Abstract
Objectives: Obstructive sleep apnea (OSA) is an emerging risk factor for cardiovascular disease and is mostly undiagnosed. Sudden changes in heart rate mediated by the autonomic nervous system are observed during sleep apnea episodes. It is not clear whether the presence of cyclic variation of heart rate (CVHR) is useful in predicting OSA. The purpose of the present study was to estimate the diagnostic accuracy of electrocardiographic Holter monitoring to identify patients with significant OSA in a selected population compared to polysomnogram. Methods: 136 consecutive patients underwent polysomnography (PSG) and electrocardiogram (ECG) Holter monitoring simultaneously for eight hours during sleep-time. All data from the PSG, the ECG Holter recordings and the automated sleep apnea software were evaluated to compare patients with regard to cyclic variation of heart rate, apnea and hypopnea index (AHI) and sleep parameters.
Highlights
There is a large amount of recent evidence supporting that obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular disease [1]
Patients diagnosed as severe Obstructive sleep apnea (OSA) had longer duration of cyclic variation of heart rate (CVHR) measured by the Holter monitoring
There was a moderate correlation between the duration of the CVHR episodes and the apnea-hypopnea index (AHI) (r = 0.50; P
Summary
There is a large amount of recent evidence supporting that obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular disease [1]. Individuals with OSA are at greater risk of stroke [4], hypertension [5,6], atrial and ventricular arrhythmias [7-9], impaired quality of life [10] and has been linked to adverse cardiovascular outcomes including coronary artery disease and congestive heart failure [11,12]. Severe untreated OSA has been associated with increased all-cause and cardiovascular mortality [13-16]. The gold standard diagnostic test for OSA is an overnight polysomnography (PSG), but it has several limitations including a prolonged wait time depending on available local resources, inconvenience of an overnight sleep study and expense, especially for lower socioeconomic areas [21]. Portable monitors can be used as an alternative tool to PSG for OSA diagnosis in patients with high pre test probability of having moderate to severe OSA. Portable monitors can be indicated when critical illness or limited mobility is an issue [22]
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