Detection of sleep-disordered breathing with ambulatory Holter monitoring

Sleep and Breathing - 2018
Ian Grasso1, Mark Haigney2,3, David Mortara4, Jacob F. Collen1, Jordanna Hostler5, Aimee Moores6, Karen Sheikh1, William Kelly2,1
1Division of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center (WRNMMC), Bethesda, USA
2Department of Medicine, Uniformed Services University, Bethesda, USA
3Division of Cardiology, WRNMMC, Bethesda, USA
4Department of Nursing, University of California, San Francisco, USA
5Division of Pulmonary, Critical Care, and Sleep Medicine, Tripler Army Medical Center, Honolulu, USA
6Department of Medicine, Madigan Army Medical Center, Tacoma, USA

Tóm tắt

Obstructive sleep apnea (OSA) syndrome is a common condition that can impact clinical outcomes among patients with cardiovascular disease. Screening all subjects with heart disease via polysomnography (PSG) is costly and resource-limited. We sought to compare a Holter monitor-based algorithm to detect OSA to in-laboratory polysomnography (PSG). Prospective cohort study of patients undergoing in-laboratory attended PSG for the evaluation of OSA. A standard 12-lead Holter monitor was attached to patients at the initiation of PSG. Holter-derived respiratory disturbance index (HDRDI) was extracted from the respiratory myogram, based on detecting skeletal muscle “noise” detected on the baseline. Apneic and hypopneic episodes were identified by comparing sudden changes in the myogram to abrupt increases in heart rate. The HDRDI was compared with the PSG-derived apnea-hypopnea index (PDAHI). Thirty patients underwent simultaneous Holter monitoring and overnight diagnostic PSG. An ROC curve for peak HDRDI was 0.79 (95% CI 0.61, 0.97) for OSA, with sensitivity of 94.4% and specificity of 54.5%. A cutoff value of HDRDI < 10 appeared to identify those individuals without clinically significant sleep-disordered breathing. Holter-derived respiration detected OSA comparable to PSG. Further study is warranted to determine its utility for screening and diagnosing OSA in appropriately selected patients.

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