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Utility of overnight pulse oximetry and heart rate variability analysis to screen for sleep-disordered breathing in chronic heart failure

Background Sleep-disordered breathing (SDB) is under diagnosed in chronic heart failure (CHF). Screening with simple monitors may increase detection of SDB in a cardiology setting. This study aimed to evaluate the accuracy of heart rate variability analysis and overnight pulse oximetry for diagnosis... Full description

Journal Title: Thorax 2012-11, Vol.67 (11), p.1000-1005
Main Author: Ward, Neil R
Other Authors: Cowie, Martin R , Rosen, Stuart D , Roldao, Vitor , De Villa, Manuel , McDonagh, Theresa A , Simonds, Anita , Morrell, Mary J
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: London: BMJ Publishing Group Ltd and British Thoracic Society
ID: ISSN: 0040-6376
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title: Utility of overnight pulse oximetry and heart rate variability analysis to screen for sleep-disordered breathing in chronic heart failure
format: Article
creator:
  • Ward, Neil R
  • Cowie, Martin R
  • Rosen, Stuart D
  • Roldao, Vitor
  • De Villa, Manuel
  • McDonagh, Theresa A
  • Simonds, Anita
  • Morrell, Mary J
subjects:
  • Aged
  • Algorithms
  • assisted ventilation
  • Beta blockers
  • Biological and medical sciences
  • Cardiac arrhythmia
  • Cardiology. Vascular system
  • Chronic Disease
  • COPD mechanisms
  • Demographic aspects
  • Diagnosis
  • Electrocardiography
  • Electrocardiography, Ambulatory
  • exercise
  • Female
  • Heart
  • Heart beat
  • Heart failure
  • Heart Failure - complications
  • Heart Failure - epidemiology
  • Heart Failure - physiopathology
  • Heart failure, cardiogenic pulmonary edema, cardiac enlargement
  • Heart Rate
  • heart rate variability
  • Humans
  • lung physiology
  • Male
  • Mass Screening
  • Medical sciences
  • Middle Aged
  • non-invasive ventilation
  • Oximetry
  • palliative care
  • Patients
  • perception of asthma/breathlessness
  • Pneumology
  • Polysomnography
  • Predictive Value of Tests
  • pulmonary embolism
  • pulse oximetry
  • Research
  • Respiratory system : syndromes and miscellaneous diseases
  • sensitivity
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Sleep apnea syndromes
  • Sleep Apnea Syndromes - complications
  • Sleep Apnea Syndromes - diagnosis
  • Sleep Apnea Syndromes - epidemiology
  • Sleep Apnea Syndromes - physiopathology
  • sleep apnoea
  • Sleep-disordered breathing
  • Studies
  • systemic disease and lungs
  • United Kingdom - epidemiology
  • Usage
ispartof: Thorax, 2012-11, Vol.67 (11), p.1000-1005
description: Background Sleep-disordered breathing (SDB) is under diagnosed in chronic heart failure (CHF). Screening with simple monitors may increase detection of SDB in a cardiology setting. This study aimed to evaluate the accuracy of heart rate variability analysis and overnight pulse oximetry for diagnosis of SDB in patients with CHF. Methods 180 patients with CHF underwent simultaneous polysomnography, ambulatory electrocardiography and wrist-worn overnight pulse oximetry. SDB was defined as an apnoea-hypopnoea index ≥15/h. To identify SDB from the screening tests, the per cent very low frequency increment (%VLFI) component of heart rate variability was measured with a pre-specified cutoff ≥2.23%, and the 3% oxygen desaturation index was measured with a pre-specified cutoff >7.5 desaturations/h. Results 173 patients with CHF had adequate sleep study data; SDB occurred in 77 (45%) patients. Heart rate variability was measurable in 78 (45%) patients with area under the %VLFI receiver operating characteristic curve of 0.50. At the ≥2.23% cutoff, %VLFI sensitivity was 58% and specificity was 48%. The 3% oxygen desaturation index was measurable in 171 (99%) patients with area under the curve of 0.92. At the pre-specified cutoff of >7.5 desaturations/h, the 3% oxygen desaturation index had a sensitivity of 97%, specificity of 32%, negative likelihood ratio of 0.08 and positive likelihood ratio of 1.42. Diagnostic accuracy was increased using a cutoff of 12.5 desaturations/h, with sensitivity of 93% and specificity of 73%. Conclusions The high sensitivity and low negative likelihood ratio of the 3% oxygen desaturation index indicates that pulse oximetry would be of use as a simple screening test to rule out SDB in patients with CHF in a cardiology setting. The %VLFI component of heart rate variability is not suitable for detection of SDB in CHF.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0040-6376
fulltext: fulltext
issn:
  • 0040-6376
  • 1468-3296
url: Link


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titleUtility of overnight pulse oximetry and heart rate variability analysis to screen for sleep-disordered breathing in chronic heart failure
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creatorWard, Neil R ; Cowie, Martin R ; Rosen, Stuart D ; Roldao, Vitor ; De Villa, Manuel ; McDonagh, Theresa A ; Simonds, Anita ; Morrell, Mary J
creatorcontribWard, Neil R ; Cowie, Martin R ; Rosen, Stuart D ; Roldao, Vitor ; De Villa, Manuel ; McDonagh, Theresa A ; Simonds, Anita ; Morrell, Mary J
descriptionBackground Sleep-disordered breathing (SDB) is under diagnosed in chronic heart failure (CHF). Screening with simple monitors may increase detection of SDB in a cardiology setting. This study aimed to evaluate the accuracy of heart rate variability analysis and overnight pulse oximetry for diagnosis of SDB in patients with CHF. Methods 180 patients with CHF underwent simultaneous polysomnography, ambulatory electrocardiography and wrist-worn overnight pulse oximetry. SDB was defined as an apnoea-hypopnoea index ≥15/h. To identify SDB from the screening tests, the per cent very low frequency increment (%VLFI) component of heart rate variability was measured with a pre-specified cutoff ≥2.23%, and the 3% oxygen desaturation index was measured with a pre-specified cutoff >7.5 desaturations/h. Results 173 patients with CHF had adequate sleep study data; SDB occurred in 77 (45%) patients. Heart rate variability was measurable in 78 (45%) patients with area under the %VLFI receiver operating characteristic curve of 0.50. At the ≥2.23% cutoff, %VLFI sensitivity was 58% and specificity was 48%. The 3% oxygen desaturation index was measurable in 171 (99%) patients with area under the curve of 0.92. At the pre-specified cutoff of >7.5 desaturations/h, the 3% oxygen desaturation index had a sensitivity of 97%, specificity of 32%, negative likelihood ratio of 0.08 and positive likelihood ratio of 1.42. Diagnostic accuracy was increased using a cutoff of 12.5 desaturations/h, with sensitivity of 93% and specificity of 73%. Conclusions The high sensitivity and low negative likelihood ratio of the 3% oxygen desaturation index indicates that pulse oximetry would be of use as a simple screening test to rule out SDB in patients with CHF in a cardiology setting. The %VLFI component of heart rate variability is not suitable for detection of SDB in CHF.
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0ISSN: 0040-6376
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subjectAged ; Algorithms ; assisted ventilation ; Beta blockers ; Biological and medical sciences ; Cardiac arrhythmia ; Cardiology. Vascular system ; Chronic Disease ; COPD mechanisms ; Demographic aspects ; Diagnosis ; Electrocardiography ; Electrocardiography, Ambulatory ; exercise ; Female ; Heart ; Heart beat ; Heart failure ; Heart Failure - complications ; Heart Failure - epidemiology ; Heart Failure - physiopathology ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Heart Rate ; heart rate variability ; Humans ; lung physiology ; Male ; Mass Screening ; Medical sciences ; Middle Aged ; non-invasive ventilation ; Oximetry ; palliative care ; Patients ; perception of asthma/breathlessness ; Pneumology ; Polysomnography ; Predictive Value of Tests ; pulmonary embolism ; pulse oximetry ; Research ; Respiratory system : syndromes and miscellaneous diseases ; sensitivity ; Sensitivity and Specificity ; Severity of Illness Index ; Sleep apnea syndromes ; Sleep Apnea Syndromes - complications ; Sleep Apnea Syndromes - diagnosis ; Sleep Apnea Syndromes - epidemiology ; Sleep Apnea Syndromes - physiopathology ; sleep apnoea ; Sleep-disordered breathing ; Studies ; systemic disease and lungs ; United Kingdom - epidemiology ; Usage
ispartofThorax, 2012-11, Vol.67 (11), p.1000-1005
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1Cowie, Martin R
2Rosen, Stuart D
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4De Villa, Manuel
5McDonagh, Theresa A
6Simonds, Anita
7Morrell, Mary J
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descriptionBackground Sleep-disordered breathing (SDB) is under diagnosed in chronic heart failure (CHF). Screening with simple monitors may increase detection of SDB in a cardiology setting. This study aimed to evaluate the accuracy of heart rate variability analysis and overnight pulse oximetry for diagnosis of SDB in patients with CHF. Methods 180 patients with CHF underwent simultaneous polysomnography, ambulatory electrocardiography and wrist-worn overnight pulse oximetry. SDB was defined as an apnoea-hypopnoea index ≥15/h. To identify SDB from the screening tests, the per cent very low frequency increment (%VLFI) component of heart rate variability was measured with a pre-specified cutoff ≥2.23%, and the 3% oxygen desaturation index was measured with a pre-specified cutoff >7.5 desaturations/h. Results 173 patients with CHF had adequate sleep study data; SDB occurred in 77 (45%) patients. Heart rate variability was measurable in 78 (45%) patients with area under the %VLFI receiver operating characteristic curve of 0.50. At the ≥2.23% cutoff, %VLFI sensitivity was 58% and specificity was 48%. The 3% oxygen desaturation index was measurable in 171 (99%) patients with area under the curve of 0.92. At the pre-specified cutoff of >7.5 desaturations/h, the 3% oxygen desaturation index had a sensitivity of 97%, specificity of 32%, negative likelihood ratio of 0.08 and positive likelihood ratio of 1.42. Diagnostic accuracy was increased using a cutoff of 12.5 desaturations/h, with sensitivity of 93% and specificity of 73%. Conclusions The high sensitivity and low negative likelihood ratio of the 3% oxygen desaturation index indicates that pulse oximetry would be of use as a simple screening test to rule out SDB in patients with CHF in a cardiology setting. The %VLFI component of heart rate variability is not suitable for detection of SDB in CHF.
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13exercise
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16Heart beat
17Heart failure
18Heart Failure - complications
19Heart Failure - epidemiology
20Heart Failure - physiopathology
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22Heart Rate
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24Humans
25lung physiology
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27Mass Screening
28Medical sciences
29Middle Aged
30non-invasive ventilation
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32palliative care
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44Severity of Illness Index
45Sleep apnea syndromes
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47Sleep Apnea Syndromes - diagnosis
48Sleep Apnea Syndromes - epidemiology
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titleUtility of overnight pulse oximetry and heart rate variability analysis to screen for sleep-disordered breathing in chronic heart failure
authorWard, Neil R ; Cowie, Martin R ; Rosen, Stuart D ; Roldao, Vitor ; De Villa, Manuel ; McDonagh, Theresa A ; Simonds, Anita ; Morrell, Mary J
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2assisted ventilation
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abstractBackground Sleep-disordered breathing (SDB) is under diagnosed in chronic heart failure (CHF). Screening with simple monitors may increase detection of SDB in a cardiology setting. This study aimed to evaluate the accuracy of heart rate variability analysis and overnight pulse oximetry for diagnosis of SDB in patients with CHF. Methods 180 patients with CHF underwent simultaneous polysomnography, ambulatory electrocardiography and wrist-worn overnight pulse oximetry. SDB was defined as an apnoea-hypopnoea index ≥15/h. To identify SDB from the screening tests, the per cent very low frequency increment (%VLFI) component of heart rate variability was measured with a pre-specified cutoff ≥2.23%, and the 3% oxygen desaturation index was measured with a pre-specified cutoff >7.5 desaturations/h. Results 173 patients with CHF had adequate sleep study data; SDB occurred in 77 (45%) patients. Heart rate variability was measurable in 78 (45%) patients with area under the %VLFI receiver operating characteristic curve of 0.50. At the ≥2.23% cutoff, %VLFI sensitivity was 58% and specificity was 48%. The 3% oxygen desaturation index was measurable in 171 (99%) patients with area under the curve of 0.92. At the pre-specified cutoff of >7.5 desaturations/h, the 3% oxygen desaturation index had a sensitivity of 97%, specificity of 32%, negative likelihood ratio of 0.08 and positive likelihood ratio of 1.42. Diagnostic accuracy was increased using a cutoff of 12.5 desaturations/h, with sensitivity of 93% and specificity of 73%. Conclusions The high sensitivity and low negative likelihood ratio of the 3% oxygen desaturation index indicates that pulse oximetry would be of use as a simple screening test to rule out SDB in patients with CHF in a cardiology setting. The %VLFI component of heart rate variability is not suitable for detection of SDB in CHF.
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