Screening for obstructive sleep apnea by cyclic variation of heart rate

Junichiro Hayano, Eiichi Watanabe, Yuji Saito, Fumihiko Sasaki, Keisaku Fujimoto, Tetsuo Nomiyama, Kiyohiro Kawai, Itsuo Kodama, Hiroki Sakakibara

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Abstract

Background-Despite the adverse cardiovascular consequences of obstructive sleep apnea, the majority of patients remain undiagnosed. To explore an efficient ECG-based screening tool for obstructive sleep apnea, we examined the usefulness of automated detection of cyclic variation of heart rate (CVHR) in a large-scale controlled clinical setting. Methods and Results-We developed an algorithm of autocorrelated wave detection with adaptive threshold (ACAT). The algorithm was optimized with 63 sleep studies in a training cohort, and its performance was confirmed with 70 sleep studies of the Physionet Apnea-ECG database. We then applied the algorithm to ECGs extracted from all-night polysomnograms in 862 consecutive subjects referred for diagnostic sleep study. The number of CVHR per hour (the CVHR index) closely correlated (r>0.84) with the apnea-hypopnea index, although the absolute agreement with the apnea-hypopnea index was modest (the upper and lower limits of agreement, 21 per hour and =19 per hour) with periodic leg movement causing most of the disagreement (P<0.001). The CVHR index showed a good performance in identifying the patients with an apnea-hypopnea index >15 per hour (area under the receiver-operating characteristic curve, 0.913; 83% sensitivity and 88% specificity, with the predetermined cutoff threshold of CVHR index >15 per hour). The classification performance was unaffected by older age (>65 years) or cardiac autonomic dysfunction (SD of normal-to-normal R-R intervals over the entire length of recording <65 ms; area under the receiver-operating characteristic curve, 0.915 and 0.911, respectively). Conclusions-The automated detection of CVHR with the ACAT algorithm provides a powerful ECG-based screening tool for moderate-to-severe obstructive sleep apnea, even in older subjects and in those with cardiac autonomic dysfunction.

Original languageEnglish
Pages (from-to)64-72
Number of pages9
JournalCirculation: Arrhythmia and Electrophysiology
Volume4
Issue number1
DOIs
Publication statusPublished - 01-02-2011

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All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Hayano, J., Watanabe, E., Saito, Y., Sasaki, F., Fujimoto, K., Nomiyama, T., Kawai, K., Kodama, I., & Sakakibara, H. (2011). Screening for obstructive sleep apnea by cyclic variation of heart rate. Circulation: Arrhythmia and Electrophysiology, 4(1), 64-72. https://doi.org/10.1161/CIRCEP.110.958009