Objective: Respiratory sinus arrhythmia (RSA) refers to heart rate oscillations synchronous with respiration, and it is one of the major representations of cardiorespiratory coupling. Its strength has been suggested as a biomarker to monitor different conditions, and diseases. Some approaches have been proposed to quantify the RSA, but it is unclear which one performs best in specific scenarios. The main objective of this study is to compare seven state-of-the-art methods for RSA quantification using data generated with a model proposed to simulate, and control the RSA. These methods are also compared, and evaluated on a real-life application, for their ability to capture changes in cardiorespiratory coupling during sleep. Methods: A simulation model is used to create a dataset of heart rate variability, and respiratory signals with controlled RSA, which is used to compare the RSA estimation approaches. To compare the methods objectively in real-life applications, regression models trained on the simulated data are used to map the estimates to the same measurement scale. Results, and conclusion: RSA estimates based on cross entropy, time-frequency coherence, and subspace projections showed the best performance on simulated data. In addition, these estimates captured the expected trends in the changes in cardiorespiratory coupling during sleep similarly. Significance: An objective comparison of methods for RSA quantification is presented to guide future analyses. Also, the proposed simulation model can be used to compare existing, and newly proposed RSA estimates. It is freely accessible online.

Objective: the aim of this study is to evaluate whether noninvasive autonomic activity assessment could represent a potential tool for the stratification of asthmatic subjects based on symptoms control, using only 10-min electrocardiographic and respiratory signals. Methods: several heart rate variability (HRV) derived indexes, which are regarded as surrogates of autonomic activity, were evaluated in a group of asthmatic patients classified based on their symptomatology control. The effect of respiration on HRV was mitigated by means of orthogonal subspace projection. The most relevant features were used for training different classifiers. Results: similar classification performance was obtained when using HRV or clinical features, with just a 10% decrease in accuracy when using the HRV features (80% vs. 70%). This classification performance is equivalent to that achieved in new patients using the current asthma control tests. Conclusion: results suggest that the noninvasive assessment of autonomic activity could represent an added value for the monitoring of asthmatic subjects outside the clinic, using less cumbersome equipment, and therefore being suitable for an objective asthma self-monitoring. Significance: This study provides evidence on the usefulness of noninvasive autonomic activity assessment for asthma control stratification, supporting it as a potential complement to the current clinical practice.

Respiratory sinus arrhythmia (RSA) is one of the forms of cardiorespiratory coupling. It has been suggested as a potential biomarker for diverse illnesses and conditions. In general, methods for non-invasive quantification of the RSA combine information from heart rate variability (HRV) and respiratory signals. Abnormal beats, which commonly occur in different populations, alter the reliability of the HRV and thus hinder the quantification of the RSA. To overcome this problem, several methods for detection and correction of irregular beats have been reported in literature. However, the effect of each of these methods on the quantification of the RSA is not well understood yet. For this reason, an approach that avoids this step might be useful. This paper presents an alternative based on robust regression models. For comparison purposes, an algorithm to detect and correct for irregular beats, in combination with a state-of-the-art RSA estimate, are tested. A similar performance is achieved with both approaches. These results show that the proposed robust methodology is able to capture the strength of the RSA, even when irregular beats are present, avoiding the irregularities correction step.