Application of a Speedy Modified Entropy Method in Assessing the Complexity of Baroreflex Sensitivity for Age-Controlled Healthy and Diabetic Subjects

Abstract

The percussion entropy index (PEIorginal) was recently introduced to assess the complexity of baroreflex sensitivity. This study aimed to investigate the ability of a speedy modified PEI (i.e., PEINEW) application to distinguish among age-controlled subjects with or without diabetes. This was carried out using simultaneous photo-plethysmo-graphy (PPG) pulse amplitude series and the R wave-to-R wave interval (RRI) series acquired from healthy subjects (Group 1, number = 42), subjects diagnosed as having diabetes mellitus type 2 with satisfactory blood sugar control (Group 2, number = 38), and type 2 diabetic patients with poor blood sugar control (Group 3, number = 35). Results from PEIorginal and multiscale cross-approximate entropy (MCAE) were also addressed with the same datasets for comparison. The results show that optimal prolongation between the amplitude series and RRI series could be delayed by one to three heartbeat cycles for Group 2, and one to four heartbeat cycles for Group 3 patients. Group 1 subjects only had prolongation for one heartbeat cycle. This study not only demonstrates the sensitivity of PEINEW and PEIorginal in differentiating between Groups 2 and 3 compared with MCAE, highlighting the feasibility of using percussion entropy applications in autonomic nervous function assessments, it also shows that PEINEW can considerably reduce the computational time required for such processes.

Digital Volume Pulse Measured at the Fingertip as an Indicator of Diabetic Peripheral Neuropathy in the Aged and Diabetic

“…The diabetic patients were then divided into two groups; namely, middle-aged subjects diagnosed as having type 2 diabetes without peripheral neuropathy within 5 years (group 2, age range: 42-86 years, n = 42, glycated hemoglobin (HbA1c) ≥ 6.5%), and type 2 diabetic patients with peripheral neuropathy within 5 years (group 3, age range: 37-75 years, n = 24). There were 10 diabetic patients in group 3 with good blood glucose control (i.e., 6.5% HbA1c < 8%) in our present study, and 14 diabetic patients who originally had poor blood glucose control (i.e., HbA1c 8%) [17]. The screening DPN of type 2 diabetes patients at baseline of PPG measurement and follow-up periods (i.e., 5 years) was based on the presence of symptoms of numbness, tingling, or pain of distal extremities lasting for more than 3 months, along with a confirmed diagnosis by the clinic doctor.…”

“…Although PEI RRI has recently been reported to assess the complexity of BRS [16,17], the significance of smaller PEI RRI values concerning the identification of subjects with type 2 diabetes who are more prone to develop DPN is unknown. In addition, there were no notable differences between the test diabetic patients in groups 2 and 3 with anthropometric, demographic, hemodynamic, and serum biochemical parameters (p > 0.017) ( Table 1).…”

“…The baroreflex is one of the body's homeostatic mechanisms that is reflected in a physiological phenomenon where a decrease in blood pressure makes the RRI shorter, and an increase in blood pressure makes the RRI longer. In our previous study [16,17], synchronized RRI and amplitude series from DVP signals were used to develop a percussion entropy index to assess diabetic autonomic nervous dysfunction. However, an ECG is not convenient for real-time application.…”

“…The LHR index is considered to reflect human autonomic failure [10,11], because physiological signals from the human body are almost nonstationarity and nonlinear [12][13][14]. Recently, several new parameters based on nonlinear HRV calculations were reported for autonomic function and BRS assessments [15][16][17]. Among these parameters, a small-scale multiscale entropy index (MEI RRI ) was addressed to reflect on autonomic function based on a nonlinear method for studying HRV using only the RRI datasets [15].…”

“…Among these parameters, a small-scale multiscale entropy index (MEI RRI ) was addressed to reflect on autonomic function based on a nonlinear method for studying HRV using only the RRI datasets [15]. In recent years, the percussion entropy index (PEI) using synchronized ECG and photoplethysmography (PPG) signals has been used effectively to assess BRS complexity in the aged and diabetic patients associated with type 2 diabetes-associated autonomic dysfunction [16,17]. The peak-to-peak intervals (PPIs) acquired by the PPG sensor were reported to assess HRV [18][19][20][21][22][23].…”