Sleep Disorders |

Can Holter Electrocardiographic Monitoring Accurately Diagnose Sleep Disordered Breathing? FREE TO VIEW

William Kelly; Ian Grasso; Jordanna Hostler; Jacob Collen; Mark Haigney
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Uniformed Services University of the Health Sciences, Potomac, MD

Chest. 2014;146(4_MeetingAbstracts):937A. doi:10.1378/chest.1995205
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SESSION TITLE: Sleep Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The purpose of the study was to assess the sensitivity and specificity of standard, continuous electrocardiographic assessments of sleep-disordered breathing in subjects undergoing the current gold standard, which is formal polysomnography with at least four channels attended by a technologist.

METHODS: Sequential adults referred to our sleep laboratory for a diagnostic polysomnogram were invited to participate in this IRB approved pilot study. Thirty consented to enrollment and wore a 12-lead, multi-hour ambulatory electrocardiographic monitor (“Holter”) during the night of their sleep study. Respiratory events were measured by conventional polysmonography channels and obstructive and central apneic events recorded as defined by American Academy of Sleep Medicine (AASM) scoring criteria. Blinded to these PSG results, a cardiologist determined respiratory events using a combination of myogram, R-R interval (inversely proportional to heart rate), and ECG derived responses. Success of overall diagnosis (normal, mild, moderate, severe apnea), type of events (obstructive, central, mixed), and detection of individual events, were compared.

RESULTS: Enrollment completed in March. Preliminarily Holter monitoring resulted in similar diagnosis rates and severity classifications. False positives were seen with arousals unrelated to apneas, resulting in high sensitivity but lower specificity. Complete test characteristics will be described. Arrhythmias were better detected in the Holter. There were no adverse events.

CONCLUSIONS: Continuous electrocardiogram (Holter) when compared to technician attended polysomnogram, successfully identified obstructive apneas and cheyne-stokes respiration, categorized the severity of sleep apnea, and confirmed its partial response to CPAP therapy.

CLINICAL IMPLICATIONS: Cardiologists may be able to readily detect co-morbid sleep apnea in their patients with atrial fibrillation and congestive heart failure that are already undergoing Holter monitoring. Sleep physicians may be able to use Holters as an additional home-sleep study (HST) option for diagnosis and/or to confirm response to CPAP therapy in addition to better screening for sleep-related arrhythmias.

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

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