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Eye GazeInduced Mental Stress Alters the

Heart Rate Variability Analysis
ARTICLE in JOURNAL OF CLINICAL ENGINEERING APRIL 2014
DOI: 10.1097/JCE.0000000000000023

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Feature Article

Eye GazeYInduced Mental Stress Alters the

Heart Rate Variability Analysis
Yogender Aggarwal, PhD, Nishant Singh, MSc, Subhojit Ghosh, PhD, and Rakesh Kumar Sinha, PhD

The objective of this work was to investigate mental stress

produced under eye fixation through the analysis of heart
rate variability (HRV). The multichannel electrophysiological
data (electrocardiogram, pulse plethysmogram along with
electro-oculogram) were acquired from young, healthy
male volunteers (aged 20-30 years; weight, 55-65 kg), and
20 trials per subject were recorded for 30 seconds of eye
gaze followed by 10 seconds of relaxation. The parameters
for HRV were calculated, analyzed, and compared before
the feature extraction and classification of eye gaze from
rest using fuzzy C means clustering and Kohonen
neural network. Only HRV data were considered for final
feature extraction and classification purposes as the pulse
rate variability represented similar variations as HRV.
Irrespective to subject and condition, analyses show
changes in all the parameters, but with contradiction in
1 of 2 subjects that showed no change in at least 1 parameter.
Furthermore, on the extracted features from frequency
spectrum of HRV data (100 gaze and 100 relax), fuzzy
C means clustering and Kohonen neural network were
found to be efficient with an accuracy of 98%. This high
accuracy in features classification strongly supports its practical
implementation in the evaluation of mental stress level.

Corresponding author: Yogender Aggarwal, PhD, Center for Biomedical

Instrumentation, Birla Institute of Technology, Mesra, Ranchi, Jharkhand,
India 835215 (yogender.aggarwal@gmail.com).
Yogender Aggarwal, PhD, is an assistant professor at the Center for
Biomedical Instrumentation, Birla Institute of Technology, Mesra, Ranchi,
Jharkhand, India.
Nishant Singh, MSc, is a research scholar at the Center for Biomedical
Instrumentation, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India.
Subhojit Ghosh, PhD, is an assistant professor at the Department of Electrical
Engineering, National Institute of Technology, Raipur, Chhatisgarh, India.
Rakesh Kumar Sinha, PhD, is an associate professor at the Center for
Biomedical Instrumentation, Birla Institute of Technology, Mesra, Ranchi,
Jharkhand, India.
This article has not been published, nor is being considered for publication,
elsewhere.
Financial support was received through University Grants Commission,
New Delhi, India, for under Major Research Project (F. No. 36-60/2008
[SR]) and Minor Research Project (F. No. 40-470/2011 [SR]).
DOI: 10.1097/JCE.0000000000000023

Journal of Clinical Engineering

Introduction
Stress has a psychological origin and/or is due to mental
mode under different events and abnormalities1 that affect
several physiological processes.2,3 Stress triggers the autonomic
nervous system (ANS) in which parasympathetic nervous
system (PNS) is suppressed and sympathetic nervous system (SNS) is activated. This activation and suppression of
the ANS cause the release of hormones in bloodstream responsible for vasoconstriction and alterations in blood pressure and heart rate. However, when stress is no longer present,
the sympathovagal balance is established through homeostasis between the SNS and PNS.4 With the applications
of advanced functional imaging devices and with mental
chronometric techniques,5 it is now established that the
degree of zonal cerebral activation is correlated with the
degree of mental stress or effort,6 which is also responsible
for modulating the autonomic responses.7,8 Furthermore,
it can be suggested that the unidirectional continuous goal
directed eye gaze may produce mental effort, and the firing
of the cortical neurons of the parietal and occipital region of
the brain is highly correlated with the visual information.9-11
A number of methods have been suggested in stress measurement through speech, salivary amylase, oxygen saturation in arteries, skin temperature fluctuations, heartbeat rate,
blood pressure, electrodermal activity, and pressure at fingertips.1 In this, the heart rate variability (HRV) as an indicator of the dynamic interaction and balance between the
sympathetic and parasympathetic systems2 has been widely
accepted in stress assessment. For the change in heart rate,
explained as alterations in activation of sympathetic activity,
in evaluating the sleep stages,3 concentration meditation1,2
has already been proposed. Furthermore, the spectral analysis method has also been suggested in understanding the
state of ANS and its use in assessing the HRV.3 These works
have demonstrated that significant alteration in autonomic
parameters occurs with the mental efforts. But the literature on the analysis of variation in autonomic responses
due to visual and/or eye gaze parameters is still virtually
nonexistent.
In the present work, therefore, efforts have been made
to analyze the effects of prolonged eye gaze on a specific
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Feature Article

FIGURE 1. The experimental paradigm used for the recording.

autonomic response, that is, the HRV. Furthermore, the

features extracted from the HRV have been classified into
2 categories corresponding to active gaze and rest periods
with the help of fuzzy C means clustering and Kohonen
neural network (KNN). The primary aim of this work was
to identify the variations in HRV, if any, produced by the
eye gaze and to evaluate whether the alterations in HRV
can be used for mental stress assessment.

Subjects and Experimental Setup

This study involved 5 healthy male young volunteers, aged
20 to 30 years and weigh 55 to 65 kg. The protocol for data
recording was well explained and demonstrated to all the
subjects, and written consent was obtained for their participation in this research study. The experiment was designed
to record the electrocardiogram (ECG) and pulse plethysmogram (PPG) with electro-oculogram (EOG) to analyze
the effects, if any, with the steadiness of eye fixation with the
help of 4-channel bioamplifier (Biopac Inc, Goleta, California)
and Ag-AgCl disposable electrodes. Three-channel electrophysiology recordings were performed for 20 trials per
subject (total 100 trials from 5 subjects; S1-S5). Each trial
consists of 30 seconds of eye gaze followed by 10 seconds
relaxation period (Figure 1). During the eye gaze, a smiley
appears at the center of the computer screen for 30 seconds.
The subjects were asked to gaze the smiley constantly. After

the finish of gaze period, a star appears on the screen for

10 seconds to signal the subject for rest condition. During
the rest period, subjects were instructed to relax with the eye
opened; however, eye blink was allowed. For the recording,
the subject was made to sit on an armed rest chair with the
foot resting on an insulated surface. The PPG signal was
recorded from distal phalanges of the index finger of the
left hand. For EOG, 1 electrode was placed above the nasion,
and 2 below the outer canthi of the eyes, on right and left
positions, respectively, generating a right-angled triangle
(Figure 2) as suggested by Scherer et al.12 Digital records
(sampling frequency: 200 samples/s) of electrophysiological
data were stored for further processing and classification.
The ECG and PPG data were preprocessed to remove the
baseline drift and high-frequency movement noise. These
data were filtered with bandpass filter of 2 to 25 Hz before
the HRVanalysis. The EOG signals were taken as reference
for constant eye gaze.

Theory and Methods

The present work is divided in 2 sections, that is, HRV
analysis and feature extraction and classification.
Heart Rate Variability
A time series of RR interval is the time between successive
R waves, and the variation in the time series of consecutive
heartbeats is referred to as tachogram. It is considered as

FIGURE 2. Representative diagram of the electrode placement and recording setup.

80

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Volume 39 & Number 2 & April/June 2014

Feature Article
an index of autonomic neural control of cardiopulmonary
system. Furthermore, the calculated tachogram is used for
HRV analyses with the help of HRVAS,13 using different
techniques, which includes analysis in time domain, frequency domain, time-frequency domain, and nonlinear
methods to estimate the fluctuations in the heart rate13-16
for both the eye fixation and relax condition.
Interpolated HRV Estimation
For the present work, a total of 200 trials (100 each for gaze
and relax periods) for the 5 subjects using Acknowledge
4.0 (Biopac Inc) have been used. A threshold level of 0.5 V
was decided for the selection of R-wave peaks. It was used
for the calculation of interpolated HRV (IHRV) and interpolated PPG (IPPG) from ECG and PPG signals at 8-Hz
spline resampling frequency, respectively, by a linear interpolation method. The trials of IHRV and IPPG were normalized to keep their origin at 1 point. It was achieved by
subtracting digital values of the trials with their fifth digital
value. Furthermore, the average of these normalized trials
were calculated and plotted for mean IHRVand mean IPPG
analysis both for eye gaze (30 seconds) and relax condition
(10 seconds).
Time-Domain Analysis
Parameters included in the time-domain method are mean
RR interval, SD of RR interval series (SDNN), SD of the
heart rate, root mean square of the successive differences
in RR time series (RMSSD), triangular index (TI), and triangular interpolation of the RR interval histogram (TiNN).
These parameters are calculated as follows:
SDNN

SDHR

s
;
1 N
~ RRj
RR2
N
1 j
1

v
u N 

; 2
u
u~
60000=RRj
HR
t
j
1

N
1

s
2
1 N
1 
RMSSD
~ RRj1
RRj
N
1 j
1
TI

N
Y

where N is the number of RR interval, Y is the highest denY

Y
sity of RR interval on histogram, and HR is the mean RR
interval and the mean heart rate.
Some geometric measures are based on the density distribution (histogram) of RR intervals, which are converted
into a discrete scale. The most common geometric pattern
derived from this density distribution used is the TiNN of
RR intervals. In this, the effect of irregular data points is
reduced and usually shorter or longer than the normal RR
intervals and thus falls out of the normal range.
Frequency-Domain Analysis
The estimated IHRV is highly nonstationary and unevenly
sampled signal. Thus, here the Lomb-Scargle periodogram
Journal of Clinical Engineering

method has been used to evaluate changes in respective

frequency bands, that is, (i) very low frequency (VLF) 0 to
0.04 Hz; (ii) low frequency (LF) 0.04 to 0.15 Hz, and (iii)
high frequency (HF) 0.15 to 0.4 Hz. The Lomb-Scargle
periodogram estimates are obtained by performing the leastsquares fit of sinusoids to the data (X) of length N for arbitrary time tn, which is given as follows:
2
2 
2 3
N
N
;
;
~ X t n
X Cos2f t n

~ X t n
X Sin 2f tn
 7
1 6
6 n
1
7
n
1
PLS f 2 6

75
N
N
5
2
4
~ Cos2 2f t n

~ Sin2 2f t n

n
1

n
1

where, X and
2 are the mean and variance of the time series and
0 N
1
~ Sin4Pft n
B n
1
C
C
T tan
1 B
@N
A
~ Cos4Pft n

n
1

where, T is a frequency-dependent time delay.

Time-Frequency Analysis
The time-frequency analysis has been done to evaluate both
the power distribution in frequency and the temporal information of the signal. The RR time series signals were analyzed using the wavelet transform and used to evaluate the
ratio of LF to HF and the power of LF and HF bands in
normalized units (nu),
where
Total power ms2 LF ms2 HF ms2 VLF ms2
LF nu LF ms2 = total power ms2
VLF ms2
HF nu HF ms2 = total power ms2
VLF ms2
LF=HF ratio of LF ms2 = HF ms2

Poincare Plot Analysis

Poincare plot is another important parameter to analyze
the HRV of the subject. It is used to estimate the selfsimilarity of successive RR intervals that involves parameterizing the shape to fit an ellipse to the plot. The ellipse is
oriented according to the line of identity (RRj = RRj+1).
The SD of the points perpendicular to the line of identity
is denoted by SD1, also known as short-term variability,
which is mainly caused by respiratory sinus arrhythmia.
The SD along the line of identity is denoted by SD2 and
describes the long-term variability. The points above and
below the line of identity show increase (decrease in HR)
and decrease (increase in HR) in RR interval, respectively,
and the points on the line of identity have equal RR interval. In reality, the ellipse is primarily a visual aid, and the
numerical values of the SDs SD1 and SD2 contain the important data.15
Detrended Fluctuation Analysis
The detrended fluctuation analysis (DFA) is the root-meansquare fluctuation of an integrated and detrended time series, measured at different scales. The first step in DFA
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81

Feature Article
calculation is the integration of RR interval time series
of length N.
k h
;
yk ~ RRi
RR 

(7

i1

where, RRi is the ith RR interval.

The second step is to segregate the y(k) into segments of
length n; a least-squares line is fit to the data to define the
local trend. Let yn(k) denotes these regression lines. Then,
we detrend the y(k), by subtracting the yn(k), in each segment. The root-mean-square fluctuation of this integrated
and detrended heart rate data is calculated by
F n

r

1 N
~ yk
yn k 2
N k1

Typically, F(n) increases with the segment length. The

fluctuations can be characterized by the slope of the regression line relating log(F(n)) to log n. In DFA, the shortand long-term fluctuations are separated by a break point,
and the correlation is given by a slope of the corresponding
regression line.
Sample Entropy (SE)
It is the embedded entropy that attempts to quantify a signals
complexity and defines the randomness of the heart activity.16 It can be described as the negative logarithm of the
conditional probability of randomly selecting 2 finite length
sequences, from a signal. If the sample entropy (SE) is zero,
then consecutive sequences are identical. On the other hand,
larger values of SE represent higher complexity.
Feature Extraction and Clustering
The frequency spectrum approach using fast Fourier transform (FFT) involves the transformation of a signal from
time domain to frequency domain that is widely used for
extracting features in biological signals. The spectrum can
be considered as a harmonic decomposition of variations
in the signal and hence is equivalent to the analyses of the
distribution in the time-domain properties of a particular
physiological phenomenon. The FFT utilizes the information contained in a signal as a random process to describe
the domination of various frequency components. In the
present work, FFT has been applied to consecutive IHRV
using the Cooley-Tukey algorithm.17
N

j
1k
1

X k ~ xj!N

j1

where, UN = exp ((Y2Pi) /N) and x(j) is the time sequence

to which the transformation is applied.
The FFTs of the IHRV for gaze and rest periods of each
trial were decomposed in 3 subbands of frequency (VLF,
LF, and HF) to get the quantitative measures of the contribution of various frequencies contained in the IHRV.
Following frequency transformation, a fuzzy-based clustering algorithm and the KNN were applied on the data
of subfrequency components for the feature classification.
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Fuzzy C Means Clustering

The principle idea behind the clustering algorithms
is to determine well-distinguishable and compact clusters of some population of data points. Conventional
algorithms generate a partition of the population
Z fxk ; yk : k 1; 2; I; M g, so that each member of
the population is assigned to a particular cluster. The algorithms are based on the idea of rigid partition derived
from the classical set theory: the partition matrix U(Hik),
whose elements Hik denote the degree to which a particular data element k belongs to a cluster i and contains values
either 0 or 1, with zero indicating null membership and
one indicating full membership to the ith cluster, with i = 1,
2, I, C. For a given number of data points and clusters,
the elements of the membership matrix satisfy the following properties:
a Kik Df0; 1g 1 e i e C; 1 e k e M
C

b ~ Kik 1

1 e k e M:

10

i1

Unlike the conventional clustering algorithms, fuzzy

clustering results in overlapping clusters that is, membership degree or the extent of belonging of a data element
to a particular cluster may attain any real value between
zero and one. The elements of the population fulfill the
conditions given in (Eq. 10), except that the condition (a)
changes to
Kik D0; 1 1  i  C; 1  k  M

11

In the present work, the widely used fuzzy C means algorithm18 is applied. The algorithm is based on reducing
the Euclidian distance between data points and cluster prototypes (centers). This is achieved by the minimization of
the following objective function.19
C

J U ; P : Z ~ ~ K ik m d ik 2
i1

12

k1

where U is the fuzzy partition (membership) matrix with

Kik as its elements, P is a matrix of cluster prototypes
(centers), and m 9 1 is a weighting exponent, which determines the degree of fuzziness of the resulting clusters. The
partition matrix assigns each data point a vector of membership degrees (1 value for each cluster). The distance between the data points and the cluster centers Vi is given by
dik as
d ik2 Z k
V i T Z k
V i

13

From an initially randomly selected cluster centers, the

centers are updated with the aim of reducing dik. The
cluster centers Vi and the elements of the membership are
given as
"
Kik

j1

jj Z k
V i jj
jj Z k
V j jj

2 #
1
14

V i ~ Kik m Z k
k1
M

15

~ Kik m

k1

Volume 39 & Number 2 & April/June 2014

Feature Article
In the present work, fuzzy clustering has been applied
to distinguish between the rest and eye gaze based on
the features extracted from frequency spectrum, that is,
Fourier coefficients.
Kohonen Neural Network
The KNN is one of the most widely used neural networks
based on unsupervised learning algorithm. It utilizes the
concept of self-organizing feature mapping by using a
similarity index to cluster a set of data points. The similarity index is generally derived using the Euclidian distance
computation. Similar to the fuzzy clustering approach, the
features extracted from Fourier spectrum are used as an
input to the KNN. The 2-layered network learns by identifying similarities in the input patterns and modifies itself
to the future presentation of these patterns. A set of similar
input vectors is recognized such that only that neuron responds, which contains information closer to the input.
For a network performing the clustering of data points in
n dimension into m clusters, the weights connecting the
input and output layer are initialized by random numbers.
For every presentation of the input pattern xi, the Euclidean
distance dj is calculated

between xi xi1 xi2 Ixin  and the

weight vector wj wj1 wj2 Iwjn of the jth neuron in the
output layer as per the following equation:
n
2
d j ~ xik
wjk

16

k1

The node having the shortest distance to the input xi

is referred to as the winner. The weight vector of the winner node is updated with the aim of making weights closer
to the input pattern xi. The weights are updated as follows:


wnew
wold
> xi
wold
j
j
j

17

where > is the learning rate parameter. The weight vector

of the nodes other than the winner node is kept unchanged.
The same procedure is repeated for a complete presentation of all the input patterns, generally referred to as epoch.
The weight updating process is carried out until a predefined number of epochs or if not appreciable change in
the weights is observed between 2 successive epochs.

Results
At first, the HRV/IHRV data have been analyzed for all
the parameters, and then the IHRV was used for the feature extraction and classification purposes.
Analysis of HRV
The summarized results of the HRV analysis are presented
in the Table. The relatively higher mean RR interval and
the lower SDNN have been observed for all the 5 subjects
during the gaze duration as compared with the relax condition. However, for RMSSD, TI and TiNN lower values
have been achieved during the eye fixation period, although
marginal higher values have been obtained from S2 and
Journal of Clinical Engineering

S3 for TI and S2 showing a little higher value for TiNN

during the gaze period. Furthermore, the spectral analysis
of IHRV has been evaluated using the LS method and discrete wavelet transform in frequency and time-frequency
domain, respectively, which shows almost similar findings.
Three subjects (S1, S2, and S4) show decrease in LF and
increase in HF power components, whereas reverse results
have been observed for 2 subjects (S3 and S5) (Table).
In Poincare analysis, subjects S1-S4 show reasonably
lower values of SD1 and SD2 during the gaze period as
compared with the rest period. Conversely, higher values
for SD1 and SD2 are obtained from subject S5. Furthermore, SD1/SD2 ratio shows lower value during the eye
fixation except in subject S5, which shows a higher value.
Visual inspection of the Poincare graphs shows an elliptical shape lies at the center of the quadrant, and the graphs
are symmetrical both during the gaze and in the relaxation
period. The results are shown in Figure 3A and B. In DFA
analysis, lower values of >1 has been observed in subjects
S2, S4, and S5 and higher in subjects S1 and S3 during the
eye fixation. In long-term fluctuation, subjects exhibit the
higher values, except in subject S5, where marginally lower
value during the eye fixation is observed. The graphical
representation is illustrated in Figure 4A and B. Similar to
the DFA, during the gaze period, subjects S2, S4, and S5
show higher values, and lower values have been observed
in subjects S1 and S3 for SE.
It has also been observed that heart rate and pulse rate
decrease during eye gazing and try to attain the baseline
during relaxed condition (Figure 5 and 6), although the time
corresponding to the maximum variation in these 2 signals
is almost same (27.58 seconds for ECG and 22.44 seconds
for PPG) during the trial. The consistency in variation
in the PPG is not as good as it was obtained with ECG.
The mean pulse rate variability showed sudden rise at
22.44 seconds due to which the result shows high variation in pulse rate (9.43 beats/min) in comparison to the
changes in heart rate (6.30 beats/min). Based on the observations, it can be suggested that the nonstationary component in the PPG is more prominent than that of ECG signals.
Feature Extraction and Clustering
For the classification of HRV signal for gaze and relax
conditions, 2 unsupervised methods, that is, fuzzy C means
clustering and KNN, have been adopted. The feature extraction process for performing the classification has been
carried out using FFT. As mentioned earlier, the frequency
spectrum obtained from the FFT has been decomposed in
3 subbands. The area covered under each of these subbands
is used to obtain the feature space. Figure 7 represents the
HRV (for both gaze and relax condition) by a point in
3-dimensional spaces. The entire data set (200 cases, 20 each
for gaze and relax condition for 5 subjects) has been
divided into completely different training and validation
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Feature Article

TABLE. Variations in the Parameters for Gaze/Relax Condition Using Different HRV Analysis Techniques

Sl No.
1

Subjects

Heart Rate
Variability
Analysis

S1
(Gaze/Relax)

S2
(Gaze/Relax)

S3
(Gaze/Relax)

S4
(Gaze/Relax)

S5
(Gaze/Relax)

709.8/700.6

776/767.5

833.6/808.4

871.3/861.1

901.8/865.6

66.6/86.6

86.3/108.3

57.7/85.4

68.6/124.9

89.3/115.7

8.1/13.3

10.2/14.1

4.3/14.2

8.3/15.9

8.8/14.1

65.1/109.5

101.2/146.2

67.8/112.1

75.8/152.6

100.4/148.2

4.7/5.2

3.8/3.1

3.6/3.2

3.4/2.8

4.5/5.1

TiNN, ms

230.6/279.7

230.6/239.1

193.6/185.6

165.0/186.3

319.2/347.3

Frequency
domain

LF, nu

0.441/0.458

0.406/0.428

0.477/0.442

0.346/0.351

0.483/0.451

HF, nu

0.559/0.542

0.594/0.572

0.523/0.558

0.654/0.649

0.517/0.549

Time-frequency

VLF, ms2

580.4/800.2 1,405.1/955.4

518.7/697.8

858.5/3,187.2

1,406.6/1,435.1

LF, nu

0.455/0.461

0.421/0.445

0.461/0.451

0.358/0.428

0.525/0.446

HF, nu

0.545/0.539

0.579/0.555

0.539/0.549

0.642/0.572

0.475/0.554

LF/HF

0.835/0.855

0.727/0.801

0.854/0.822

0.559/0.748

1.105/0.834

SD1, ms

46.0/77.6

71.6/103.6

48.0/79.4

53.6/108.1

71.1/18.8

SD2, ms

82.2/94.8

98.8/112.9

66.1/9.0

80.9/139.7

104.4/31.8

SD1/SD2

0.559/0.818

0.724/0.917

0.776/0.872

0.662/0.773

0.681/0.591

Detrended
fluctuation
analysis

>1

0.921/0.867

0.679/0.713

0.849/0.717

0.757/0.884

0.874/0.932

>2

0.670/0.545

0.865/0.357

0.719/0.422

1.071/0.703

0.707/0.785

Sample
entropy

SE

2.225/2.232

1.990/1.591

1.648/1.927

1.819/1.605

2.522/2.216

Time domain

Parameter
Mean RR
interval, ms
SDNN, ms
SD of the heart
rate, beats/min
RMSSD, ms
TI

Poincare
analysis

data sets of equal length. Care is taken to accommodate

widely varying trials of all subjects.
The fuzzy C means process is initiated at randomly selected cluster centers. The 2 centers are updated iteratively
until no changes in the clusters are observed between 2 successive iterations for all the data points of the training set.
For the present case, the algorithm is found to converge
after 10 iterations at the cluster centers C1 = [80.5006
5.3168 2.0182] and C2 = [12.4344 6.6622 1.9486] for
gaze and relax conditions, respectively. The data points
of the validation data set are grouped based on the degree of closeness to the cluster centers. On the validation
data set, except for 2 cases, fuzzy C means classifier is able
to classify all the cases correctly, that is, a classification
84

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accuracy of 98%. The points corresponding to the arrow

marker in Figure 7 denote the data points and hence the
HRV, which has been incorrectly classified (same for each
classifier). Both these cases correspond to the same subjects
(S1), whereas all the data points for the other 4 subjects are
correctly classified. During the training of KNN, for randomly selected weight vectors, the individual weights are
iteratively updated with the aim of reducing the Euclidian
distance between the vectors corresponding to the 2 classes
and the associated data points. The iterative process of weight
updating is carried out for 100 iterations, after which the
weight vectors correspond to W1 = [80.5605 5.3141 2.0413]
and W2 = [12.5649 6.5596 2.0413]. The trained network is
simulated with the validation data set, resulting in 2 possible
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Feature Article

FIGURE 3. Poincare
analysis during (A) gaze period and (B) rest period, where IBI is interbeat interval.

outputs depending on the distance of the weight vectors

from the data points. Exactly similar classification accuracy
is observed for both the classifiers; that is, the same data
points are classified/misclassified. From Figure 7, it is observed that high classification accuracy can be attributed to
the high disparity in the feature corresponding to the lowest
subband, which was normally ignored for the HRVanalysis
as it is related to thermoregulatory processes and reninangiotensin system.20 The features for the other 2 subbands
are not very distinct for gaze and relax condition. No change
in the pattern of classification is observed when only the
lowest subband is considered to that when all the 3 bands
are taken. In other words, the LF and the HF bands do not
add any additional information for classification.

Discussion
Since the last several decades, cardiac activities have been
used as an important tool to monitor the mental effort
Journal of Clinical Engineering

and workload.21 Furthermore, research has demonstrated

that the psychophysiological measure of the actual mental
effort considerably changes the HRV of the subjects.22 In
the present work, we have tried to evaluate the mental stress
under prolonged eye fixation with the features extracted
through HRV analysis. The obtained features will be used
to classify the stressed and resting condition.
The PPG has been suggested as an alternative to the
HRV, and the throbbing of arteries reflects the heartbeat.23-25
The mean IHRV when compared with the mean IPPG
shows almost identical variations, as shown in Figure 5
and 6. Furthermore, it has been suggested that the vagal
stimulation yielded a rapid lengthening of the heart period
that commenced within the first second of stimulation, approached asymptotic levels within 3 to 4 seconds, and rapidly returned to baseline after termination of stimulation.26
Here, only HRV/IHRV data were considered for final feature extraction and classification purposes.
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FIGURE 4. Detrended uctuation analysis during (A) gaze condition and (B) rest condition.

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FIGURE 5. Mean pulse rate variability under eye gaze of 30 seconds followed by 10 seconds relaxation period (n = 5, 100 trials).

It is important to note that in many HRV parameters

subjectwise variability has been observed. However, changes
have been analyzed in all the parameters irrespective of the
subject and condition. In general, 3 to 4 subjects showed
similar results in time domain, frequency domain, timefrequency domain, Poincare analysis, DFA, and SE with
minor deviation in other subject(s) (Table). In time-domain
analysis, enhanced RR interval and lower SDNN have been
obtained, which reflects the dominance of PNS activity. As
the increase in RR interval causes the decrease in heart rate,27
conversely, lower values have been analyzed during the eye
fixation period for RMSSD, TI, and TiNN, although marginal higher values have been obtained from 2 subjects for

TI and 1 subject shows little higher value for TiNN during

the gaze period. Furthermore, during the gaze, LF power
component was found to decrease, with the increase in HF
component for both frequency and time-frequency analysis.
Furthermore, lower values of SD1 and SD2 have been
observed in Poincare analysis and DFA, respectively. Under
healthy condition, the heart shows continuous short-term
variability owing to SNS and PNS activity, which has impact on the formation of cloud around the line of identity.28
This is clear with the ratio of SD1 to SD2 that shows lower
value during eye gaze, thus not eliminating the role of SNS
activity in controlling the heartbeat. However, the eye gaze
values of both the SD1 and SD2 decrease as compared with

FIGURE 6. Mean HRV under eye gaze of 30 seconds followed by 10 seconds relaxation period (n = 5, 100 trials).

Journal of Clinical Engineering

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FIGURE 7. Three-dimensional features extracted from the Fourier spectrum of the HRV under different trials of eye gaze movement (circle)
and rest condition (dot). The arrow refers to the feature vectors that have been misclassied using fuzzy C means clustering.

rest condition. Small and moderate increase in SD1 and

SD2 in resting state has already been suggested by Gamelin
et al.29 The lower value of short-term fluctuation (>1) and
higher value for long-term fluctuation (>2) has been obtained
during the gaze in 3 of the subjects. On the other hand, it
has been suggested that the value of >2 and >1 increases
and decreases, respectively, for normal subjects and conversely for abnormal subjects.16 Similar to the DFA, during
the gaze period, 3 of the 5 subjects show higher value, and
others show a lower value for the SE. Thus, no concrete
conclusion can be proposed. This intersubject variability
in the results is evident as it is already established that with
psychological conditions, some subjects show largely sympathetic activation, whereas others show vagal withdrawal.30
The decreasing trend in heart and pulse rate has also been
observed during the gaze duration, which tries to normalize
during the rest condition.
Past research work has also demonstrated that in the
spectral analysis of HRV, the power of LF and HF occurring in synchrony with vasomotor waves and respiratory
acts, respectively, appears to reflect in their reciprocal relationship the state of the sympathovagal balance in numerous physiological and pathophysiological conditions.31 The
ratio of LF to HF power of HRV defines the autonomic
balance of the heart. If the ratio increases, then it is sympathetic dominance with vagal modulation otherwise parasympathetic dominance.27,31 Furthermore, literature also
suggested an increase in HRV with shift of autonomic balance toward a parasympathetic predominance.32-34 It should
be noted that LF power is an index of both SNS and PNS,29
and it is primarily parasympathetically mediated and not due
to SNS.31 Our result shows the decrease in LF power and
increase in HF power during the gaze period. The increase
in HF power may have occurred because of the activation
of PNS, and decrease in LF power is attributed to withdrawal of SNS activity, and the enhanced power of HF defines the respiratory sinus arrhythmia.35 Review of literature
reveals that in resting normal subjects the power of LF is
more than that of HF with LF/HF and is more than 1.
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Mental efforts and stressors cause increase in SNS and decrease in PNS activity that can be realized with the increase
in LF and decrease in HF resulting in the increase in LF/HF,
like in most of the mental arithmetic tasks. Furthermore,
mental tasks such as perceptual illusion and focused attention have also been shown with PNS activation or PNS/SNS
activation. Overall, mental efforts are shown to enhance
the SNS activity, which is reflected by reduced total power
and increase in LF along with decrease in HF.30,36 Thus,
the LF/HF is task dependent and differs with individuals.
With the aim of classification between the resting and
the stresses condition, classifiers based on fuzzy clustering
and KNN have been proposed to identify the IHRV data
to extract the features for classification for all the trials.
The application of frequency spectrum-based features revealed the significance of LF subbands in the clustering
process. A wide disparity in the feature corresponding to
the lowest subband was observed between the gaze and
relax condition for all the subjects. An accuracy of 98% was
achieved for both the classifiers with the lowest subband.

Conclusions
Mental stress is a huge problem in todays society and can
be developed in a number of day-to-day activities and enhances the SNS and decreases the PNS activity but task
dependent. With these findings, it has been understood
that the continuous eye gazeYinduced mental stress influences
the ANS. The accuracy in feature classification obtained
from the frequency analysis of the HRV was found to be
98% in the lowest subband, which favors its practical implementation in evaluating the mental stress level.
Mental efforts cause alterations in increase in SNS and
decrease in PNS activity. Furthermore, mental tasks such
as perceptual illusion and focused attention have also been
shown with PNS activation or PNS/SNS activation. Overall,
mental efforts are shown to enhance the SNS activity, which
is reflected by reduced total power and increase in LF along
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with decrease in HF.30,36 Thus, the LF/HF is task dependent
and differs with individuals.

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