The predictive value of Holter monitoring in the risk of obstructive sleep apnea

Abstract

Background: Patients with obstructive sleep apnea (OSA) often present with cardiovascular symptoms.Holter monitors were reported to predict sleep apnea, though were rarely used in everyday clinical practice. In this study, by comparing Holter monitoring to polysomnography (PSG), we try to find out an operable way for clinicians to use Holter to predict OSA risk. Methods: Patients (n=63) suspected of OSA underwent Holter monitoring with concurrent PSG at a sleep center. Respiration and heart rate variability (HRV) indices were calculated from the Holter and compared with PSG indices. Results: The sensitivity of the Holter-derived respiratory waveform for OSA was 90.0%, and the specificity was 82.6%. The time domain indices including standard deviation of all NN intervals during 24 hours, mean of standard deviation of the averages of NN intervals in all 5-minute segments, square root of the mean squared differences of successive NN intervals, percentage of beat-to-beat NN interval differences that were more than 50 milliseconds, and the frequency domain index of high frequency decreased in participants with OSA and correlated with the PSG derived indices including apnea-hypopnea index (AHI), oxygen reduction index (ODI) and nadir SaO 2 . Logistic regression showed that standard deviation of all NN intervals during 24 hours and gender could predict the risk of OSA (P<0.001), with a sensitivity for diagnosing moderate to severe OSA of 87.5% and could accurately distinguish the risk of OSA in 77.8% of patients. Males with standard deviation of all NN intervals during 24 hours ≤177 ms or females with standard deviation of all NN intervals during 24 hours ≤80.9 ms were considered to be at high risk for OSA. Conclusions: Commercial and common parameters from Holter monitoring could predict the risk of OSA with high sensitivity. Therefore, the risk of OSA may be assessed using the Holter examination to improve the diagnosis and treatment rate of OSA.

An association between heart rate variability and pediatric obstructive sleep apnea

“…As previously reported, SDNN was negatively associated with OSA in adult patients with OSA [ 29 ]. The SDNN levels suggestive for OSA between adults and children were slightly different (177 vs. 138 ms).…”

“…This correlation may be explained from OSA induced HRV [ 30 , 31 ]. Another difference between this study and the adult study was that sex was not a predictor for pOSA in this study, while sex was also independently associated with being OSA in adult patients with OSA [ 29 ]. These results may imply that SDNN may be a stronger predictor for pOSA than sex or even AHI.…”

Targeting autonomic nervous system as a biomarker of well-ageing in the prevention of stroke

“…Furthermore, autonomic sympathetic activation during sleep predicts new-onset ambulatory hypertension (Roche et al, 2012). These strong relationships reinforce the interest in using Holter systems to detect OSA from Holter ECG (Pichot et al, 2015;Lao et al, 2021), and ANS activity may also be particularly well suited to follow treatment efficacy (Kim et al, 2020).…”

Heart rate variability changes in patients with obstructive sleep apnea: A systematic review and meta‐analysis

“…Duchenne muscular dystrophy and subacute myocardial infarction) or under medical treatment (Jo et al, 2005). The inclusion criterion of use of the AHI as a diagnostic criterion for the diagnosis of OSA was not met in 13 studies (Balachandran et al, 2012;Dingli et al, 2003;Gula et al, 2003;Guzik et al, 2013;Jurysta et al, 2013Jurysta et al, , 2006Khoo et al, 1999;Lao et al, 2021;Narkiewicz et al, 1998;Roche et al, 2002Roche et al, , 2003Salo et al, 2000;Zhu et al, 2012). In addition, the data involved in two studies were from open source databases, and it was difficult to determine whether the data overlapped with the included studies (Kamble et al, 2020;Li et al, 2019).…”