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Publicações

2019

A wearable approach for intraoperative physiological stress monitoring of multiple cooperative surgeons

Autores
Pimentel, G; Rodrigues, S; Silva, PA; Vilarinho, A; Vaz, R; Silva Cunha, JPS;

Publicação
International Journal of Medical Informatics

Abstract
It is known that excessive levels of occupational stress affect professionals’ technical and non-technical skills and surgeons are no exception. However, very few studies address this problem in neurosurgeons. A system for monitoring cardiovascular strain and autonomic imbalance during intracranial aneurysm procedures is proposed in order to obtain overall cardiac measures from those procedures. Additionally, this study also allows to detect stressful events and compare their impact with the surgeon's own appraisal. Linear and nonlinear heart rate variability (HRV) features were extracted from surgeon's electrocardiogram (ECG) signal using wearable ECG monitors and mobile technology during 10 intracranial aneurysm surgeries with two surgeons. Stress appraisal and cognitive workload were assessed using self-report measures. Findings suggest that the surgeon associated to the main role during the clipping can be exposed to high levels of stress, especially if a rupture occurs (pNN20 = 0%), while the assistant surgeon tends to experience mental fatigue. Cognitive workload scores of one of the surgeons were negatively correlated with AVNN, SDNN, pNN20, pNN50, 1 V, 2 L V, SD2 and CVI measures. Cognitive workload was positively related with stress appraisal, suggesting that more mentally demanding procedures are also assessed as more stressful. Finally, pNN20 seems to better mirror behavior during stress moments than pNN50. Additionally, a sympathovagal excitation occurs in one of the professionals after changing to main role. The present methodology shows potential for the identification of harmful events. This work may be of importance for the design of effective interventions in order to reduce surgeons stress levels. Furthermore, this approach can be applied to other professions. © 2019 Elsevier B.V.

2019

The effect of seizure type on ictal and early post-ictal Heart Rate Variability in patients with focal resistant epilepsy

Autores
Faria, MT; Rodrigues, S; Dias, D; Rego, R; Rocha, H; Sa, F; Oliveira, A; Campelo, M; Pereira, J; Rocha Goncalves, F; Cunha, JPS; Martins, E;

Publicação
EUROPEAN HEART JOURNAL

Abstract
Abstract Background Seizures commonly affect the heart rate and its variability. The increased interest in this area of research is related to the possible connection with sudden unexpected death in epilepsy (SUDEP). Generalized tonic-clonic seizures (GTCS) are reported as the most consistent risk factor for SUDEP. However, the general risk of seizures (and their type) on cardiac function still remains uncertain. Purpose To evaluate the influence of seizure type (GTCS vs non-GTCS) on ictal and early post-ictal Heart Rate Variability (HRV) in patients with refractory epilepsy. Methods From January 2015 to July 2018, we prospectively evaluated 121 patients admitted to our institution's Epilepsy Monitoring Unit with focal resistant epilepsy. All patients underwent a 48-hour Holter recording. We included only patients who had both GTCS and non-GTCS during the recording and selected the first seizure of each type to analyze. HRV (AVNN, SDNN, RMSSD, pNN50, and LF/HF) was evaluated by analyzing 5-min-ECG epochs, starting with the seizure onset (ictal and early post-ictal period). The study was approved by our Institution Ethics Committee and all patients gave informed consent. Results Fourteen patients were included (7 Females, 4 patients with Temporal Lobe Epilepsy). The median age was 39 years (min-max, 18–57). Thirty-six percent presented cardiovascular risk factors without known cardiac disease. A significant statistical reduction was found for AVNN (p=0.013), RMSSD (p=0.008), pNN50 (p=0.005) and HF (p=0.003), during GTCS when compared with non-GTCS (Wilcoxon test, p<0.05; two tailed). Conclusion Our study shows a significant reduced vagal tone during GTCS when compared with non-GTCS. Hence, GTCS had a more pronounced impact on HRV changes than other seizure types, which can be associated with higher SUDEP risk after GTCS.

2019

The influence of tonic-clonic seizures on heart rate variability in patients with refractory epilepsy

Autores
Faria, MT; Rodrigues, S; Dias, D; Rego, R; Rocha, H; Sa, F; Oliveira, A; Campelo, M; Pereira, J; Rocha Goncalves, F; Cunha, JPS; Martins, E;

Publicação
EUROPEAN HEART JOURNAL

Abstract
Abstract Background Heart Rate Variability (HRV) is an increasing area of interest in patients with epilepsy. The effects of epilepsy on the autonomic control of the heart are not completely understood and that autonomic dysfunction has been implicated in some cases of Sudden Unexpected Death in Epilepsy (SUDEP). Objective To study the influence of generalized tonic-clonic seizures (GTCS) on HRV of patients with focal refractory epilepsy. Method We prospectively evaluated (January 2015 to July 2018) 121 patients admitted to our institution's Epilepsy Monitoring Unit. All patients performed a 48-hour Holter recording. Patients who had GTCS during the recording were included and we selected the first GTCS as the index seizure. HRV (AVNN, SDNN, RMSSD, pNN50, and LF/HF) was evaluated by analyzing 5-min-ECG epochs during inter-ictal and post-ictal periods: baseline, pre-ictal (5 min before the GTCS seizure), post-ictal (5 min after the seizure), and late post-ictal (>5 hours after the seizure). We compared HRV data from these patients with normative values for a healthy population (controlling age and gender). The study was approved by our Institution Ethics Committee and all patients gave informed consent. Results Twenty three patients were included (mean age: 38.61±11.58; 70% Female). Thirty percent presented cardiovascular risk factors without known cardiac disease. We found significant differences between the analyzed periods for all but one (LF/HF) HRV metrics (using Friedman test, p<0.05, two-tailed). Specifically during the post-ictal period, we found a significant reduction for AVNN, SDNN, RMSSD and pNN50 (Wilcoxon test, p<0.05; two-tailed). LF/HF was increased during this period, but changes were not statistically significant. There was also a tendency for a reduction of AVNN, SDNN, RMSSD and pNN50 and an increase of LF/HF in our patients during all the analyzed periods when compared to normative healthy population values. Conclusion Our work shows reduced HRV after a GTCS in patients with focal resistant epilepsy, both in inter-ictal and post-ictal periods, when compared to normative healthy population values. These results might reflect long term structural changes in autonomic centers. The HRV changes were significant particularly during the post-ictal period, and should prompt further investigation, giving this period is critical for SUDEP.

2019

Transitioning from recruit to officer: An investigation of how stress appraisal and coping influence work engagement

Autores
Rodrigues, S; Sinval, J; Queiros, C; Maroco, J; Kaiseler, M;

Publicação
International Journal of Selection and Assessment

Abstract

2018

Cognitive impact and psychophysiological effects of stress using a biomonitoring platform

Autores
Rodrigues, S; Paiva, JS; Dias, D; Aleixo, M; Filipe, RM; Cunha, JPS;

Publicação
International Journal of Environmental Research and Public Health

Abstract
Stress can impact multiple psychological and physiological human domains. In order to better understand the effect of stress on cognitive performance, and whether this effect is related to an autonomic response to stress, the Trier Social Stress Test (TSST) was used as a testing platform along with a 2-Choice Reaction Time Task. When considering the nature and importance of Air Traffic Controllers (ATCs) work and the fact that they are subjected to high levels of stress, this study was conducted with a sample of ATCs (n = 11). Linear Heart Rate Variability (HRV) features were extracted from ATCs electrocardiogram (ECG) acquired using a medical-grade wearable ECG device (Vital Jacket® (1-Lead, Biodevices S.A, Matosinhos, Portugal)). Visual Analogue Scales (VAS) were also used to measure perceived stress. TSST produced statistically significant changes in some HRV parameters (Average of normal-to-normal intervals (AVNN), Standard Deviation of all NN (SDNN), root mean square of differences between successive rhythm-to-rhythm (RR) intervals (RMSSD), pNN20, and LF/HF) and subjective measures of stress, which recovered after the stress task. Although these short-term changes in HRV showed a tendency to normalize, an impairment on cognitive performance was evident. Despite that participant’s reaction times were lower, the accuracy significantly decreased, presenting more errors after performing the acute stress event. Results can also point to the importance of the development of quantified occupational health (qOHealth) devices to allow for the monitoring of stress responses. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.