Abstract
BACKGROUND: Sleep-disordered breathing (SDB) is critically associated with cardiovascular mortality and morbidity, especially in patients with heart failure (HF). However, the majority of SDB patients remain undiagnosed. In contrast, abnormality in heart rate variability has been reported in patients with SDB. To explore an efficient electrocardiogram (ECG)-based screening tool for SDB, we examined the usefulness of cyclic variation in heart rate score (CVHRS) by Holter ECG in subjects with HF.
METHODS: In this study, 102 subjects with HF were enrolled. We simultaneously performed Holter ECG with overnight portable sleep monitoring, and we measured the respiratory disturbance index (RDI) and CVHRS. We determined the temporal position of the individual dips comprising the CVHRS using time-domain methods. CVHRS was measured as cyclic and autocorrelated dips in smoothed interbeat interval time series.
RESULTS: There were 25 subjects with severe SDB (RDI ≥ 30 events/h) and 77 subjects with none-to-moderate SDB (0 ≤ RDI < 30 events/h). There was a significant positive correlation between CVHRS and RDI (r = 0.60, P < .001). In receiver operating characteristic analysis, CVHRS (cutoff of 30 events/h) identified severe SDB with a sensitivity of 82%, a specificity of 77%, and an area under the curve of 0.83.
CONCLUSIONS: CVHRS determined by Holter ECG is a useful screening index for severe SDB in subjects with HF.
Footnotes
- Correspondence: Akiomi Yoshihisa MD PhD, Department of Cardiology and Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan. E-mail: yoshihis{at}fmu.ac.jp.
Supplementary material related to this paper is available at http://www.rcjournal.com.
This study was supported in part by Grant-in-Aid for Scientific Research 25461061 from the Japan Society for the Promotion of Science and grants-in-aid from the Japanese Ministry of Health, Labour, and Welfare (Tokyo, Japan). The Department of Advanced Cardiac Therapeutics is supported by Fukuda Denshi. The authors have disclosed no other conflicts of interest.
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