ANS ANALYSIS PROFESSIONAL – INGENIOUSLY SIMPLE
ANS Analysis Professional is designed for use in a therapeutic practice. It measures exactly the recommended, practicable and practice-relevant HRV parameters and contains standard values and risk cut-off values from meta-analyses.
It encompasses the recommended and practice-relevant HRV and ANS parameters and meets all the scientific criteria that must be considered when measuring heart rate variability.
To ensure that you, as a user, have the utmost confidence that ANS Analysis delivers valid and reliable values, ANS Analysis is regularly synchronized with the scientific Kubios HRV software.
The ANS Analysis Professional System has already proven itself in hundreds of practices and clinics around the world. In addition to scientiﬁc validation, our customers ﬁnd the ease of use with their comprehensive and practical functions particularly important and helpful.
ANS Analysis offers the unique opportunity to gain fast and easy insight into the regulatory capacity of the autonomic nervous system (ANS). The functional state of the ANS provides important information that allows practitioners to assess health conditions or disorders better than ever before. The measurement results help to answer many questions, including:
- To what extent do risk factors exist for cardiovascular disease or other chronic dysfunctions?
- Is the body able to cope with stress or have stress factors already produced a health impairment?
- Are the applied therapies successful (therapy monitoring)?
- Can therapies improve the functional state of a disturbed autonomic nervous system?
- What effect do problems and conflicts have on the body?
These are just a few of the many questions that ANS Analysis can answer better than anything else. For this reason, it is recommended that an ANS Analysis is performed both as a preventive measure and for patients with stress symptoms, chronic illnesses or problems and conflicts at work.
ANS Analysis is painless, free of side effects and takes about seven minutes to perform.
More than just a software – a strong relationship with the patient.
ALL IN ONE APP
- HRV: ANS Analysis measures all relevant parameters of the heart rate variability & the ANS. The evaluation is distinguished between HRV & ANS parameters
- BIOFEEDBACK: The integrated cardio-respiratory biofeedback stimulates the parasymphatetic nervous system and reveals the reserves. The patient can see the impressive effect of breathing exercises in a before/after comparison.
- THERAPY MONITORING: The aim is to restore the balance in autonomic regulation through suitable therapies. Each therapy can be tested for its effect on the ANS.
Exact detection of RR intervals with a high measurement accuracy (approx. 1-2 ms) is a prerequisite for a valid HRV analysis of the most diverse target groups. The ANS Analysis uses an ECG-accurate chest lead with a recognized gold standard.
Data Processing & Parameters:
The robust time range parameters, which have been reproduced in applied settings, have been established for short-term measurement. In terms of simple handling and optimal interpretation of the HRV analysis for therapists and patients, the ANS Analysis is reduced to the parameters that reﬂect the crucial information on the ability to regulate
the ANS, are not redundant and have established themselves to be the best prognostic variables in studies.
Classiﬁcation of Reference Values:
The reference values of the ANS Analysis are based on evidence and on a comprehensively interpretable international data base of the last 20 years and comprise more than 20,000 subjects of a healthy population. Age-related dependencies, the importance of absolute and relative risk-cutoﬀ values, as well as lifestyle factors and physical performance were also included for standardization.
The HRV analysis is an evidence-based method of quantifying the functionality of cardiovascular and psychophysiological control circuits as well as the autonomic regulatory capacity and thus provides very good possibilities for risk stratiﬁcation, health forecasting and intervention control.
Quality Assurance & Validation:
For quality assurance of the ANS Analysis, the ANS Analysis software is regularly calibrated with the scientiﬁc reference software Kubios HRV. An analysis of more than 150 subjects of both sexes from diﬀerent clinical-therapeutic areas (age: 20-80 years, heart rate range: 40-120 bpm) shows a highly signiﬁcant correspondence of the main parameters heart rate, SDNN, RMSSD and alpha 1 (> 99.6%) for all areas of application.
Artefact-free raw data is necessary for the reliable calculation of HRV parameters. The ANS Analysis provides a reliable, robust and automatic correction function with references to possible artefacts to prevent erroneous interpretation of the measured values. In case of an artefact rate of more than 10%, the ANS Analysis automatically provides an indication to repeat the measurement or to perform an ECG to clarify potential cardiac arrhythmia.
In addition to a measurement at rest, an integrated measurement under a respiratory rhythm speciﬁcation (test of respiratory sinus arrhythmia, RSA) is recommended, as the mobilization of parasympathetic reserves can be made visible under standardized conditions. In addition to the guideline-compliant respiratory rhythm of 6 respiratory cycles per minute, the ANS Analysis oﬀers additional rhythms to meet the needs of the patient.
Dr Stephan Bortfeldt, general practitioner from Hanover, reports from his practice and explains the background of heart rate variability and its possible applications.
WHAT is ANS Analysis
The ANS Analysis App measures the autonomic nervous system via the heart rate variability (HRV).
ANS Analysis is a very simple and fast method to show how well our body’s primary control center, the autonomic nervous system (ANS) is working and performing its regulatory duties. With its two main divisions, the sympathetic and the parasympathetic nervous system (or vagus), the ANS represents a superordinate control center in the body. It controls and regulates subordinate processes and all vital functions, including blood pressure, respiratory rate, heart rate, immune system, endocrine system, digestive system, energy supply, etc.
When a superordinate system controls and regulates subordinate systems, the functional state of the superordinate system is the most important diagnostic parameter.
WHY ANS Analysis
As the heart is controlled directly by the sympathetic and parasympathetic nervous system, it acts as an effector organ to measure the autonomic nervous system. The sympathetic and parasympathetic nervous systems register and process internal and external stimuli. They initiate the proper reactions (regulation) to optimally prepare the organism according to the needs of the moment (e.g. energy supply in times of sudden danger).
A malfunction of the ANS with an overactive sympathetic and hypoactive parasympathetic nervous system inevitably leads to a physiological change in the heart’s excitation pattern. Thus, the heart rate variability (beat-to-beat interval) will be changed accordingly. This change is measurable.
It has been shown that the changes in the autonomous regulation at times precede the clinical manifestation of illnesses and symptoms. There is no other examination that detects incipient disorders this early and easy, which makes it ideally suited as an entry examination for all disciplines.
What is measured in ANS Analysis
Heart rate variability (HRV) is measured, meaning the time interval in milliseconds from heartbeat to heartbeat. HRV is the ability of an organism to change the rate of the cardiac rhythm from one heartbeat to the next.
The sinus node of the heart is permanently modulated by sympathetic and parasympathetic impulses. In this way, the heart serves as an eﬀector organ in the ANS Analysis, making it possible to determine the exact state of regulation of the
sympathetic and parasympathetic nervous system. The heart rate variability (HRV) is thus the expression of a permanent adaptation of the heart to the autonomic nervous system (e.g. frequency increase during inspiration, frequency reduction during expiration). The greater the variability from one heartbeat to the next, the greater the parasympathetic activity and the better the adaptability of the organism to internal and external stimuli. In 1996, the standards for the ANS Analysis were deﬁned by an international task force and published in the European Heart Journal.
The ANS Analysis Professional App combines many unique features & important functions in one program:
- Parameters of the heart rate variability
- Parameters of the autonomic nervous system
- ECG-accurate measurement
- Real-time display of the parasympathetic nervous system
- Clear comparisons of the ANS parameters
- Recording of a defined number of heartbeats (no defined time) to ensure comparability
- Immediate evaluation of the measurement
- Patient view and therapist view
- Different views and filter options of the patients/measurements
- Fast and illustrative therapy monitoring & comparative measurements
- Validated standard values for adults between 20 and 80 years of age*
- Validated standard values for children aged 10 – 19 years*
- Age-dependent standard value adjustment
- Validated standard value adjustment for athletes
- Unlimited, objective progress monitoring
- Unlimited number of patients/customers
- Unlimited number of measurements
- Fully automatic correction of incorrectly measured values (artefacts, dysrhythmia)
- Integrated cardiovagal biofeedback (optical & acoustic)
- Comparison and progress display of up to 10 measurements
- Selection of the parameters to be included in the comparison (e.g. Only the parasympathetic course)
- Scientific quality assurance and regular data reconciliation with Kubios HRV
- Diagnosis entries alphabetically and/or according to ICD10 (120 most frequently used ICD diagnoses)
- Therapy records for conventional medicine and naturopathy
- Marker and memo function for intervention recording
- Expanded risk stratiﬁcation
- Notes on measurement via dictation function and keyboard input
- Free updates, no maintenance contracts
- Permanent, free phone support
- Direct emails to our support team for evaluation questions (anonymous)
- Compatible with Apple ipad, ipad pro and ipad Mini
- Automatic printout of the ANS Analysis via a Wifi printer
- USB connection and storage of the ANS Analysis as PDF for the index card in the practice program
- Email delivery of the ANS Analysis with explanatory text to patient
- Email to archive email address
- Anonymization of the data in emails can be set
- Data export for further evaluation (studies & scientific works) as .txt file (flat file), e.g. For Kubios HRV
- Automatic data backup outside the hardware possible with encryption
- Software available in English, German, Italian and Chinese
*ANS Analysis is the only system on the market which contains exclusively validated study-based standard values. The validated standard values have hitherto been in the age range of 20 to 80 years. Through our strong connections to colleges and universities, we are proud to say that we are the first system to integrate validated study-based standardized values for children worldwide. Since the autonomic regulation in children and adolescents differs significantly from adults, the use of an autonomous functional diagnosis in children was only possible to a limited extent so far.
The ANS Analysis is the world’s first system, which has integrated study-based children’s reference values after a discovery phase over many years. The new update complements the already existing standard values for 20 – 80 years with the age range of 10 – 19 years and now enables children and adolescents to assess the autonomic nervous system, to evaluate their stress resilience as well as their ability to regenerate themselves, and to prevent the stress cycle which leads to illnesses sooner or later.
Delegable performance + low time requirement
Positive validation study + evidence-based standard values based on studies of the past 20 years + absolute risk-cutoﬀ values + reliable artefact correction
Understandable graphical representation + wireless measurement + objective therapy monitoring + best prevention + email notiﬁcation of the measurement
Limitation to recommended and practice-relevant parameters + intuitive operation + small and handy + cardiovagal biofeedback + Support function for evaluation issues + immediate evaluation of the measurement results
How to measure
- Operation of the ANS Analysis on the iPad is intuitive and a 100% delegable service.
- A chest strap is applied to the patient (in women under the bra; undressing is not necessary).
- The measurement takes place at rest while the patient is sitting or lying down.
- The patient should be left alone during the measurement.
- The measurement time is 520 RR intervals, depending on heart rate 5 to 10 minutes.
- The measuring automatically ends with a beep and is stored with the date, time and type of measurement.
- The measurement result of the HRV is immediately evaluated and displayed graphically.
How to interpret the results
The ANS Analysis Professional contains two illustration options. By default, the simplified patient illustration is shown. It contains the following parameter: resting pulse rate, sympathetic nervous system (SI) and parasympathetic nervous system (RMSSD).
With a fingertip, you can change to the therapist illustration showing the Alpha 1 value and the SDNN (see images and explanation below).
All illustrated parameters are calculated mathematically on the basis of the heart rate variability. Those mathematic formulas were standardized in 1996 by an American and European task force.
Patient View of Good and Impaired Regulation
Therapist View of Good and Impaired Regulation
The therapist view offers two additional parameters to the patient view: the Alpha 1 value as well as the SDNN.
The Alpha 1 value indicates the quality of the regulation. In the best case, it should be within the green normal range. The more it increases, the more compensation processes are taking place in the body. The more it decreases, the more chaos is taking place in the system. It is a sign for a collapse of the control systems.
You should pay most attention to the Alpha 1 value if the sympathetic nervous system is increased and the parasympathetic nervous system is decreased. An increase of the Alpha 1 shows that the body is already compensating. The question becomes for how long the body will be able to withstand this dysregulation.
A decrease of the Alpha 1 in combination with an impaired regulation (dominant sympathetic nervous system) represents an increased risk for the heart – this has been presented by multiple studies. The control systems cannot cooperate effectively anymore – there is chaos within the system. The dominant sympathetic nervous system indicates that all organs are mainly being controlled by it.
The SDNN is the standard deviation and consequently the overall variability. The more the SDNN increases, the greater the variability. This also means the adaptability of the autonomic nervous system increases. The more the SDNN decreases, the lesser the variability. This means there is limited autonomic regulation.
Below you can see two evaluations of heart rate variability (HRV) with the rhythmogram, histogram and scatter plot. The left measurement shows good HRV and the right measurement shows a severely restricted HRV.
The heart rate variability (HRV) is plotted in milliseconds in the rhythmogram. The more irregular (jagged) the rhythmogram is, the better the HRV. The ﬂatter the rhythmogram, the worse the HRV.
The histogram is a percentage-based distribution curve of the measured heartbeats. A broad Gaussian distribution reﬂects a good HRV. Few bars in the histogram indicate a restricted HRV.
In the scatter plot, a point in the coordinate system results from two adjacent RR intervals. The ﬁrst value is plotted on the X axis and the second on the Y axis. The larger the scatter plot cluster, the better the HRV. The more dense the cluster is, the more restricted the HRV.
We recommend the use of ANS Analysis for:
- All patients, as an entry examination to obtain an overview of the adaptability of the whole organism.
- All check-ups for additional monitoring.
- Any patient with stress-related symptoms in all disciplines.
- For therapy monitoring, to check the eﬀect of the applied therapy and medication on the autonomic nervous system.
- Risk stratiﬁcation of existing diseases.
- Sleep disorders
- Recurrent infections
- Stress level situation
- Depressive moods
- Tumor diseases
- Chronic fatigue syndrome
- Erectile dysfunction
- Allergic reactions
- Irritable bowel syndrome
- Risk stratiﬁcation of any type
- Heart failure
- Preoperative diagnostics
- Early detection of coronary heart disease
- Burnout diagnostics
- Recurrent back pain / lumbago
- Menopausal symptoms
- Psychosomatic complaints
- Chronic pain / ﬁbromyalgia
- Central serous retinopathy
- and much more …
With conspicuously high parasympathetic values and condition disorders of the patient, exhibiting signs of exhaustion and lack of energy, the question arises whether this is caused by a regulatory disturbance with a hyperactive parasympathetic nervous system and a weakened sympathetic nervous system.
To assess these patients better, an orthostatic test or change of position should be carried out. 130 RR intervals are measured for the patient while lying down. This is followed by an acoustic signal as well as the note: ‘Please stand up now’. Thereafter, 210 RR intervals are measured while standing.
In contrast to the pulsed breathing with which one can control the switching on of the parasympathetic nervous system, the change of position causes a stress impulse, with which one can control the shutdown of the parasympathetic nervous system. In comparison, a clear difference between lying down and the standing position should be recognizable. The heart rate (HR) and the stress index (SI, red bar) should increase, whereas the parasympathetic nervous system (RMSSD, blue bar) should decrease.
None, or only a very slight change in the parameters is an indication of a regulatory disorder with a dominant parasympathetic nervous system and a weakened sympathetic nervous system.
The following graphs show an ideal result of the orthostatic test. The standing phase clearly differs from the lying phase.
1. HRV-recording with course of parasympathetic activity
2. HRV-recording with rhythmogram, histogram and scatter plot
3. Comparison of parameters: pulse, sympathetic and parasympathetic index during lying and standing position
During the measurement, someone should always stay with the patient.
The patient is first measured while lying down. After a preset time, ANS Analysis gives the signal “Please stand up”. The remaining measurement is then carried out in the standing position. The total measurement time is 340 RR intervals, approx. 5 minutes.
In the end, the measurement in the lying position is compared with the one in the standing position.
This video shows the ANS Analysis add-on module for long-term measurement. It makes it possible to carry out measurements without time limits. In addition to the display of the heart rate variability, the parasympathetic activity is visualized as a blue line in real time. With the special marker and memo function, individual markers can be created and set before and during the measurement. The effect of therapeutic interventions on the autonomic nervous system can thus be illustrated for more detailed therapy monitoring during the measurement.
The add-on module IHT (Intermittent Hypoxia Training) enables the measurement of the parasympathetic activity in real time during IHT training. Since the autonomic nervous system reacts directly and variably to hypoxia, the intensity of the therapy as well as the duration of the hypoxic and normoxic intervals should be adapted to the ANS regulation. Thus, a too severe decrease in the parasympathetic nervous system can be avoided and at the same time patient safety can be increased.
For the best possible assessment of the changes in the parasympathetic activity, the duration of the hypoxia and the normoxia phase as well as the number of cycles are adjusted according to the settings of the IHT device.