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Published on: June 5, 2019
Validation of Photoplethysmography Using a Mobile Phone Application for the Assessment of Heart Rate Variability in
Willeke van Dijk1, Anja C Huizink, Mirjam Oosterman
1From the Departments of Clinical, Neuro and Developmental Psychology (van Dijk, Huizink, Lemmers-Jansen) and Clinical Child and Family Studies (Oosterman), Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam; Institute for Brain and Behavior Amsterdam (IBBA), Amsterdam, the Netherlands; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom (Lemmers-Jansen); and Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands (de Vente).
Objective:
Heart rate variability-biofeedback (HRV-BF) is an effective intervention to reduce stress and anxiety and requires accurate measures of real-time HRV. HRV can be measured through photoplethysmography (PPG) using the camera of a mobile phone. No studies have directly compared HRV-BF supported through PPG against classical electrocardiogram (ECG). The current study aimed to validate PPG HRV measurements during HRV-BF against ECG.
Methods:
Fifty-seven healthy participants (70% women) with a mean (standard deviation) age of 26.70 (9.86) years received HRV-BF in the laboratory. Participants filled out questionnaires and performed five times a 5-minute diaphragmatic breathing exercise at different paces (range, ~6.5 to ~4.5 breaths/min). Four HRV indices obtained through PPG, using the Happitech software development kit, and ECG, using the validated NeXus apparatus, were calculated and compared: RMSSD, pNN50, LFpower, and HFpower. Resonance frequency (i.e., optimal breathing pace) was also compared between methods.
Results:
All intraclass correlation coefficient values of the five different breathing paces were "near perfect" (>0.90) for all HRV indices: lnRMSSD, lnpNN50, lnLFpower, and lnHFpower. All Bland-Altman analyses (with just three incidental exceptions) showed good interchangeability of PPG- and ECG-derived HRV indices. No systematic evidence for proportional bias was found for any of the HRV indices. In addition, correspondence in resonance frequency detection was good with 76.6% agreement between PPG and ECG.
Conclusions:
PPG is a potentially reliable and valid method for the assessment of HRV. PPG is a promising replacement of ECG assessment to measure resonance frequency during HRV-BF.
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