Detection of sleep-disordered breathing with ambulatory Holter monitoring

• Published in: Sleep & breathing Vol. 22; no. 4; pp. 1021 - 1028
• Main Authors: Grasso, Ian, Haigney, Mark, Mortara, David, Collen, Jacob F., Hostler, Jordanna, Moores, Aimee, Sheikh, Karen, Kelly, William
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2018; Springer Nature B.V
• Subjects: Algorithms; Apnea; Cardiac arrhythmia; Clinical significance; Cohort Studies; Coronary artery disease; Dentistry; Electrocardiography, Ambulatory - methods; Equipment Design; Heart diseases; Heart rate; Humans; Internal Medicine; Laboratories; Medicine; Medicine & Public Health; Monitoring, Ambulatory - methods; Neurology; Otorhinolaryngology; Pediatrics; Pneumology/Respiratory System; Polysomnography - methods; Prospective Studies; Respiration; Sensitivity and Specificity; Skeletal muscle; Sleep; Sleep apnea; Sleep Apnea, Obstructive - diagnosis; Sleep Breathing Physiology and Disorders • Original Article; Sleep disorders; Holter monitor; Sleep apnea; Home sleep test; Portable monitor; Obstructive sleep apnea
• ISSN: 1520-9512; 1522-1709
• DOI: 10.1007/s11325-018-1623-9

Purpose 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). Methods 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). Results 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. Conclusion 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.