Utility of cyclic variation of heart rate score as a screening tool for sleep-disordered breathing in patients with heart failure.

STUDY OBJECTIVES: Patients with sleep-disordered breathing have cyclic variation of heart rate (CVHR) in response to respiratory events. However, limited data are available regarding the utility of CVHR as a screening tool for sleep-disordered breathing in patients with mixed heart failure (HF) and those without HF. METHODS: We enrolled consecutive patients with and without HF who underwent full polysomnographies with simultaneous Holter electrocardiogram monitoring. We determined the temporal position of the individual dips comprising the CVHR score using time-domain methods. RESULTS: The data of 101 patients, including 70 with and 31 without HF, were analyzed. The CVHR score was significantly correlated with the apnea-hypopnea index (r = .667, P < .001) and limits of agreement between the apnea-hypopnea index and CVHR score were -21.8 to 35.2. The receiver operating characteristic analysis demonstrated that the CVHR score (best cut-off of 23.5 events/h) identified severe sleep-disordered breathing with a sensitivity of 83.3%, specificity of 79.5%, and the area under the curve of 0.856. In addition, there was no interaction between the presence or absence of HF and the apnea-hypopnea index-CVHR score relationship (P = .323). CONCLUSIONS: The CVHR score, determined by Holter electrocardiogram monitoring, is a useful tool for evaluating sleep-disordered breathing even in patients with mixed HF and patients without HF. CITATION: Yatsu S, Kasai T, Naito R, et al. Utility of cyclic variation of heart rate score as a screening tool for sleep-disordered breathing in patients with heart failure. J Clin Sleep Med. 2021;17(11):2187-2196.

Influence of Eyelid Pressure on Fluorescein Staining of Ocular Surface in Dry Eyes.

PURPOSE: To determine the relationship between eyelid pressure during blinking and the fluorescein staining of the cornea and conjunctiva in dry eye patients. DESIGN: Cross-sectional prospective study. METHODS: The pressure of the upper and lower eyelids was measured with a specially designed blepahro-tensiometer in 130 eyes of 65 dry eye patients (D group) and in 58 eyes of 31 normal controls (N group). The correlations between the location and degree of ocular surface staining scores and the eyelid pressure were calculated for the D group. RESULTS: The pressures of the upper and lower eyelids were significantly higher in the D group than in the N group (upper P < .0001, lower P = .0040). The lower eyelid pressure was significantly correlated with the ocular surface staining scores for the inferior cornea (r = 0.19, P = .0307) and conjunctiva (r = 0.19, P = .0252). CONCLUSIONS: The significant correlation between the eyelid pressure and the ocular surface staining suggests that mechanical friction on the ocular surface by the eyelids may be one of the factors that affects the fluorescein staining of the inferior ocular surface.