Multi-modal ECG Holter system for sleep-disordered breathing screening: a validation study.

BACKGROUND: The high prevalence of sleep disordered breathing (SDB) among heart diseases patients becomes increasingly recognized. A reliable exploring tool of SDB well adapted to cardiologists practice would be very useful for the management of these patients. METHODS: We assessed a novel multi-modal electrocardiogram (ECG) Holter which incorporated both thoracic impedance and pulse oximetry signals. We compared in a home setting, a standard condition for Holter recordings, results from the novel device to a classical ambulatory polygraph in subjects with suspected SDB. The analysis of cardiac arrhythmias in relationship with SDB is also presented. A total of 118 patients clinically suspected of having SDB were evaluated (mean age 57 ± 14 years, mean body mass index [BMI] 32 ± 6 kg/m(2)). The new device allows calculating a new index called thoracic impedance (TI) disturbance index (TIDI+) evaluated from TI and SpO(2) signals recorded from a Holter monitor. RESULTS: In the population under study, 93% had more than 70% of usable TI signal and 95% had more than 90% for SpO(2) during sleep time recording. Screening performance results based on automatic analysis is accurate: TIDI + demonstrates a high level of sensitivity (96.8%), specificity (72.3%) as well as positive (82.4%) and negative (94.4%) predictive value for the detection of SDB. Moreover, detection of SDB periods permits us to observe a possible respiratory association of several nocturnal arrhythmias. CONCLUSIONS: The multi-modal Holter should be considered as a valuable evaluating tool for SDB screening and as a case selection technique for facilitating access to a full polysomnography for severe cases. Moreover, it offers a unique opportunity to study arrhythmia consequences with both respiratory and hypoxia disturbances.

Novel mathematical processing method of nocturnal oximetry for screening patients with suspected sleep apnoea syndrome.

AIM: Polysomnography (PSG) is the current standard for diagnosing sleep apnea syndrome (SAS). A reliable test would be useful to reduce the considerable resources required for PSG. METHODS: We developed a new mathematical analysis, which quantifies amplitude variations of pulse oximetry (SpO(2)) and heart rate (HR) throughout the night, allowing measurement of the total time in which ΔSpO(2) >4% and presented as a new oximetric index ventilatory hypoxemic index (VHI). VHI was compared prospectively with standard PSG parameters apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) in 106 patients (aged, 57 ± 14 years; BMI, 29 ± 5 kg/m(2)) suspected of having SAS. The criterion for diagnosis of SAS was AHI >15/h of sleep during PSG. The relationship between ΔSpO(2) and ΔΗR was also investigated. RESULTS: We observed a significant correlation between the AHI and VHI (R = 0.87, p < 0.0001). Using VHI >15 as the criterion for SpO(2), oximetry had a sensitivity of 81%, specificity of 98%, positive predictive value (PPV) of 98%, and negative predictive value (NPV) of 84% as a screening test for SAS. We also observed a clear linear relationship between ΔSpO(2) and ΔΗR, and concomitant use of VHI and the ΔSpO(2)/ΔHR slope improved the NPV to 90%. CONCLUSIONS: The present findings from wavelet-aggregate processing of oximeter data and the relationship between ΔSpO(2) and ΔΗR show promise as a useful summary prediction of screening SAS.

Use of high-frequency peak in spectral analysis of heart rate increment to improve screening of obstructive sleep apnoea.

PURPOSE: Several studies have correlated the ratio of the very low frequency power spectral density of heart rate increment (%VLFI) with obstructive sleep apnoea syndrome (OSAS). However, patients with impaired heart rate variability may exhibit large variations of heart rate increment (HRI) spectral pattern and alter the screening accuracy of the method. METHODS: To overcome this limitation, the present study uses the high-frequency increment (HFI) peak in the HRI spectrum, which corresponds to the respiratory influence on RR variations over the frequency range 0.2 to 0.4 Hz. We evaluated 288 consecutive patients referred for snoring, observed nocturnal breathing cessation and/or daytime sleepiness. Patients were classified as OSAS if their apnoea plus hypopnoea index (AHI) during polysomnography exceeded 15 events per hour. Synchronized electrocardiogram Holter monitoring allowed HRI analysis. RESULTS: Using a %VLFI threshold >2.4% for identifying the presence of OSAS, sensitivity for OSAS was 74.9%, specificity 51%, positive predictive value 54.9% and negative predictive value 71.7% (33 false negative subjects). Using threshold for %VLFI >2.4% and HFI peak position >0.4 Hz, negative predictive value increased to 78.2% while maintaining specificity at 50.6%. Among 11 subjects with %VLFI <2.4% and HFI peak >0.4 Hz, nine demonstrated moderate to severe OSAS (AHI >30). CONCLUSIONS: HFI represents a minimal physiological criterion for applying %VLFI by ensuring that heart rate variations are band frequency limited.

Does postural chain muscular stiffness reduce postural steadiness in a sitting posture?

This study investigated the effect of postural chain muscular stiffening on postural steadiness when it is rhythmically perturbed by respiration. It consisted of an analysis of centre of pressure (CP) displacements when constant sub-maximum pushing efforts were performed in a sitting posture. Muscular stiffness, assessed by surface electromyography (iEMG), was imposed at two controlled levels, using two intensities of pushing effort (20% and 40% of the maximum voluntary contraction: 20MVC and 40MVC). Lumbo-pelvic mobility was varied using two different support areas at the seat contact (100% and 30% of the ischio-femoral length: 100BP and 30BP). Respiratory disturbance to posture was varied using two respiratory rate conditions (quiet breathing (QB), which is the spontaneous rate, and fast breathing (FB) at a rate imposed by a metronome). The results demonstrated that an increased push effort was associated to a higher iEMG level, and induced greater mean deviation (X (p)) and sway path (SP) of antero-posterior CP displacements. It was concluded that postural muscle stiffness reduces postural steadiness. It was suggested that it could be related to a weaker compensation of respiratory disturbance to body posture.