Heart rate variability (HRV) is the physiological phenomenon of variation in the time interval between heartbeats. It is measured by the variation in the beat-to-beat interval. Other terms used include: "cycle length variability", "RR variability" (where R is a point corresponding to the peak of the QRS complex of the ECG wave; and RR is the interval between successive Rs), and "heart period variability". See also Heart rate turbulence, Sinus rhythm. Methods used to detect beats include: ECG, blood pressure, ballistocardiograms,[1][2] and the pulse wave signal derived from a photoplethysmograph (PPG). ECG is considered superior because it provides a clear waveform, which makes it easier to exclude heartbeats not originating in the sinoatrial node. The term "NN" is used in place of RR to emphasize the fact that the processed beats are "normal" beats.

1. Heart Rate Variability Guide
Randy Clare
Respiratory Diagnostics
2016

2. Normal HRV
Normal Poincaré Plot
Has variability to
react to the
physiologic changes
that the body is going
through during sleep

3. Heart Rate Variability
• The Poincaré Plot
◦ X-axis :: measure of the current RR interval
◦ Y-axis :: measure of the next RR interval
Current
RRn
Interval
(x-axis)
Next RR Interval (RRn+1)
(y-axis)

4. Bradycardia
- Normal Sinus Rhythm,
where heart rate is
below 60 bpm
- All of the points shift to
the upper right
- Display’s INCREASED
time between R-R
intervals

5. Tachycardia
◦ All of the points
shift to the lower
left
◦ Display’s
DECREASED
time between R-
R intervals

6. -“Dot” Pattern
represents
pacemaker
-NO variability from
the
patient
-Heart rate totally
controlled
by pacer
Pacemaker

7. On Demand Pacemaker
◦ Controlled
Rhythm
◦ Not much
variance

8. OSA – Brady/Tachy
• Typical Pattern for OSA patient
◦ HR DECREASES during Apneic Event
◦ HR INCREASES after Apneic Event
Decreased
HR
Increased
HR

9. Obstructive Sleep Apnea
“Fan” Pattern
• Wide variations in R-wave
interval
• Typical OSA Patient pattern
• Data points vary from
Tachycardia (lower left
corner) to Bradycardia (upper
right corner)
Tachycardia Points
Bradycardia Points

10. OSA Patient Pre-Treatment

11. OSA Patient Post Treatment

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14. Questions

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