The Effect of Device-Controlled Breathing on the Pulse Arrival Time and the Heart Rate Asymmetry Parameters in Healthy Volunteers

Background: The development of wearables has facilitated the monitoring of biomedical parameters in everyday life. One of the most common sensors of these gadgets is the photoplethysmograph (PPG); hence, the proper processing and interpretation of the PPG signal are essential. Besides pulse rate detection, these devices—together with an ECG—compute the pulse arrival time (PAT), from which the actual beat-to-beat blood pressure can be estimated. The heart rate shows asymmetrical accelerations and decelerations, quantified by the parameters of heart rate asymmetry (HRA). In the present study, we investigated the influences of different breathing-patterns on the PATs and HRA parameters. Methods: The authors evaluated 5 min simultaneous respiratory-, ECG- and PPG-signal recordings of 35 healthy, young volunteers specifically expressing the following breathing patterns: metronome-controlled inspiration, and both inspiration and expiration controlled at 1:1 and 1:2 ratios, respectively. The records were analyzed by HRVScan_Merge v3.2 software. The PAT values were calculated at eight different reference points. The HRA parameters and the PAT values at different breathing patterns were compared using the Friedman test and post hoc Wilcoxon paired-sample test. Results: Porta- and Guzik-indices significantly increased at 1:1 breathing compared to 1:2 and single-paced breathing. PATs increased significantly in dual-paced series compared to single-paced series at each reference point. Conclusion: Based on our results, the increased PATs at dual-paced versus single-paced breathing may indicate the involvement of cognitive functions. The symmetrical respiration ratio increases the heart rate symmetry; however, this effect is not detectable in the periphery through the PATs.