Stress is an increasingly prevalent mental health condition across the world. In Europe, for example, stress is considered one of the most common health problems, and over USD 300 billion are spent on stress treatments annually. Therefore, monitoring, identification and prevention of stress are of the utmost importance. While most stress monitoring is carried out through self-reporting, there are now several studies on stress detection from physiological signals using Artificial Intelligence algorithms. However, the generalizability of these models is only rarely discussed. The main goal of this work is to provide a monitoring proof-of-concept tool exploring the generalization capabilities of Heart Rate Variability-based machine learning models. To this end, two Machine Learning models are used, Logistic Regression and Random Forest to analyze and classify stress in two datasets differing in terms of protocol, stressors and recording devices. First, the models are evaluated using leave-one-subject-out cross-validation with train and test samples from the same dataset. Next, a cross-dataset validation of the models is performed, that is, leave-one-subject-out models trained on a Multi-modal Dataset for Real-time, Continuous Stress Detection from Physiological Signals dataset and validated using the University of Waterloo stress dataset. While both logistic regression and random forest models achieve good classification results in the independent dataset analysis, the random forest model demonstrates better generalization capabilities with a stable F1 score of 61%. This indicates that the random forest can be used to generalize HRV-based stress detection models, which can lead to better analyses in the mental health and medical research field through training and integrating different models.

/pdf/cross-dataset-analysis-for-generalizability-of-hrv-based-1kua7kji.pdf

Cross Dataset Analysis for Generalizability of HRV-Based Stress Detection Models

Heart rate variability (HRV) has been studied for decades in clinical environments. Currently, the exponential growth of wearable devices in health monitoring is leading to new challenges that need to be solved. These devices have relatively poor signal quality and are affected by numerous motion artifacts, with data loss being the main stumbling block for their use in HRV analysis. In the present paper, it is shown how data loss affects HRV metrics in the time domain and frequency domain and Poincaré plots. A gap-filling method is proposed and compared to other existing approaches to alleviate these effects, both with simulated (16 subjects) and real (20 subjects) missing data. Two different data loss scenarios have been simulated: (i) scattered missing beats, related to a low signal to noise ratio; and (ii) bursts of missing beats, with the most common due to motion artifacts. In addition, a real database of photoplethysmography-derived pulse detection series provided by Apple Watch during a protocol including relax and stress stages is analyzed. The best correction method and maximum acceptable missing beats are given. Results suggest that correction without gap filling is the best option for the standard deviation of the normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD) and Poincaré plot metrics in datasets with bursts of missing beats predominance (p<0.05), whereas they benefit from gap-filling approaches in the case of scattered missing beats (p<0.05). Gap-filling approaches are also the best for frequency-domain metrics (p<0.05). The findings of this work are useful for the design of robust HRV applications depending on missing data tolerance and the desired HRV metrics.

https://www.mdpi.com/1424-8220/22/15/5774/pdf?version=1660212934

Effects of Missing Data on Heart Rate Variability Metrics

Thanks to wearable devices joint with AI algorithms, it is possible to record and analyse physiological parameters such as heart rate variability (HRV) in ambulatory environments. The main downside to such setups is the bad quality of recorded data due to movement, noises, and data losses. These errors may considerably alter HRV analysis and should therefore be addressed beforehand, especially if used for medical diagnosis. One widely used method to handle such problems is interpolation, but this approach does not preserve the time dependence of the signal. In this study, we propose a new method for HRV processing including filtering and iterative data imputation using a Gaussian distribution. The particularity of the method is that many physiological aspects are taken into consideration, such as HRV distribution, RR variability, and normal boundaries, as well as time series characteristics. We study the effect of this method on classification using a random forest classifier (RF) and compare it to other data imputation methods including linear, shape-preserving piecewise cubic Hermite (pchip), and spline interpolation in a case study on stress. Features from reconstructed HRV signals of 67 healthy subjects using all four methods were analysed and separately classified by a random forest algorithm to detect stress against relaxation. The proposed method reached a stable F1 score of 61% even with a high percentage of missing data, whereas other interpolation methods reached approximately 54% F1 score for a low percentage of missing data, and the performance drops to about 44% when the percentage is increased. This suggests that our method gives better results for stress classification, especially on signals with a high percentage of missing data.

/pdf/preprocessing-methods-for-ambulatory-hrv-analysis-based-on-1ueplixw.pdf

Preprocessing Methods for Ambulatory HRV Analysis Based on HRV Distribution, Variability and Characteristics (DVC)

AIMS
Heart failure is a serious condition that often goes undiagnosed in primary care due to the lack of reliable diagnostic tools and the similarity of its symptoms with other diseases. Non-invasive monitoring of heart rate variability (HRV), which reflects the activity of the autonomic nervous system, could offer a novel and accurate way to detect and manage heart failure patients. This study aimed to assess the feasibility of using machine learning techniques on HRV data as a non-invasive biomarker to classify healthy adults and those with heart failure.


METHODS AND RESULTS
We used digitized electrocardiogram recordings from 54 adults with normal sinus rhythm and 44 adults categorized into New York Heart Association classes 1, 2, and 3, suffering from congestive heart failure. All recordings were sourced from the PhysioNet database. Following data pre-processing, we performed time-domain HRV analysis on all individual recordings, including root mean square of the successive difference in adjacent RR interval (RRi) (RMSSD), the standard deviation of RRi (SDNN, the NN stands for natural or sinus intervals), the standard deviation of the successive differences between successive RRi (SDSD), the number or percentage of RRi longer than 50 ms (NN50 and pNN50), and the average value of RRi [mean RR interval (mRRi)]. In our experimental classification performance evaluation, on the computed HRV parameters, we optimized hyperparameters and performed five-fold cross-validation using four machine learning classification algorithms: support vector machine, k-nearest neighbour (KNN), naïve Bayes, and decision tree (DT). We evaluated the prediction accuracy of these models using performance criteria, namely, precision, recall, specificity, F1 score, and overall accuracy. For added insight, we also presented receiver operating characteristic (ROC) plots and area under the ROC curve (AUC) values. The overall best performance accuracy of 77% was achieved when KNN and DT were trained on computed HRV parameters with a 5 min time window. KNN obtained an AUC of 0.77, while DT attained 0.78. Additionally, in the classification of severe congestive heart failure, KNN and DT had the best accuracy of 91%, with KNN achieving an AUC of 0.88 and DT obtaining 0.92.


CONCLUSIONS
The results show that HRV can accurately predict severe congestive heart failure. The findings of this study could inform the use of machine learning approaches on non-invasive HRV, to screen congestive heart failure individuals in primary care.

Time-domain heart rate variability features for automatic congestive heart failure prediction.

Advances in robotics have contributed to the prevalence of human-robot collaboration (HRC). However, working and interacting with collaborative robots in close proximity can be psychologically stressful. Therefore, understanding the impacts of human-robot interaction (HRI) on mental stress is crucial for enhancing workplace well-being. To this end, this study investigated how the HRI factors – presence, complexity, and modality – affect the psychological stress of workers. We employed both the NASA-Task Load Index for subjective assessment and physiological metrics including galvanic skin responses, electromyography, and heart rate for objective evaluation. An experimental setup was implemented in which human operators worked together with a collaborative robot on Lego assembly tasks, using different interaction paradigms including pressing buttons, showing hand gestures, and giving verbal commands. The results revealed that the introduction of interactions during HRC helped reduce mental stress and that complex interactions resulted in higher mental stress than simple interactions. Meanwhile, using hand gestures led to significantly higher mental stress than pressing buttons and verbal commands. The findings provided practical insights for mitigating mental stress in the workplace and promoting wellness in the era of HRC. 

Exploring the impact of human-robot interaction on workers' mental stress in collaborative assembly tasks.

Although chronic stress is proven to be very harmful to physical and mental well being, its diagnosis is punctual and nontrivial, which calls for reliable, continuous and automated stress monitoring systems that do not yet exist. Wireless biosensors offer opportunities to remotely detect and monitor mental stress levels, enabling improved diagnosis and early treatment. There are different algorithms and methods for wearable stress detection, however, only a few standard and publicly available datasets exist today. In this paper, we introduce a multi-modal high-quality stress detection dataset with details of the experimental protocol. The dataset includes physiological, behavioural and motion data from 74 subjects during a lab study. Different modalities such as electrocardiograms (ECG), photoplethysmograms (PPG), electrodermal activity (EDA), electromyograms (EMG) as well as three axis gyroscope and accelerometer data were recorded. In addition, protocol validation was achieved using both subject’s self-reports and cortisol levels which is considered as gold standard for stress detection.

Mmsd: A Multi-modal Dataset for Real-time, Continuous Stress Detection from Physiological Signals

The Impact of Missing Data on Heart Rate Variability Features: A Comparative Study of Interpolation Methods for Ambulatory Health Monitoring

Stress has been classified as the health epidemic of the 21st century with an increasingly active research interest within the fields of psychology, neuroscience, medicine, and more recently affective computing. At present, stress is identified through cortisol levels in saliva but there is no unanimously accepted standard for continuous stress evaluation. With recent development in wearable sensors, many scientists are interested in stress identification through physiological signals such as the Heart rate variability (HRV). In this paper, we present a supervised machine learning-based algorithm to detect stress from HRV derived from electrocardiograms (ECG) as well as photoplethysmograms (PPG), as a low cost alternative to ECG. HRV features from ECG and PPG signals of 46 healthy subjects were analysed and used to separately train and test a subject-independent Random Forest algorithm. In both datasets, stress was accurately identified with more than 80% F1-score and 90% AUC. Results show that PPG is a good surrogate to ECG for HRV analysis and stress detection. The proposed algorithm has the potential to assist researchers and clinicians in the automated continuous analysis of stress.

Comparison of Stress Detection through ECG and PPG signals using a Random Forest-based Algorithm

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