JMIR Publications

ABSTRACT

Background:

Deep diaphragmatic breathing (‘belly breathing’) is a popular behavioral intervention that helps children cope with anxiety, stress, and their experience of pain. Combining physiological monitoring with accessible mobile technology can motivate children to comply with this intervention through biofeedback and gaming. These innovative technologies have the potential to improve patient experience and compliance with strategies that reduce anxiety, change the experience of pain and enhance self-regulation during distressing medical procedures.

Objective:

The aim of this paper is to describe a simple biofeedback method for quantifying breathing compliance to be used in a mobile smartphone application.

Methods:

A smartphone application was developed that combined pulse oximetry with an animated protocol for paced deep breathing. We collected photoplethysmogram (PPG) data during spontaneous and subsequently paced deep breathing in children. Two measures, synchronized respiratory sinus arrhythmia (RSAsync) and the corresponding relative synchronized inspiration/expiration heart rate ratio (HR-I:Esync) were extracted from the PPG.

Results:

Data collected from 80 children aged 5-17 years showed a positive RSAsync effect in all participants during paced deep breathing, with a median [(IQR) range] HR-I:Esync ratio of 1.26 [(1.16-1.35) 1.01-1.60] during paced deep breathing compared to 0.98 [(0.96-1.02) 0.82-1.18] during spontaneous breathing (median difference 0.25, 95% confidence interval 0.23-0.30, p-value <0.001). The measured HR-I:Esync values appeared to be age invariant.

Conclusions:

An HR-I:Esync level of 1.1 was identified as an age independent threshold for programming the breathing pattern for optimal compliance in biofeedback.