Sleep Disorders |

Use of Holter Monitoring to Diagnose Sleep Disordered Breathing FREE TO VIEW

Ian Grasso, BS; Jacob Collen, MD; Mark Haigney, MD; William Kelly, MD
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Uniformed Services University, Bethesda, MD

Chest. 2014;145(3_MeetingAbstracts):571A. doi:10.1378/chest.1834972
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SESSION TITLE: Sleep Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Cardiologists and sleep/pulmonary physicians are increasingly co-managing patients in an environment of healthcare cost concerns and other increasing external pressures. The incidence of sleep apnea in patients with atrial fibrillation approaches 100%. Perhaps more concerning is the finding that 60% of patients with severe sleep apnea have significant ventricular arrhythmias. Patients initially diagnosed with arrhythmia due to subjective complaint of palpations may, in fact, have an underlying diagnosis of sleep apnea. Failure to recognize and treat sleep-related breathing disorders results in high costs, both financially and in terms of patients’ morbidity and mortality. However, sleep apnea is underdiagnosed due to backlogs in sleep laboratories and limitations of at-home testing.

METHODS: We present a case of a 41 year old male with severe complex sleep apnea who was placed on Holter Monitoring with a Mortara H12+ Monitor. Data was collected in the standard fashion and was an Electrophysiologist using standard waveform analysis program where sleep apnea was diagnosed from the ECG signal in a process referred to in the literature at EDR (ECG Dervied Respiration). Later, the patient underwent polysomnography and the findings were confirmed.

RESULTS: Sleep apnea was diagnosed using our novel holter device, with subsequent confirmation by in-laboratory polysomnography. Test characteristics and correlations between the two techniques will be described. Subject enrollment continues.

CONCLUSIONS: In this single case, in which methods for diagnosing sleep disordered breathing through Holter monitoring were tested as a proof of concept, a correlation between ECG waveforms and sleep study data was found. This data is being applied to a pilot study that recently gained IRB approval at the Walter Reed National Military Medical Center.

CLINICAL IMPLICATIONS: The use of polysomnography as a diagnostic tool is skyrocketing - with associated costs to health organizations and federal systems increasing exponentially. The advantage of diagnosing sleep apnea via this novel holter monitor is obvious. It costs much less and can be done more quickly and conveniently than in-lab polysomnography, and it can simultaneously and accurately diagnose co-existing cardiac dysrhythmias without the single lead limitations, short monitoring times, and frequent artifacts of home sleep apnea systems.

DISCLOSURE: The following authors have nothing to disclose: Ian Grasso, Jacob Collen, Mark Haigney, William Kelly

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