Chang Francis Hsu

In a collaborative effort between Labfront and Garmin, an actigraphy-based sleep analysis report has been developed for Garmin’s consumer-grade wearable devices, accessible via the Labfront application. Comparative analyses against established medical-grade actigraphic devices, namely Actiwatch-2 and Motionlogger, demonstrate notable concordance in key performance indicators. Specifically, the Garmin device yielded a sensitivity of over 95% for sleep detection, a specificity of over 80% for wake detection, and an overall accuracy exceeding 95%. The study introduces a transparent methodology for deriving sleep metrics from acceleration data, thereby addressing a current gap in the literature regarding consumer-grade actigraphy solutions. Additionally, the system allows for individual customization of sleep/wake detection parameters, offering adaptability to specific user conditions. These findings suggest that consumer-grade wearable devices may serve as viable alternatives to medical-grade actigraphs for sleep analysis, without sacrificing analytical rigor.

Exercise stress testing (EST) has limited power in diagnosing obstructive coronary artery disease (CAD). The heart rate variability (HRV) analysis might increase the sensitivity of CAD detection. This study aimed to evaluate the correlation between short-term HRV and myocardial ischemia during EST, including the acceleration, maximum, and recovery stages of heart rate (HR). The HRV during EST from 19 healthy (RHC) subjects and 35 patients with CAD (25 patients with insignificant CAD (iCAD), and 10 patients with significant CAD (sCAD)) were compared. As a result, all HRV indices decreased at the maximum stage and no significant differences between iCAD and sCAD were found. The low-frequency power of heart rate signal (LF) of the RHC group recovered relatively quickly from the third to the sixth minutes after maximum HR, compared with that of the sCAD group. The relative changes of most HRV indices between maximum HR and recovery stage were lower in the sCAD group than in the RHC group, especially in LF, the standard deviation of all normal to normal intervals (SDNN), and the standard deviation in the long axis direction of the Poincaré plot analysis (SD2) indices (p < 0.05). The recovery slope of LF was significantly smaller in the sCAD group than in the RHC group (p = 0.02). The result suggests that monitoring short-term HRV during EST provides helpful insight into the cardiovascular autonomic imbalance in patients with significant CAD. The relative change of autonomic tone, especially the delayed sympathetic recovery, could be an additional marker for diagnosing myocardial ischemia.

Background: The current method to evaluate the autonomic balance after renal denervation (RDN) relies on heart rate variability (HRV). However, parameters of HRV were not always predictive of response to RDN. Therefore, the complexity and disorder of heart rhythm, measured by entropy of entropy (EoE) and average entropy (AE), have been used to analyze autonomic dysfunction. This study evaluated the dynamic changes in autonomic status after RDN via EoE and AE analysis.Methods: Five patients were prospectively enrolled in the Global SYMPLICITY Registry from 2020 to 2021. 24-h Holter and ambulatory blood pressure monitoring (ABPM) was performed at baseline and 3 months after RDN procedures. The autonomic status was analyzed using the entropy-based AE and EoE analysis and the conventional HRV-based low frequency (LF), high frequency (HF), and LF/HF.Results: After RDN, the ABPM of all patients showed a significant reduction in blood pressure (BP) and heart rate. Only AE and HF values of all patients had consistent changes after RDN (p < 0.05). The spearman rank-order correlation coefficient of AE vs. HF was 0.86, but AE had a lower coefficient of variation than HF.Conclusions: Monitoring the AE and EoE analysis could be an alternative to interpreting autonomic status. In addition, a relative change of autonomic tone, especially an increasing parasympathetic activity, could restore autonomic balance after RDN.

Gait stability has been measured by using many entropy-based methods. However, the relation between the entropy values and gait stability is worth further investigation. A research reported that average entropy (AE), a measure of disorder, could measure the static standing postural stability better than multiscale entropy and entropy of entropy (EoE), two measures of complexity. This study tested the validity of AE in gait stability measurement from the viewpoint of the disorder. For comparison, another five disorders, the EoE, and two traditional metrics methods were, respectively, used to measure the degrees of disorder and complexity of 10 step interval (SPI) and 79 stride interval (SI) time series, individually. As a result, every one of the 10 participants exhibited a relatively high AE value of the SPI when walking with eyes closed and a relatively low AE value when walking with eyes open. Most of the AE values of the SI of the 53 diseased subjects were greater than those of the 26 healthy subjects. A maximal overall accuracy of AE in differentiating the healthy from the diseased was 91.1%. Similar features also exists on those 5 disorder measurements but do not exist on the EoE values. Nevertheless, the EoE versus AE plot of the SI also exhibits an inverted U relation, consistent with the hypothesis for physiologic signals.

Multiscale entropy (MSE) was used to analyze electroencephalography (EEG) signals to differentiate patients with Alzheimer’s disease (AD) from healthy subjects. It was found that the MSE values of the EEG signals from the healthy subjects are higher than those of the AD ones at small time scale factors in the MSE algorithm, while lower than those of the AD patients at large time scale factors. Based on the finding, we applied the linear discriminant analysis (LDA) to optimize the differentiating performance by comparing the resulting weighted sum of the MSE values under some specific time scales of each subject. The EEG data from 15 healthy subjects, 69 patients with mild AD, and 15 patients with moderate to severe AD were recorded. As a result, the weighted sum values are significantly higher for the healthy than the patients with moderate to severe AD groups. The optimal testing accuracy under five specific scales is 100% based on the EEG signals acquired from the T4 electrode. The resulting weighted sum value for the mild AD group is in the middle of those for the healthy and the moderate to severe AD groups. Therefore, the MSE-based weighted sum value can potentially be an index of severity of Alzheimer’s disease.

Static standing postural stability has been measured by multiscale entropy (MSE), which is used to measure complexity. In this study, we used the average entropy (AE) to measure the static standing postural stability, as AE is a good measure of disorder. The center of pressure (COP) trajectories were collected from 11 subjects under four kinds of balance conditions, from stable to unstable: bipedal with open eyes, bipedal with closed eyes, unipedal with open eyes, and unipedal with closed eyes. The AE, entropy of entropy (EoE), and MSE methods were used to analyze these COP data, and EoE was found to be a good measure of complexity. The AE of the 11 subjects sequentially increased by 100% as the balance conditions progressed from stable to unstable, but the results of EoE and MSE did not follow this trend. Therefore, AE, rather than EoE or MSE, is a good measure of static standing postural stability. Furthermore, the comparison of EoE and AE plots exhibited an inverted U curve, which is another example of a complexity versus disorder inverted U curve.

Static standing postural stability has been measured by multiscale entropy (MSE), which is used to measure complexity. In this study, we used the average entropy (AE) to measure the static standing postural stability, as AE is a good measure of disorder. The center of pressure (COP) trajectories were collected from 11 subjects under four kinds of balance situation, from stable to unstable: bipedal with open eyes, bipedal with closed eyes, unipedal with open eyes, and unipedal with closed eyes. The AE, entropy of entropy (EoE), and MSE methods were used to analyze these COP data, and EoE was found to be a good measure of complexity. The AE of the 11 subjects sequentially increased by 100%as the balance situations progressed from stable to unstable, but the results of EoE and MSE did not follow this trend. Therefore, AE, rather than EoE or MSE, is a good measure of static standing postural stability. Furthermore, the comparison of EoE and AE plots exhibited an inverted U curve, which is another example of a complexity versus disorder inverted U curve.

The complexity of biological signals has been proposed to reflect the adaptability of a given biological system to different environments. Two measures of complexity—multiscale entropy (MSE) and entropy of entropy (EoE)—have been proposed, to evaluate the complexity of heart rate signals from different perspectives. The MSE evaluates the information content of a long time series across multiple temporal scales, while the EoE characterizes variation in amount of information, which is interpreted as the “state changing,” of segments in a time series. However, both are problematic when analyzing white noise and are sensitive to data size. Therefore, based on the concept of “state changing,” we propose state change probability (SCP) as a measure of complexity. SCP utilizes a statistical hypothesis test to determine the physiological state changes between two consecutive segments in heart rate signals. The SCP value is defined as the ratio of the number of state changes to total number of consecutive segment pairs. Two common statistical tests, the t-test and Wilcoxon rank–sum test, were separately used in the SCP algorithm for comparison, yielding similar results. The SCP method is capable of reasonably evaluating the complexity of white noise and other signals, including 1/f noise, periodic signals, and heart rate signals, from healthy subjects, as well as subjects with congestive heart failure or atrial fibrillation. The SCP method is also insensitive to data size. A universal SCP threshold value can be applied, to differentiate between healthy and pathological subjects for data sizes ranging from 100 to 10,000 points. The SCP algorithm is slightly better than the EoE method when differentiating between subjects, and is superior to the MSE method.