Low HRV entropy is strongly associated with myocardial infarction.

Heart rate variability (HRV) is a marker of autonomous activity in the heart. An important application of HRV measures is the stratification of mortality risk after myocardial infarction. Our hypothesis is that the information entropy of HRV, a non-linear approach, is a suitable measure for this assessment. As a first step, to evaluate the effect of myocardial infarction on the entropy, we compared the entropy to standard HRV parameters. The entropy was estimated by compressing the tachogram with Bzip2. For univariate comparison, statistical tests were used. Multivariate analysis was carried out using automatically generated decision trees. The classification rate and the simplicity of the decision trees were the two evaluation criteria. The findings support our hypothesis. The meanNN-normalized entropy is reduced in patients with myocardial infarction with very high significance. One entropy parameter alone exceeds the discrimination strength of multivariate standards-based trees.     

Sympathetic Tone Induced by High Acoustic Tempo Requires Fast Respiration

Many studies have revealed the influences of music, and particularly its tempo, on the autonomic nervous system (ANS) and respiration patterns. Since there is the interaction between the ANS and the respiratory system, namely sympatho-respiratory coupling, it is possible that the effect of musical tempo on the ANS is modulated by the respiratory system. Therefore, we investigated the effects of the relationship between musical tempo and respiratory rate on the ANS. Fifty-two healthy people aged 18–35 years participated in this study. Their respiratory rates were controlled by using a silent electronic metronome and they listened to simple drum sounds with a constant tempo. We varied the respiratory rate—acoustic tempo combination. The respiratory rate was controlled at 15 or 20 cycles per minute (CPM) and the acoustic tempo was 60 or 80 beats per minute (BPM) or the environment was silent. Electrocardiograms and an elastic chest band were used to measure the heart rate and respiratory rate, respectively. The mean heart rate and heart rate variability (HRV) were regarded as indices of ANS activity. We observed a significant increase in the mean heart rate and the low (0.04–0.15 Hz) to high (0.15–0.40 Hz) frequency ratio of HRV, only when the respiratory rate was controlled at 20 CPM and the acoustic tempo was 80 BPM. We suggest that the effect of acoustic tempo on the sympathetic tone is modulated by the respiratory system.     

Cardiorespiratory interactions during resistive load breathing

The addition to the respiratory system of a resistive load results in breathing pattern changes and in negative intrathoracic pressure increases. The aim of this study was to use resistive load breathing as a stimulus to the cardiorespiratory interaction and to examine the extent of the changes in heart rate variability (HRV) and respiratory sinus arrhythmia (RSA) in relation to the breathing pattern changes. HRV and RSA were studied in seven healthy subjects where four resistive loads were applied in a random order during the breath and 8-min recording made in each condition. The HRV spectral power components were computed from the R-R interval sequences, and the RSA amplitude and phase were computed from the sinusoid fitting the instantaneous heart rate within each breath. Adding resistive loads resulted in 1) increasing respiratory period, 2) unchanging heart rate, and 3) increasing HRV and changing RSA characteristics. HRV and RSA characteristics are linearly correlated to the respiratory period. These modifications appear to be linked to load-induced changes in the respiratory period in each individual, because HRV and RSA characteristics are similar at a respiratory period obtained either by loading or by imposed frequency breathing. The present results are discussed with regard to the importance of the breathing cycle duration in these cardiorespiratory interactions, suggesting that these interactions may depend on the time necessary for activation and dissipation of neurotransmitters involved in RSA.     

Cardiorespiratory Information Dynamics during Mental Arithmetic and Sustained Attention

An analysis of cardiorespiratory dynamics during mental arithmetic, which induces stress, and sustained attention was conducted using information theory. The information storage and internal information of heart rate variability (HRV) were determined respectively as the self-entropy of the tachogram, and the self-entropy of the tachogram conditioned to the knowledge of respiration. The information transfer and cross information from respiration to HRV were assessed as the transfer and cross-entropy, both measures of cardiorespiratory coupling. These information-theoretic measures identified significant nonlinearities in the cardiorespiratory time series. Additionally, it was shown that, although mental stress is related to a reduction in vagal activity, no difference in cardiorespiratory coupling was found when several mental states (rest, mental stress, sustained attention) are compared. However, the self-entropy of HRV conditioned to respiration was very informative to study the predictability of RR interval series during mental tasks, and showed higher predictability during mental arithmetic compared to sustained attention or rest.     

A new method in applying power spectral statistics to examine cardio-respiratory interactions in fish

Power spectral analysis (PSA) provides a powerful tool for determining frequency oscillations in time signals, and it is accepted that mammals can show distinct components in the heart rate (fH) spectrum that are synchronous with ventilatory frequency (fV). Using similar signal processing techniques, these fundamental components at fV are not apparent in the spectrum calculated from fish fH. Here we compare conventional PSA on the R-R interval tachogram generated from ECG traces recorded in rats and fish, with PSA on the raw ECG waveform. The rat R-R tachogram showed a defined sigmoidal component, whereas the fish R-R tachogram was a more chaotic waveform. In agreement with the literature, PSA of these respective waveforms produced a component at the same frequency as ventilation in the rat, but of lower frequency than ventilation for the fish. Applying PSA to the rat ECG produced a spectrum with a fundamental component of similar frequency to that observed in the R-R tachogram spectrum, indicating that the latter adequately contained heart rate variability (HRV) oscillations. However, PSA of the ECG in fish contrasted with that from the R-R tachogram, with components observed in the latter spectrum being absent from the former. This suggests that the frequency components determined by PSA on the fish R-R tachogram were not true components, but were aliased (or folded-back) from higher up in the spectrum. Using established aliasing equations, recalculation of these peaks showed that their true frequency was similar to that of the ventilatory frequency for individual fish. The extent of cardio-respiratory interaction, resulting in fV < f(H/2) in rats but fV > f(H/2) in fish, is suggested to be the origin of the differences observed.     

Short-Term Heart Rate Variability—Influence of Gender and Age in Healthy Subjects

In the recent years, short-term heart rate variability (HRV) describing complex variations of beat-to-beat interval series that are mainly controlled by the autonomic nervous system (ANS) has been increasingly analyzed to assess the ANS activity in different diseases and under various conditions. In contrast to long-term HRV analysis, short-term investigations (<30 min) provide a test result almost immediately. Thus, short-term HRV analysis is suitable for ambulatory care, patient monitoring and all those applications where the result is urgently needed. In a previous study, we could show significant variations of 5-min HRV indices according to age in almost all domains (linear and nonlinear) in 1906 healthy subjects from the KORA S4 cohort. Based on the same group of subjects, general gender-related influences on HRV indices are to be determined in this study. Short-term 5-min HRV indices from linear time and frequency domain and from nonlinear methods (compression entropy, detrended fluctuation analysis, traditional and segmented Poincaré plot analysis, irreversibility analysis, symbolic dynamics, correlation and mutual information analysis) were determined from 782 females and 1124 males. First, we examined the gender differences in two age clusters (25–49 years and 50–74 years). Secondly, we investigated the gender-specific development of HRV indices in five age decade categories, namely for ages 25–34, 35–44, 45–54, 55–64 and 65–74 years. In this study, significant modifications of the indices according to gender could be obtained, especially in the frequency domain and correlation analyses. Furthermore, there were significant modifications according to age in nearly all of the domains. The gender differences disappeared within the last two age decades and the age dependencies disappeared in the last decade. To summarize gender and age influences need to be considered when performing HRV studies even if these influences only partly differ.     

Autonomic Effects of Music in Health and Crohn's Disease: The Impact of Isochronicity,Emotional Valence,and Tempo

BackgroundMusic can evoke strong emotions and thus elicit significant autonomic nervous system (ANS) responses. However, previous studies investigating music-evoked ANS effects produced inconsistent results. In particular, it is not clear (a) whether simply a musical tactus (without common emotional components of music) is sufficient to elicit ANS effects; (b) whether changes in the tempo of a musical piece contribute to the ANS effects; (c) whether emotional valence of music influences ANS effects; and (d) whether music-elicited ANS effects are comparable in healthy subjects and patients with Crohn´s disease (CD, an inflammatory bowel disease suspected to be associated with autonomic dysfunction).MethodsTo address these issues, three experiments were conducted, with a total of n = 138 healthy subjects and n = 19 CD patients. Heart rate (HR), heart rate variability (HRV), and electrodermal activity (EDA) were recorded while participants listened to joyful pleasant music, isochronous tones, and unpleasant control stimuli.ResultsCompared to silence, both pleasant music and unpleasant control stimuli elicited an increase in HR and a decrease in a variety of HRV parameters. Surprisingly, similar ANS effects were elicited by isochronous tones (i.e., simply by a tactus). ANS effects did not differ between pleasant and unpleasant stimuli, and different tempi of the music did not entrain ANS activity. Finally, music-evoked ANS effects did not differ between healthy individuals and CD patients.ConclusionsThe isochronous pulse of music (i.e., the tactus) is a major factor of music-evoked ANS effects. These ANS effects are characterized by increased sympathetic activity. The emotional valence of a musical piece contributes surprisingly little to the ANS activity changes evoked by that piece.     

Increased heart rate variability in mice overexpressing the Cu/Zn superoxide dismutase

Cu/Zn superoxide dismutase (SOD1) is implicated in various pathological conditions including Down's syndrome, neurodegenerative diseases, and afflictions of the autonomic nervous system (ANS). To assess the SOD1 contribution to ANS dysfunction, especially its influence on cardiac regulation, we studied the heart rate variability (HRV) and cardiac arrhythmias in conscious 12-month-old male and female transgenic mice for the human SOD1 gene (TghSOD1). TghSOD1 mice presented heart rate reduction as compared with control FVB/N individuals. All HRV parameters reflecting parasympathetic activity were increased in TghSOD1. Pharmacological studies confirmed that the parasympathetic tone was exacerbated and the sympathetic pathway was functional in TghSOD1 mice. A high frequency of atrioventricular block and premature ventricular contractions was observed in TghSOD1. By biochemical assays we found that SOD1 activities were multiplied by 9 and 4 respectively in the heart and brainstem of transgenic mice. A twofold decrease in cholinesterase activity was observed in the heart but not in the brainstem. We demonstrate that SOD1 overexpression induces an ANS dysfunction by an exacerbated vagal tone that may be related to impaired cardiac activity of the cholinesterases and may explain the high occurrence of arrhythmias.     

Assessment of Heart Autonomic Control on the Basis of Spectral Analysis of Heart Rate Variability

An orthostatic test with frequency-controlled breathing (with a respiration period of 10 s) or spontaneous breathing was used to analyze frequency estimates of the heart rate variability (HRV) in the low-frequency (LF) and high-frequency (HF) ranges in young men and women. It was demonstrated that the spectral components of HRV bear no signs of sex differentiation, suggesting a uniform structural organization of the system of autonomic nervous control of the heart (SANCH) in humans. The LF component of the HRV spectrum is a marker of the functional state of the SANCH; it should be studied under conditions of controlled breathing at a frequency of 0.1 Hz. The HF and LF components of the HRV characterize the state of the SANCH at a given moment and do not reflect directly its adaptation reserve. The HF component of the HRV is interesting as a parameter that may be used for estimating the changes in the adaptation reserve of heart autonomic control. It is preferable to analyze this component in the absence of external disturbances in the LF range of the spectrum.     

Heart Rate and Heart Rate Variability in Dairy Cows with Different Temperament and Behavioural Reactivity to Humans

From the 1990s, extensive research was started on the physiological aspects of individual traits in animals. Previous research has established two extreme (proactive and reactive) coping styles in several animal species, but the means of reactivity with the autonomic nervous system (ANS) activity has not yet been investigated in cattle. The aim of this study was the characterization of cardiac autonomic activity under different conditions in cows with different individual characteristics. For this purpose, we investigated heart rate and ANS-related heart rate variability (HRV) parameters of dairy cows (N = 282) on smaller- and larger-scale farms grouped by (1) temperament and (2) behavioural reactivity to humans (BRH). Animals with high BRH scores were defined as impulsive, while animals with low BRH scores were defined as reserved. Cardiac parameters were calculated for undisturbed lying (baseline) and for milking bouts, the latter with the presence of an unfamiliar person (stressful situation). Sympathetic tone was higher, while vagal activity was lower in temperamental cows than in calm animals during rest both on smaller- and larger-scale farms. During milking, HRV parameters were indicative of a higher sympathetic and a lower vagal activity of temperamental cows as compared to calm ones in farms of both sizes. Basal heart rate did not differ between BRH groups either on smaller- or larger-scale farms. Differences between basal ANS activity of impulsive and reserved cows reflected a higher resting vagal and lower sympathetic activity of reserved animals compared to impulsive ones both on smaller- and larger-scale farms. There was no difference either in heart rate or in HRV parameters between groups during milking neither in smaller- nor in larger-scale farms. These two groupings allowed to draw possible parallels between personality and cardiac autonomic activity during both rest and milking in dairy cows. Heart rate and HRV seem to be useful for characterisation of physiological differences related to temperament and BRH.     

What options does the supine-standing-supine test offer to patients with hypertension? Demonstrations of examples

Aims: The purpose of the study was to demonstrate autonomic nervous system (ANS) changes associated with treatment in hypertensive patients and utilization of these measurements in practice. Methods: Hypertensive patients were examined before the start of treatment and after blood pressure compensation. The telemetric system VarCor PF 5 was used for non-invasive heart rate registration and automatic evaluation of heart rate variability (HRV) parameters. The supine-standing-supine test with ortho-clinostatic loading in standard conditions was used for HRV evaluation. Results: The influence of antihypertensive therapy on ANS was demonstrated in two cases. The first was a case of a responder to therapy and the second case was example of a non-responder to monotherapy regarding more therapeutic steps for blood pressure control. Different modes of results presentation are demonstrated: 3D graph, numeric form of standard parameters of HRV, computer interpretation of results by means of complex parameters and indices in numeric, graphic and verbal form with functional age calculation, cross graph of vagal activity index versus sympatho-vagal balance index was used for repeated measurements and follow-up. The increased spectral performance with augmented vagal activity and slope down of sympatho-vagal ratio are evident after blood pressure control achievement. Improvement of functional age parameter associated with blood pressure compensation is visible using a complex age-dependent parameters interpretation. Conclusions: HRV evaluation in hypertensive patients provides new parameters for patient's examination. These parameters are influenced by both the illness itself and by pharmacotherapy. Such an approach offers more complex information about patient.     

Coupling of the respiratory rhythm in fish with activity in hypobranchial nerves and with heartbeat

Fish have a central respiratory pattern generator (CRPG) in the brain stem that initiates activity in a series of cranial nerves innervating respiratory muscles. These nerves burst sequentially in the order of their rostrocaudal distribution in the central nervous system. When respiratory drive is high, this activity spreads caudally to occipital and anterior spinal neurons that project via the hypobranchial nerves to stimulate hypaxial muscles, causing active jaw abduction. The CRPG may also recruit the heart. Fish, like mammals, show respiratory components in the intrinsic variability of heart rate (HRV). Cardiorespiratory synchrony in the dogfish is driven by bursting activity in the cardiac branches of the vagus nerve, which emanates from preganglionic neurons in the dorsal vagal motor nucleus. A respiratory component in HRV is difficult to discriminate in other species, requiring the use of power spectral analysis and the subsequent elimination of aliased components.     

Heart Rate Variability and Skin Conductance During Repetitive TMS Course in Children with Autism

Autism spectrum disorder (ASD) is a developmental disorder marked by difficulty in social interactions and communication. ASD also often present symptoms of autonomic nervous system (ANS) functioning abnormalities. In individuals with autism the sympathetic branch of the ANS presents an over-activation on a background of the parasympathetic activity deficits, creating an autonomic imbalance, evidenced by a faster heart rate with little variation and increased tonic electrodermal activity. The objective of this study was to explore the effect of 12 sessions of 0.5 Hz repetitive transcranial magnetic stimulation (rTMS) over dorsolateral prefrontal cortex (DLPFC) on autonomic activity in children with ASD. Electrocardiogram and skin conductance level (SCL) were recorded and analyzed during each session of rTMS. The measures of interest were time domain (i.e., R–R intervals, standard deviation of cardiac intervals, NN50-cardio-intervals >50 ms different from preceding interval) and frequency domain heart rate variability (HRV) indices [i.e., power of high frequency (HF) and low frequency (LF) components of HRV spectrum, LF/HF ratio]. Based on our prior pilot studies it was proposed that the course of 12 weekly inhibitory low-frequency rTMS bilaterally applied to the DLPFC will improve autonomic balance probably through improved frontal inhibition of the ANS activity, and will be manifested in an increased length of cardiointervals and their variability, and in higher frequency-domain HRV in a form of increased HF power, decreased LF power, resulting in decreased LF/HF ratio, and in decreased SCL. Our post-12 TMS results showed significant increases in cardiac intervals variability measures and decrease of tonic SCL indicative of increased cardiac vagal control and reduced sympathetic arousal. Behavioral evaluations showed decreased irritability, hyperactivity, stereotype behavior and compulsive behavior ratings that correlated with several autonomic variables.     

Respiratory influences on non-linear dynamics of heart rate variability in humans

 The goal of our study was to determine whether evidence for chaos in heart rate variability (HRV) can be observed when the respiratory input to the autonomic controller of heart rate is forced by the deterministic pattern associated with periodic breathing. We simultaneously recorded, in supine healthy volunteers, RR intervals and breathing volumes for 20 to 30 min (1024 data point series) during three protocols: rest (control), fixed breathing (15 breath/min) and voluntary periodic breathing (3 breaths with 2 s inspiration and 2 s expiration followed by an 8 s breath hold). On both the RR interval and breathing volume series we applied the non-linear prediction method (Sugihara and May algorithm) to the original time series and to distribution-conserved isospectral surrogate data. Our results showed that, in contrast to the control test, during both fixed and voluntary periodic breathing the variability of breathing volumes was clearly deterministic non-chaotic. During all the three protocols, the RR-interval series’ non-linear predictability was consistent with one of a chaotic series. However, at rest, no clear difference was observed between the RR-interval series and their surrogates, which means that no clear chaos was observed. During fixed breathing a difference appeared, and this difference seemed clearer during voluntary periodic breathing. We concluded that HRV dynamics were chaotic when respiration was forced with a deterministic non-chaotic pattern and that normal spontaneous respiratory influences might mask the normally chaotic pattern in HRV. Received: 7 August 1995 / Accepted in revised form: 20 March 1997     

Effects of Heart Rate Variability Biofeedback in Subjects with Stress-Related Chronic Neck Pain: A Pilot Study

Recent studies focusing on autonomic nervous system (ANS) dysfunctions, together with theoretical pathophysiological models of musculoskeletal disorders, indicate the involvement of ANS regulation in development and maintenance of chronic muscle pain. Research has demonstrated the effectiveness of heart rate variability (HRV) biofeedback (BF) in increasing HRV and reducing the symptoms of different disorders characterized by ANS aberration. The study investigated the effects of resonance frequency HRV BF on autonomic regulation and perceived health, pain, stress and disability in 24 subjects with stress-related chronic neck-shoulder pain. Twelve subjects participated in 10 weekly sessions of resonant HRV BF and were compared to a control group. Subjective reports and HRV measures during relaxation and in response to a standardized stress protocol were assessed for both groups pre- and post-intervention. Group × time interactions revealed a significantly stronger increase over time in perceived health (SF-36) for the treatment group, including vitality, bodily pain and social functioning. Interactions were also seen for HRV during relaxation and reactivity to stress. The present pilot study indicates improvement in perceived health over a 10 week intervention with HRV-biofeedback in subjects with chronic neck-pain. Increased resting HRV as well as enhanced reactivity to hand grip and cold pressor tests might reflect beneficial effects on ANS regulation, and suggest that this intervention protocol is suitable for a larger controlled trial.     

Non-linear dynamic analysis of the cardiac rhythm during transient myocardial ischemia.

Coronary artery occlusions related to myocardial ischemia drive cardiac control system reactions that may lead to heart failure. The purpose of this study was to assess the autonomic nervous system (ANS) response during prolonged percutaneous transluminal coronary angioplasty (PTCA). Continuous ECG data were acquired from 50 patients before and during PTCA, with occlusions in the left anterior descending, left circumflex or right coronary artery. Heart rate variability (HRV) was analyzed for 3-min segments of the R-R interval signal obtained from ECG data. The ANS behavior was evaluated by HRV analysis using fractal-like indices. The fractal scalar exponent alpha(1) and power-law slope beta decreased considerably during PTCA. This indicates that significant reactions of autonomic control of the heart rate occurred during coronary artery occlusions, with a reduction in complexity of the ANS.     

The circadian rhythm of selected parameters of heart rate variability

At present, two main circadian oscillators are known, responsible for the rhythm of body temperature (BT) and body activity. Their independence has been demonstrated by the dissociation of these two rhythms in people during long-term isolation. In order to ascertain the circadian rhythm (CR) of heart rate variability (HRV), the ECG was recorded in 24 healthy awake men every two hours in the sitting position, from Friday 5 p.m. to Monday 6 a.m., who were maintained on a standard regime. One hundred consecutive RR intervals in every ECG were measured and from these 11 selected indicators of HRV were computed. Chronograms from the means of BT, respiratory rate, and electrical skin resistance showed pronounced CR with acrophases at 6 to 8 p.m. "Frequency" parameters of HRV, especially the frequency of reversal points, behaved similarly. CR in the remaining 7 "amplitude" parameters was also detected in individual persons, but their acrophases were different, and averaged chronograms mostly exhibited a flat course. The study has shown that there are at least two circadian components of HRV: the first phase has the CR synchronized with BT and is interindividually more homogeneous; the second phase is synchronized with body activity rhythm and is interindividually heterogeneous. On this basis, three equal subgroups of subjects arose, tentatively called afternoon, night, and forenoon types, respectively, in accordance with information about their preference for working and sleeping.     

The Effects of Heart Rate Variability (HRV) Biofeedback on HRV Reactivity and Recovery During and After Anger Recall Task for Patients with Coronary Artery Disease

Patients with coronary artery disease (CAD) often experience anger events before cardiovascular events. Anger is a psychological risk factor and causes underlying psychophysiological mechanisms to lose balance of the autonomic nervous system (ANS). The heart rate variability (HRV) was the common index for ANS regulation. It has been confirmed that heart rate variability biofeedback (HRV-BF) restored ANS balance in patients with CAD during the resting state. However, the effects of HRV-BF during and after the anger event remain unknown. This study aimed to examine the effects of HRV-BF on ANS reactivity and recovery during the anger recall task in patients with CAD. This study was a randomized control trial with a wait-list control group design, with forty patients in the HRV-BF group (for six sessions) and 44 patients in the control group. All patients received five stages of an anger recall task, including baseline, neutral recall task, neutral recovery, anger recall task, and anger recovery. HRV reactivity in the HRV-BF group at the post-test was lower than that in the control group. HRV recovery at the post-test in the HRV-BF group was higher than that in the control group. The HRV-BF reduced ANS reactivity during anger events and increased ANS recovery after anger events for CAD patients. The possible mechanisms of HRV-BF may increase total HRV, ANS regulation, and baroreflex activation at anger events for patients with CAD, and may be a suitable program for cardiac rehabilitation.

     

Nonstationary Heart Rate Variability in Respiratory Tests

A new method was proposed for processing a nonstationary heart rate by using frequency-modulated signals rather than amplitude-modulated signals equally spaced over several points of time as in the conventional method. A frequency-modulated signal is a set of identical Gaussian peaks that coincide with the true time points of heart beats. A continuous wavelet transform was used to quantitatively describe the heart rhythm signal. A test with controlled breathing was performed as an example and included three consecutive stages: rest, rhythmic breathing at a specified frequency, and exhalation. Tachograms recorded during the breath test was found to be a nonstationary signal with the alternation of peaks of different spectral ranges. A system of quantitative parameters was developed to describe the dynamics of changes in the spectral properties of the tachogram in transitional areas. A static clustering by the effect of the respiratory test and a dynamic clustering in order to identify the time points when the autonomic nervous system is stressed were performed for all subjects. The article discusses the prospects of using the method as a means to analyze the transient effects in various functional tests and as biofeedback that would help to change the heart rhythm.     

Inhibition of heart rate variability during sleep in humans by 6700 K pre-sleep light exposure

Two different spectral analyses of heart rate (HR) variability (HRV) were performed on seven young male subjects to evaluate the effects of different color temperatures of light exposure (6700 K, 5000 K, 3000 K) before sleep on cardiac vagal activity. In investigating HRV, we used an ordinary fast Fourier transform (FFT) and coarse graining spectral analysis (CGSA), which selectively extracts random fractal components from a given time series. The results showed that suppressions of HR during sleep after 6700 K light exposure were more inhibited than the other two lighting conditions. Increases in high-frequency (HF) components of HRV during sleep were also inhibited by 6700 K pre-sleep lighting. These results indicate that pre-sleep exposure to light of a higher color temperature may inhibit the enhancement of cardiac vagal activity during sleep. Moreover, significant HF alterations were shown in fractal-free HF (not in ordinary HF) components by CGSA. Because the HF component originates from respiratory sinus arrhythmia with periodical fluctuations, CGSA may be an appropriate approach for HRV evaluation during sleep.