Oura Ring Gen 4 sensor data, not clinical measurementsN=1 case study, not validated for clinical decisionsHEV diagnosed Mar 18; Day 109 post-ruxolitinibMore
Consumer wearable data can support exploratory review only. The HEV diagnosis, temporally confounded with treatment start, remains a material confounder.

Advanced HRV Analysis

RMSSD epochs: 14,150 | HR measurements: 104,855
DFA alpha-1 (RMSSD-Epoch Proxy)
Abnormal
nan
Applied to RMSSD epochs (not RR intervals) — ref ~1.0 (not directly comparable) | 95% KI: (nan, nan)
Sample Entropy
Low
1.5534
Healthy: 1.5-2.5 | normal
Toichi CVI (vagal)
Low
2.0697
Healthy: 3.255
Allostatic Load
2/7
mild
Baevsky SI
4.22
Normal: <150 | normal
Cosinor Amplitude
Low
3.83bpm
Healthy: 15-25 bpm | Acrophase: 10:41
RQA Determinism
Low
0.4468
Healthy: >0.6 | moderately_reduced
Nightly HR CV
Elevated
12.51%
Mean: 77.1 bpm | high_variability
REPORT SECTION

1. Proxy Frequency Spectrum (Lomb-Scargle)

Note: Analysis based on 5-minute RMSSD epochs (not beat-to-beat RR intervals). Nyquist frequency is limited to ~0.00167 Hz, so the table below uses proxy bands across the accessible spectrum only. These labels are heuristic and do not support standard LF/HF physiology claims.
BandPowerProportionInterpretation
Lower proxy band0.06.1%Lowest third of accessible RMSSD-epoch spectrum
Mid proxy band0.076.4%Middle third of accessible RMSSD-epoch spectrum
Upper proxy band0.017.5%Upper third of accessible RMSSD-epoch spectrum
Upper/lower proxy ratio4.373Heuristic spectral balance only; not a standard sympathovagal index
REPORT SECTION

2. Multiscale Entropy (MSE)

Pattern: High entropy preserved - possible inflammatory pattern

Low-scale mean: 0.62 | High-scale mean: 0.6653

Costa et al. 2005: Healthy systems show high entropy across all scales. Neuropathic disease shows decline at high scales.

REPORT SECTION

3. Recurrence Quantification Analysis (RQA)

MetricValueInterpretation
Recurrence Rate (RR)0.0056Proportion of recurrent states
Determinism (DET)0.4468Reduced predictability
Laminarity (LAM)0.1439Degree of intermittency
Diagonal Entropy1.1343Complexity of diagonal lines
Moderately reduced determinism
REPORT SECTION

4. RMSSD-Epoch DFA (Proxy)

Note: DFA is originally designed for beat-to-beat RR-interval time series. Applied here to 5-minute RMSSD epochs as a proxy. Reference values from RR-interval studies; RMSSD-epoch DFA values are not directly comparable.
ParameterValue95% CIReference (RR-interval literature)
alpha-1 (short-term)nan(nan, nan)~1.0 (RR-interval ref; proxy may differ)
alpha-2 (long-term)nan(nan, nan)~1.0 (RR-interval ref; proxy may differ)
alpha (full)nan-~1.0 (RR-interval ref)
nolds not installed - DFA cannot be computed
REPORT SECTION

5. Approximate Entropy (ApEn) and Sample Entropy (SampEn)

MetricValueParametersHealthy Reference
ApEn1.5808m=2, r=2.9717~1.0-1.5
SampEn1.5534m=2, r=2.9717~1.5-2.5
Normal complexity
REPORT SECTION

6. Hjorth Parameters

ParameterValueDescription
Activity220.7745 ms2Signal variance (power)
Mobility0.5535Mean frequency (low = monotonous signal)
Complexity2.8717Rate of frequency change
REPORT SECTION

7. Baevsky Stress Index (SI)

ComponentValue
AMo (mode amplitude)7.67%
Mo (mode)8.25 ms
MxDMn (range)110.0 ms
SI (scaled)4.22
Normal stress level
Reference (Baevsky 2002): Normal <150, Moderate 150-500, High >500, Pathological >1000
REPORT SECTION

8. Toichi CVI/CSI (Vagal/Sympathetic Index)

ParameterPatientHealthy Reference% of Normal
SD1 (vagal)5.815 ms30 ms19.4%
SD2 (sympathetic)20.192 ms60 ms33.7%
CVI2.06973.255-
CSI3.47222.0-
CVI=2.07 (healthy ref: 3.26) - severely reduced vagal tone. CSI=3.47 (healthy ref: 2.0) - sympathetic dominance.
REPORT SECTION

9. Cosinor Circadian Analysis (Heart Rate)

ParameterValueReference
MESOR88.77 bpm60-80 bpm (healthy)
Amplitude3.83 bpm15-25 bpm
Acrophase10:4114:00-17:00
R20.027>0.3 for significant rhythm
Severely flattened circadian rhythm - serious chronodisruption
REPORT SECTION

10. HR Complexity (Permutation and Spectral Entropy)

MetricValueHealthy Reference
Permutation Entropy (PE)0.9752>0.85
Spectral Entropy (SE)0.6903>0.80
Normal ordinal pattern complexity
REPORT SECTION

11. Night-to-Night HR Variability

ParameterValue
Number of Nights186
Mean Nocturnal HR77.1 bpm
SD Nocturnal HR9.64 bpm
CV12.51%
Min-Max61.0 - 113.9 bpm
Trenddeclining trend (-0.14 bpm/night)
REPORT SECTION

12. Wearable Allostatic Load Score

2 / 7 MILD

BiomarkerValueThresholdStatus
Hr Avg Sleep 77.1 bpm > 80 bpm OK
Hrv Rmssd 19.0 ms > 15 ms OK
Sleep Efficiency 73.5 % < 85 % EXCEEDED
Temp Deviation 0.238 °C > 0.5 °C OK
Spo2 96.0 % < 95 % OK
Deep Sleep Pct 17.7 % < 10 % OK
Rem Sleep Pct 12.3 % < 15 % EXCEEDED
Mild allostatic load (2/7)
REPORT SECTION

Clinical Summary

Key Findings:
Advanced analysis of 14,150 RMSSD epochs and 104,855 heart rate measurements confirms severe autonomic dysfunction in this post-hsct patient.

Key Metrics:
  • DFA alpha-1 (RMSSD-Epoch Proxy) = nan (RR-interval ref ~1.0; proxy may differ): nolds not installed - DFA cannot be computed
  • SampEn = 1.5534 (RR-interval ref 1.5-2.5; RMSSD-epoch may differ): Normal complexity
  • Toichi CVI = 2.0697 (reference 3.255): Severely reduced vagal tone
  • Cosinor amplitude = 3.83 bpm (reference 15-25): Severely flattened circadian rhythm - serious chronodisruption
  • Allostatic load score = 2/7: mild
  • RQA determinism = 0.4468: Moderately reduced determinism

Clinical Interpretation:
Combined analyses show a pattern consistent with severe autonomic neuropathy with both parasympathetic failure (low CVI, low SampEn, low SD1) and chronodisruption (low cosinor amplitude). MSE pattern (inflammatory) and DFA findings support loss of fractal dynamics. The high allostatic load (2/7) indicates systemic physiological stress exceeding adaptive capacity.

Analysis based on Oura Ring Gen 4 data (Jan-Mar 2026). RMSSD epochs are 5-minute intervals during sleep. DFA and SampEn are computed from RMSSD epochs (proxy) - not beat-to-beat RR intervals. Reference values from RR-interval studies are not directly comparable. Frequency domain values are approximations based on Lomb-Scargle periodogram, not beat-to-beat analysis, and should be interpreted as relative indicators. Population norms for RMSSD are from controlled clinical 5-minute recordings; consumer wearable nocturnal values may differ.