On the quantification of heart rate changes in autonomic function tests: relations between measures in beats per minute, seconds and dimensionless ratios

1. Disorders of the autonomic nervous system are frequently diagnosed by measuring heart rate changes in response to deep-breathing and lying-to-standing manoeuvres. The heart rate changes in these manoeuvres are quantified in measures using various units, like beats per minute, seconds and dimensionless ratios. 2. In the present study we mathematically derived relationships between the measures which quantify heart rate changes in beats per minute, seconds and dimensionless ratios. The theoretical outcomes were experimentally confirmed by the results of the deep-breathing and the lying-to-standing test in 525 healthy and diabetic subjects. The measures were found to be non-equivalent, because the mean RR interval duration influenced the measures in different ways. 3. It is argued that measures in seconds are preferable to measures in beats per minute or ratios, because the physiological interpretation of this measure is easier, and the sensitivity of measures in seconds is expected to be greater. 4. Finally, we recommend that measures of heart rate variation in the deep-breathing and lying-to-standing manoeuvre are accompanied by information on the mean RR interval duration or mean heart rate to allow correct interpretation of the measures.