Maier Christoph, Friedrich Jörg, Katus Hugo, Dickhaus Hartmut
Faculty of Informatics, Heilbronn University, Heilbronn, Germany.
Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
J Electrocardiol. 2016 Nov-Dec;49(6):919-924. doi: 10.1016/j.jelectrocard.2016.07.036. Epub 2016 Aug 4.
To prospectively evaluate the applicability of a method to screen overnight Holter-ECGs for sleep disordered breathing (SDB) in an unselected clinical routine Holter sample.
Holter-ECG recordings in 50 cardiologic inpatients were complemented with nocturnal respiratory polygraphy (PG). The respiratory event index (REI) and apnea/hypopnea index (AHI) from the PG served as a reference for an ECG-derived SDB severity estimate using a previously developed method. Agreement with the PG was investigated using Bland-Altman plots color-coded by ectopy level, and screening accuracy for REI≥15/h and AHI≥15/h was assessed.
Prevalence for REI≥15/h was 52%, and 32% for AHI≥15/h. We observed better agreement of the ECG-based estimate with the REI compared to the AHI. Ectopy did not limit the detection of SDB. Binary screening for REI≥15/h provided excellent specificity of 0.96 with a sensitivity of 0.77. Ternary screening for AHI≥15/h yielded 16% borderline classifications and specificity/sensitivity of 0.96/0.86 for the remaining data.
Screening of routine Holter-ECGs for sleep disordered breathing is reasonable and promises earlier identification of a significant part of patients at no additional cost.
前瞻性评估一种在未选择的临床常规动态心电图样本中筛查夜间动态心电图以诊断睡眠呼吸障碍（SDB）的方法的适用性。
对50名心脏病住院患者的动态心电图记录补充夜间呼吸多导睡眠图（PG）。PG的呼吸事件指数（REI）和呼吸暂停/低通气指数（AHI）作为使用先前开发的方法从心电图得出的SDB严重程度估计的参考。使用按异位水平进行颜色编码的Bland-Altman图研究与PG的一致性，并评估REI≥15/h和AHI≥15/h的筛查准确性。
REI≥15/h的患病率为52%，AHI≥15/h的患病率为32%。与AHI相比，我们观察到基于心电图的估计与REI的一致性更好。异位并不限制SDB的检测。对REI≥15/h进行二元筛查，特异性极佳，为0.96，敏感性为0.77。对AHI≥15/h进行三元筛查产生了16%的临界分类，其余数据的特异性/敏感性为0.96/0.86。
对常规动态心电图进行睡眠呼吸障碍筛查是合理的，有望在不增加额外成本的情况下更早地识别出很大一部分患者。
