproducibility of heart rate variability measurements?[J]. J Physiol Anthropol, 2009,28(5):225-230.
32. 郎曉華,俞夢孫.容積脈搏波在吸相和呼相間的變異性[J].中國生物醫學工程學報,2011,30(1):17-21.
33. 蒲曉雯,梁宗安,雷飛,等.Hypno PTT監測儀對阻塞性睡眠呼吸暫停低通氣綜合征的診斷價值[J].中國呼吸與危重監護雜志,2005, 4(3):214-217.

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