Abstract
Background: Sleep apnea is common in patients with cardiovascular disease and is a factor that worsens prognosis. Holter 24-h ECG screening for sleep apnea is beneficial in the care of these patients, but due to high night-to-night variability of sleep apnea, it can lead to misdiagnosis and misclassification of disease severity. Methods: To investigate the long-term dynamic behavior of sleep apnea, seven-day ECGs recorded with a patch ECG recorder in 120 patients were analyzed for the cyclic variation of heart rate (CVHR) during sleep periods as determined by a built-in three-axis accelerometer. Results: The frequency of CVHR (Fcv) showed considerable night-to-night variability (coefficient of variance, 66 ± 35%), which was consistent with the night-to-night variability in apnea-hypopnea index and oxygen desaturation index reported in earlier studies. In patients with presumed moderate-to-severe sleep apnea (Fcv > 15 cph at least one night), it was missed on 62% of nights, and on at least one night in 88% of patients. The CV of Fcv was negatively correlated with the average of Fcv, suggesting that patients with mild sleep apnea show greater night-to-night variability and would benefit from long-term assessment. The average Fcv was higher in the supine position, but the night-to-night variability was not explained by the night-to-night variability of time spent in the supine position. Conclusions: CVHR analysis of long-term ambulatory ECG recordings is useful for improving the reliability of screening for sleep apnea without placing an extra burden on patients with cardiovascular disease and their care.
Original language | English |
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Article number | e12901 |
Journal | Annals of Noninvasive Electrocardiology |
Volume | 27 |
Issue number | 2 |
DOIs | |
Publication status | Published - 2022 Mar |
Keywords
- Holter ECG
- day-to-day variation
- heart rate dynamics
- heart rate variability
- intraweek variation
- long-term ECG monitoring
- predictive accuracy
- sensitivity
- specificity
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)