Heart rate increment: an electrocardiological approach for the early detection of obstructive sleep apnoea/hypopnoea syndrome.

The prevalence of OSAHS (obstructive sleep apnoea/hypopnoea syndrome) is high in developed countries and it is estimated that the vast majority of patients remain undiagnosed. On the basis of physiological evidence, we evaluated the frequency component of HRI (heart rate increment) as a simple and inexpensive screening tool for OSAHS detection in a first group of patients (group 1) and validated their discriminant capacity in a second group (group 2). The predictive accuracy of hourly %VLFI (frequency-domain HRI variable obtained from nocturnal ECG Holter monitoring) was analysed by comparison with an hour-by-hour respiratory disturbances index assessed by complete polysomnography in 28 consecutive clinically suspected OSAHS patients for group 1 and in 35 patients for group 2. OSAHS was present in 20 patients according to a mean hourly apnoea plus hypopnoea index >10 in group 1, and prevalence reached 77.1% in group 2. Sensitivity, specificity and positive and negative predictive accuracy were calculated and an ROC (receiver operating characteristic) curve was constructed for several polysomnographic threshold values. In group 1, hourly %VLFI appeared as an evident predictor of the apnoea/hypopnoea index (W=0.848, P<0.0001; where W is the area under the curve obtained using ROC curve analysis). Using an appropriate threshold (value > or =3.2%), %VLFI demonstrated a sensitivity of 78.1% and a specificity of 70.4%. These thresholds applied to group 2 yielded a sensitivity of 73.9% and a specificity of 76.6%. Frequency-domain analysis of the HRI appears to be a powerful tool for OSAHS prediction. The simplicity of its analysis and use makes of it a particularly well-suited variable for routine mass screening in high-risk populations undergoing ECG Holter monitoring.

Validation of a two-axis accelerometer for monitoring patient activity during blood pressure or ECG holter monitoring.

OBJECTIVES: The aim of the study was to evaluate the efficiency of a position/activity monitoring system based on a dual-axis accelerometer strapped to the subject's thigh and a position sensor located within a monitor placed on the subject's belt. METHODS: Twenty-six subjects wearing two monitors (one accelerometer on each thigh) were submitted to various activities and positions under the control of an observer. An analysis of each tracing was performed both manually by a technician and automatically by dedicated software before being compared with the information gathered during the study. RESULTS: The accelerometer allowed accurate discrimination between the standing versus the sitting and lying positions. The sitting and lying positions were correctly detected by the built-in position sensor provided the unit was firmly attached. Walking was adequately detected by the accelerometer. The activity score was well correlated with treadmill speed. Changes in position and activity were detected with a mean error of less than 3 s. CONCLUSIONS: The combination of an accelerometer placed on the subject's thigh and a position sensor located at the subject's waist appeared to be a suitable system for position/activity monitoring during ambulatory ECG and blood pressure monitoring.