Deriving Accurate Nocturnal Heart Rate, rMSSD and Frequency HRV from the Oura Ring

Cardiovascular diseases are a major cause of mortality worldwide. Long-term monitoring of nighttime heart rate (HR) and heart rate variability (HRV) may be useful in identifying latent cardiovascular risk. The Oura Ring has shown excellent correlation only with ECG-derived HR, but not HRV. We thus assessed if stringent data quality filters can improve the accuracy of time-domain and frequency-domain HRV measures. 92 younger (<45 years) and 22 older (≥45 years) participants from two in-lab sleep studies with concurrent overnight Oura and ECG data acquisition were analyzed. For each 5 min segment during time-in-bed, the validity proportion (percentage of interbeat intervals rated as valid) was calculated. We evaluated the accuracy of Oura-derived HR and HRV measures against ECG at different validity proportion thresholds: 80%, 50%, and 30%; and aggregated over different durations: 5 min, 30 min, and Night-level. Strong correlation and agreements were obtained for both age groups across all HR and HRV metrics and window sizes. More stringent validity proportion thresholds and averaging over longer time windows (i.e., 30 min and night) improved accuracy. Higher discrepancies were found for HRV measures, with more than half of older participants exceeding 10% Median Absolute Percentage Error. Accurate HRV measures can be obtained from Oura's PPG-derived signals with a stringent validity proportion threshold of around 80% for each 5 min segment and aggregating over time windows of at least 30 min.