Grasso Ian, Haigney Mark, Mortara David, Collen Jacob F, Hostler Jordanna, Moores Aimee, Sheikh Karen, Kelly William
Division of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, USA.
Division of Cardiology, WRNMMC, Bethesda, MD, USA.
Sleep Breath. 2018 Dec;22(4):1021-1028. doi: 10.1007/s11325-018-1623-9. Epub 2018 Jan 20.
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.
阻塞性睡眠呼吸暂停（OSA）综合征是一种常见病症，可影响心血管疾病患者的临床预后。通过多导睡眠图（PSG）对所有心脏病患者进行筛查成本高昂且资源有限。我们试图比较基于动态心电图监测仪的算法与实验室多导睡眠图（PSG）检测OSA的效果。
对接受实验室多导睡眠图监测以评估OSA的患者进行前瞻性队列研究。在PSG开始时，为患者连接标准的12导联动态心电图监测仪。基于检测基线时骨骼肌“噪声”，从呼吸肌电图中提取动态心电图衍生的呼吸紊乱指数（HDRDI）。通过比较肌电图的突然变化与心率的突然增加来识别呼吸暂停和低通气发作。将HDRDI与PSG衍生的呼吸暂停低通气指数（PDAHI）进行比较。
30例患者同时接受了动态心电图监测和夜间诊断性PSG。OSA的峰值HDRDI的ROC曲线为0.79（95%CI 0.61,0.97），敏感性为94.4%，特异性为54.5%。HDRDI < 10的临界值似乎可识别那些无临床显著睡眠呼吸障碍的个体。
动态心电图衍生的呼吸检测OSA的效果与PSG相当。有必要进一步研究以确定其在适当选择的患者中筛查和诊断OSA的效用。
