Accuracy of ECG-based screening for sleep-disordered breathing: a survey of all male workers in a transport company

Hayano, Junichiro; Tsukahara, Teruomi; Watanabe, Eiichi; Sasaki, Fumihiko; Kawai, Kiyohiro; Sakakibara, Hiroki; Kodama, Itsuo; Nomiyama, Tetsuo

doi:10.1007/s11325-012-0681-7

Cited by 27 publications

(48 citation statements)

References 32 publications

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“…In a previous study of 862 consecutive patients referred for standard, attended, overnight polysomnography (11), we demonstrated that the CVHR index derived by the ACAT algorithm closely correlates with polysomnographic AHI ( r = 0.84), and that using a criterion of CVHR index ≥15 per hour, patients with moderate-to-severe SA (AHI ≥15 per hour) are identified with 83% sensitivity and 88% specificity. The validity of the algorithm was confirmed also in a polysomnographic population survey of male workers (17), in which CVHR index ≥15 per hour detected individuals with moderate-to-severe SA (AHI ≥15 per hour) with 88% sensitivity and 97% specificity. We are therefore confident that the algorithm accurately detected SA in this study.…”

Section: Discussionmentioning

confidence: 74%

“…Patients were considered to have SA if they had a CVHR index ≥15 per hour. This criterion was previously shown to be optimal for identifying patients with an apnea-hypopnea index (AHI) ≥15 per hour based on overnight polysomnography (11, 17). …”

Section: Methodsmentioning

confidence: 99%

“…The ACAT algorithm has been extensively studied and found to be a reliable, sensitive, and specific measure of SA (12-16). The ACAT algorithm was validated by overnight polysomnographic studies in 862 patients referred for the diagnosis of SA (11) and in a population of 162 male workers (11, 17), in which ACAT algorithm detected moderate-to-severe SA with 83 and 88% sensitivity and 88 and 97% specificity.…”

Section: Introductionmentioning

confidence: 99%

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Interactive Associations of Depression and Sleep Apnea With Adverse Clinical Outcomes After Acute Myocardial Infarction

Hayano

Carney²,

Watanabe³

et al. 2012

Psychosomatic Medicine

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Objective Depression and sleep apnea (SA) are common among patients after acute myocardial infarction (AMI), and both are associated with increased risk for adverse outcomes. We tested the hypothesis that there is an interaction between depression and SA in relation to prognosis in post-AMI patients. Methods Participants were 337 depressed and 379 nondepressed post-AMI patients who participated in a substudy of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial. SA was identified from Holter ECG at the entry by an algorithm that detects cyclic variation of heart rate. Results During a median follow-up of 25 months, 43 (6.0%) of patients died and 83 (11.6%) either died or experienced a recurrent AMI. Among 94 patients with both depression and SA, these endpoints occurred in 20 (21.3%) and 25 (26.6%), the prevalence that was 6.9 and 3.9 times higher than predicted probabilities by ENRICHD clinical risk scores (P <.001 for both). In the patients with depression alone, SA alone, or neither, the frequencies did not differ significantly from the predicted probability. Although both depression and SA predicted death and the combined endpoint, we observed depression by SA interactions (P = .03 and .02). SA independently predicted these endpoints in depressed (P <.001 and P = .001), but not in nondepressed patients (P = .73 and .84). Similarly, depression independently predicted these endpoints in SA (P <.001 for both), but not in non-SA patients (P = .61 and .12). Conclusion The combination of depression and SA estimated by CVHR is associated with long-term adverse clinical outcomes after AMI.

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Section: Discussionmentioning

confidence: 74%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Interactive Associations of Depression and Sleep Apnea With Adverse Clinical Outcomes After Acute Myocardial Infarction

Hayano

Carney²,

Watanabe³

et al. 2012

Psychosomatic Medicine

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“…PMs are usually used as an initial diagnostic or screening tool and in selected patients, if the test results are positive, can be used to recommend treatment, while ruling out additional testing if results were negative 16. PMs can be used on an unattended basis, and several studies have reported a high diagnostic accuracy of up to 90% in detecting SDB 17, 18, 19, 20, 21. High study failure rates because of their complex unattended design can, however, result in the need for repeated studies 16.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a novel non‐contact monitor of nocturnal respiration for identifying sleep‐disordered breathing in patients with heart failure

et al. 2016

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AimsAt least 50% of patients with heart failure (HF) may have sleep‐disordered breathing (SDB). Overnight in‐hospital polysomnography (PSG) is considered the gold standard for diagnosis, but a lack of access to such testing contributes to under‐diagnosis of SDB. Therefore, there is a need for simple and reliable validated methods to aid diagnosis in patients with HF. The aim of this study was to investigate the accuracy of a non‐contact type IV screening device, SleepMinderTM (SM), compared with in‐hospital PSG for detecting SDB in patients with HF.Methods and resultsThe study included 75 adult patients with systolic HF and suspected SDB who underwent simultaneous PSG and SM recordings. An algorithm was developed from the SM signals, using digital signal processing and pattern recognition techniques to calculate the SM apnoea‐hypopnoea index (AHI). This was then compared with expert‐scored PSGAHI. The SM algorithm had 70% sensitivity and 89% specificity for identifying patients with clinically significant SDB (AHI ≥ 15/h). At this threshold, it had a positive likelihood ratio of 6.3 and a negative likelihood ratio of 0.16. The overall accuracy of the SMAHI algorithm was 85.8% as shown by the area under a receiver operator characteristic curve. The mean AHI with SM was 3.8/h (95% confidence interval 0.5–7.1) lower than that with PSG.ConclusionsThe accuracy of the non‐contact type IV screening device SM is good for clinically significant SDB in patients with systolic HF and could be considered as a simple first step in the diagnostic pathway.

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“…In previous research [3] [4], the timefrequency components of HRV time series were used to screen OSAS. Hayano et al presented indices to detect OSAS in the time domain [5] [6]. The EDR is a respiratory waveform estimated from the ECG signal.…”

Section: Introductionmentioning

confidence: 99%

Holter ECG-Based Apnea Hypopnea Index to Screen Obstructive Sleep Apnea: A New Proposal and Evaluation of Feasibility

Sakai¹,

Wei²

2015

JBM

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Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder. It has been reported that approximately 40% of patients with moderate or severe OSAS die within the first eight years of disease. In hospitals, OSAS is inspected using polysomnography, which uses a number of sensors. Because of the cumbersome nature of this polysomnography, an initial OSAS screening is usually conducted. In recent years, OSAS screening techniques using Holter electrocardiogram (ECG) have been reported. However, the techniques so far reported cannot perform an OSAS severity assessment. The present study presents a new method to distinguish the obstructive sleep apnea (OSA) and non-OSA epochs at one-second intervals based on the Apnea Hypopnea Index assessment, defined as the duration of continuous apnea. In the proposed method, the time-frequency components of the heart rate variability and three ECG-derived respiration signals calculated by the complex Morlet wavelet transformation are adopted as features. A support vector machine is employed for classification. The proposed method is evaluated using three eight-hour ECG recordings containing OSA episodes from three subjects. As a result, the sensitivity and specificity of classification are found to reach approximately 90%, a level suitable for OSAS screening in clinical settings.

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Accuracy of ECG-based screening for sleep-disordered breathing: a survey of all male workers in a transport company

Cited by 27 publications

References 32 publications

Interactive Associations of Depression and Sleep Apnea With Adverse Clinical Outcomes After Acute Myocardial Infarction

Interactive Associations of Depression and Sleep Apnea With Adverse Clinical Outcomes After Acute Myocardial Infarction

Development and validation of a novel non‐contact monitor of nocturnal respiration for identifying sleep‐disordered breathing in patients with heart failure

Holter ECG-Based Apnea Hypopnea Index to Screen Obstructive Sleep Apnea: A New Proposal and Evaluation of Feasibility

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