Key result
An SDNN index > 62 from single-channel ECG heart rate variability analysis identified moderate-to-severe obstructive sleep apnea with an AUC of 0.77, 73.3% sensitivity, and 85.7% specificity.
Why the study?
Does heart rate variability analysis from single-channel ECG accurately diagnose moderate-to-severe obstructive sleep apnea syndrome in patients undergoing sleep evaluation?
Cohort (n=51)
No
Does heart rate variability analysis from single-channel ECG accurately diagnose moderate-to-severe obstructive sleep apnea syndrome in patients undergoing sleep evaluation?
Effect estimate: AUC 0.77 (95% CI 0.63-0.87)
p-value: p=<0.01
Heart rate variability analysis from routine single-channel ECG may serve as a useful screening tool to differentiate moderate-to-severe obstructive sleep apnea from mild cases and healthy controls.
Hypothesis-generating for single-channel ECG HRV screening of moderate-severe OSA; prospective validation needed before clinical adoption.
OBJECTIVE: To evaluate the usefulness of heart rate variability analysis (HRV) analysis from the long duration electrocardiogram (ECG) recordings as a screening test for the diagnosis of moderate-to-severe obstructive sleep apnea syndrome (OSAS). METHODS: Recordings from 87 patients who were admitted to sleep laboratory for polysomnographic study (PSG) were evaluated. Finally 30 cases with apnea-hypopnea index (AHI)≥15/hour included in patient's group (male/female: 22/8; mean age: 49±10 years) and 21 cases with AHI<5 were included in control group (male/female: 10/11; mean age: 48±11 years). From the ECG recordings taken as a part of PSG, time -domain and frequency -domain HRV parameters were evaluated and their accuracy in the diagnosis of OSAS was investigated using ROC analysis. RESULTS: Statistically significant differences were found in HRV variables in time- domain parameters such as SDNN, SDNN index; frequency-domain parameters VLF, LF, nuLF, nuHF, LF/HF and geometric parameter HRV triangular index values in between groups. Cut- off value of 16 for the HRV triangular index was found to be 50% sensitive and 85.7% specific with a positive likelihood ratio (LR) of 3.50% and negative LR of 0.58% When the total power was higher than 9.611, then the analysis sensitivity was 53.3%, specificity was 95.6%, positive LR was 11.2% and negative LR was 0.49% When the SDNN was higher than 83 then its sensitivity was 80%, specificity was 76.2%, positive LR was 3.36% and negative LR was 0.26% For the cut off value of 62 calculated for SDNN index, sensitivity was 73.3%, specificity was 85.7%, positive LR was 5.13% and negative LR was 0.31%, for the cut off value of 9.12 was calculated for VLF, sensitivity was 90.4% specificity was 50% positive LR was 1.81% and negative LR was 0.19%. CONCLUSION: Heart rate variability analysis done over routine single channel ECG data gathered through routine Holter applications may be helpful in distinguishing moderate-to-severe OSAS patients from mild OSAS patients and non-OSAS control subjects.
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Karasulu et al. (2012) conducted a cohort in Obstructive sleep apnea syndrome (n=51). Heart rate variability (HRV) analysis vs. Non-OSAS controls was evaluated on Diagnostic accuracy of SDNN index > 62 for moderate-to-severe OSAS (AUC 0.77, 95% CI 0.63-0.87, p=<0.01). An SDNN index > 62 from single-channel ECG heart rate variability analysis identified moderate-to-severe obstructive sleep apnea with an AUC of 0.77, 73.3% sensitivity, and 85.7% specificity.
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