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Journal of Clinical Monitoring and Computing

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Open Access 21-10-2023 | Bariatric Surgery | Original Research

Postoperative circadian patterns in wearable sensor measured heart rate: a prospective observational study

Authors: Eveline H.J. Mestrom, Jonna A. van der Stam, Simon W. Nienhuijs, Ignace H.J.T. de Hingh, Arjen-Kars Boer, Natal A.W. van Riel, Volkher Scharnhorst, R. Arthur Bouwman

Published in: Journal of Clinical Monitoring and Computing | Issue 1/2024

Abstract

Purpose

This study aimed to describe the 24-hour cycle of wearable sensor-obtained heart rate in patients with deterioration-free recovery and to compare it with patients experiencing postoperative deterioration.

Methods

A prospective observational trial was performed in patients following bariatric or major abdominal cancer surgery. A wireless accelerometer patch (Healthdot) continuously measured postoperative heart rate, both in the hospital and after discharge, for a period of 14 days. The circadian pattern, or diurnal rhythm, in the wearable sensor-obtained heart rate was described using peak, nadir and peak-nadir excursions.

Results

The study population consisted of 137 bariatric and 100 major abdominal cancer surgery patients. In the latter group, 39 experienced postoperative deterioration. Both surgery types showed disrupted diurnal rhythm on the first postoperative days. Thereafter, the bariatric group had significantly lower peak heart rates (days 4, 7–12, 14), lower nadir heart rates (days 3–14) and larger peak-nadir excursions (days 2, 4–14). In cancer surgery patients, significantly higher nadir (days 2–5) and peak heart rates (days 2–3) were observed prior to deterioration.

Conclusions

The postoperative diurnal rhythm of heart rate is disturbed by different types of surgery. Both groups showed recovery of diurnal rhythm but in patients following cancer surgery, both peak and nadir heart rates were higher than in the bariatric surgery group. Especially nadir heart rate was identified as a potential prognostic marker for deterioration after cancer surgery.

Telias I, Wilcox ME. Sleep and circadian rhythm in critical illness. Crit Care. 2019;23(1):82. https://doi.org/10.1186/s13054-019-2366-0.CrossRefPubMedPubMedCentral

McKenna HT, Reiss IK, Martin DS. The significance of circadian rhythms and dysrhythmias in critical illness. J Intensive Care Soc. 2017;18(2):121–9. https://doi.org/10.1177/1751143717692603.CrossRefPubMedPubMedCentral

Smolensky MH, Hermida RC, Reinberg A, Sackett-Lundeen L, Portaluppi F. Circadian disruption: New clinical perspective of disease pathology and basis for chronotherapeutic intervention. Chronobiol Int. 2016;33(8):1101–19. https://doi.org/10.1080/07420528.2016.1184678.CrossRefPubMed

Alam N, Hobbelink EL, van Tienhoven AJ, van de Ven PM, Jansma EP, Nanayakkara PW. The impact of the use of the early warning score (EWS) on patient outcomes: a systematic review. Resuscitation. 2014;85(5):587–94. https://doi.org/10.1016/j.resuscitation.2014.01.013.CrossRefPubMed

Miyazaki T, Kuwano H, Kato H, Ando H, Kimura H, Inose T, et al. Correlation between serum melatonin circadian rhythm and intensive care unit psychosis after thoracic esophagectomy. Surgery. 2003;133(6):662–8. https://doi.org/10.1067/msy.2003.149.CrossRefPubMed

Paul T, Lemmer B. Disturbance of circadian rhythms in analgosedated intensive care unit patients with and without craniocerebral injury. Chronobiol Int. 2007;24(1):45–61. https://doi.org/10.1080/07420520601142569.CrossRefPubMed

Nuttall GA, Kumar M, Murray MJ. No difference exists in the alteration of circadian rhythm between patients with and without intensive care unit psychosis. Crit Care Med. 1998;26(8):1351–5. https://doi.org/10.1097/00003246-199808000-00019.CrossRefPubMed

Freedman NS, Gazendam J, Levan L, Pack AI, Schwab RJ. Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med. 2001;163(2):451–7. https://doi.org/10.1164/ajrccm.163.2.9912128.CrossRefPubMed

Ludin NM, Cheeseman JF, Merry AF, Millar CD, Warman GR. The effects of the general anaesthetic isoflurane on the honey bee (Apis mellifera) circadian clock. Chronobiol Int. 2016;33(1):128–33. https://doi.org/10.3109/07420528.2015.1113987.CrossRefPubMed

10.

Kärkelä J, Vakkuri O, Kaukinen S, Huang WQ, Pasanen M. The influence of anaesthesia and surgery on the circadian rhythm of melatonin. Acta Anaesthesiol Scand. 2002;46(1):30–6. https://doi.org/10.1034/j.1399-6576.2002.460106.x.CrossRefPubMed

11.

Poulsen RC, Warman GR, Sleigh J, Ludin NM, Cheeseman JF. How does general anaesthesia affect the circadian clock? Sleep Med Rev. 2018;37:35–44. https://doi.org/10.1016/j.smrv.2016.12.002.CrossRefPubMed

12.

van Zuylen ML, Meewisse AJG, Ten Hoope W, Eshuis WJ, Hollmann MW, Preckel B, et al. Effects of surgery and general anaesthesia on sleep-wake timing: CLOCKS observational study. Anaesthesia. 2022;77(1):73–81. https://doi.org/10.1111/anae.15564.CrossRefPubMed

13.

Davidson S, Villarroel M, Harford M, Finnegan E, Jorge J, Young D, et al. Day-to-day progression of vital-sign circadian rhythms in the intensive care unit. Crit Care. 2021;25(1):156. https://doi.org/10.1186/s13054-021-03574-w.CrossRefPubMedPubMedCentral

14.

van Ede ES, Scheerhoorn J, Bonomi AG, Buise MP, Bouwman RA, Nienhuijs SW. Continuous remote monitoring in post-bariatric surgery patients: development of an early warning protocol. Surg Obes Relat Dis. 2022. https://doi.org/10.1016/j.soard.2022.06.018.CrossRefPubMed

15.

Breteler MJM, KleinJan E, Numan L, Ruurda JP, Van Hillegersberg R, Leenen LPH, et al. Are current wireless monitoring systems capable of detecting adverse events in high-risk surgical patients? A descriptive study. Injury. 2020;51(Suppl 2):97–s105. https://doi.org/10.1016/j.injury.2019.11.018.CrossRef

16.

Eddahchouri Y, Peelen RV, Koeneman M, Touw HRW, van Goor H, Bredie SJH. Effect of continuous wireless vital sign monitoring on unplanned ICU admissions and rapid response team calls: a before-and-after study. Br J Anaesth. 2022;128(5):857–63. https://doi.org/10.1016/j.bja.2022.01.036.CrossRefPubMed

17.

Kim J, Campbell AS, de Ávila BE, Wang J. Wearable biosensors for healthcare monitoring. Nat Biotechnol. 2019;37(4):389–406. https://doi.org/10.1038/s41587-019-0045-y.CrossRefPubMedPubMedCentral

18.

Jacobs F, Scheerhoorn J, Mestrom E, van der Stam J, Bouwman RA, Nienhuijs S. Reliability of heart rate and respiration rate measurements with a wireless accelerometer in postbariatric recovery. PLoS ONE. 2021;16(4):e0247903. https://doi.org/10.1371/journal.pone.0247903.CrossRefPubMedPubMedCentral

19.

van der Stam JA, Mestrom EHJ, Scheerhoorn J, Jacobs F, de Hingh I, van Riel NAW, et al. Accuracy of vital parameters measured by a wearable patch following major abdominal cancer surgery. Eur J Surg Oncol. 2021. https://doi.org/10.1016/j.ejso.2021.10.034.CrossRefPubMed

20.

Cousins L, Rigg L, Hollingsworth D, Meis P, Halberg F, Brink G, et al. Qualitative and quantitative assessment of the circadian rhythm of cortisol in pregnancy. Am J Obstet Gynecol. 1983;145(4):411–6. https://doi.org/10.1016/0002-9378(83)90309-5.CrossRefPubMed

21.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae.CrossRefPubMedPubMedCentral

22.

Collett D. Modelling Binary Data. Boca Raton Florida: Chapman & Hall/CRC; 1999.

23.

Team R. RStudio: Integrated Development Environment for R. http://www.rstudio.com/ (2021). Accessed.

24.

Young ME, Bray MS. Potential role for peripheral circadian clock dyssynchrony in the pathogenesis of cardiovascular dysfunction. Sleep Med. 2007;8(6):656–67. https://doi.org/10.1016/j.sleep.2006.12.010.CrossRefPubMedPubMedCentral

25.

Olofsson K, Alling C, Lundberg D, Malmros C. Abolished circadian rhythm of melatonin secretion in sedated and artificially ventilated intensive care patients. Acta Anaesthesiol Scand. 2004;48(6):679–84. https://doi.org/10.1111/j.0001-5172.2004.00401.x.CrossRefPubMed

26.

Birnbaumer P, Traninger H, Borenich A, Falgenhauer M, Modre-Osprian R, Harpf H, et al. Heart rate performance curve is dependent on age, sex, and performance. Front Public Health. 2020;8:98. https://doi.org/10.3389/fpubh.2020.00098.CrossRefPubMedPubMedCentral

27.

Shargal E, Kislev-Cohen R, Zigel L, Epstein S, Pilz-Burstein R, Tenenbaum G. Age-related maximal heart rate: examination and refinement of prediction equations. J Sports Med Phys Fitness. 2015;55(10):1207–18.PubMed

28.

Davidson S, Villarroel M, Harford M, Finnegan E, Jorge J, Young D, et al. Vital-sign circadian rhythms in patients prior to discharge from an ICU: a retrospective observational analysis of routinely recorded physiological data. Crit Care. 2020;24(1):181. https://doi.org/10.1186/s13054-020-02861-2.CrossRefPubMedPubMedCentral

29.

van Goor HMR, van Loon K, Breteler MJM, Kalkman CJ, Kaasjager KAH. Circadian patterns of heart rate, respiratory rate and skin temperature in hospitalized COVID-19 patients. PLoS ONE. 2022;17(7):e0268065. https://doi.org/10.1371/journal.pone.0268065.CrossRefPubMedPubMedCentral

30.

Barazi N, Polidovitch N, Debi R, Yakobov S, Lakin R, Backx PH. Dissecting the Roles of the autonomic nervous system and physical activity on Circadian Heart Rate Fluctuations in mice. Front Physiol. 2021;12. https://doi.org/10.3389/fphys.2021.692247.

31.

Hodgetts TJ, Kenward G, Vlackonikolis I, Payne S, Castle N, Crouch R, et al. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation. 2002;54(2):115–23.CrossRefPubMed

32.

van der Stam JA, Mestrom EHJ, Nienhuijs SW, de Hingh I, Boer AK, van Riel NAW, et al. A wearable patch based remote early warning score (REWS) in major abdominal cancer surgery patients. Eur J Surg Oncol. 2022. https://doi.org/10.1016/j.ejso.2022.08.034.CrossRefPubMed

33.

van Rossum MC, Vlaskamp LB, Posthuma LM, Visscher MJ, Breteler MJM, Hermens HJ, et al. Adaptive threshold-based alarm strategies for continuous vital signs monitoring. J Clin Monit Comput. 2022;36(2):407–17. https://doi.org/10.1007/s10877-021-00666-4.CrossRefPubMed

Title: Postoperative circadian patterns in wearable sensor measured heart rate: a prospective observational study
Authors: Eveline H.J. Mestrom
Jonna A. van der Stam
Simon W. Nienhuijs
Ignace H.J.T. de Hingh
Arjen-Kars Boer
Natal A.W. van Riel
Volkher Scharnhorst
R. Arthur Bouwman
Publication date: 21-10-2023
Publisher: Springer Netherlands
Keywords: Bariatric Surgery
Bariatric Surgery
Published in: Journal of Clinical Monitoring and Computing / Issue 1/2024
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-023-01089-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Postoperative circadian patterns in wearable sensor measured heart rate: a prospective observational study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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