Utility of overnight pulse oximetry and heart rate variability analysis to screen for sleep-disordered breathing in chronic heart failure. Issue 11 (17th July 2012)

• Record Type: Journal Article
• Authors: Ward, Neil R; Cowie, Martin R; Rosen, Stuart D; Roldao, Vitor; De Villa, Manuel; McDonagh, Theresa A; Simonds, Anita; Morrell, Mary J
• Is Part Of: Thorax. Volume 67:Issue 11(2012)
• Page Start: 1000
• Page End: 1005
• Publication Date: 2012-07-17
• Subjects: Sleep-disordered breathing -- heart failure -- pulse oximetry -- heart rate variability -- sensitivity -- assisted ventilation -- non-invasive ventilation -- sleep apnoea -- exercise -- lung physiology -- perception of asthma/breathlessness -- COPD mechanisms -- pulmonary embolism -- systemic disease and lungs -- palliative care; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2012-201684
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Sleep-disordered breathing (SDB) is under diagnosed in chronic heart failure (CHF). Screening with simple monitors may increase detection of SDB in a cardiology setting. This study aimed to evaluate the accuracy of heart rate variability analysis and overnight pulse oximetry for diagnosis of SDB in patients with CHF. Methods: 180 patients with CHF underwent simultaneous polysomnography, ambulatory electrocardiography and wrist-worn overnight pulse oximetry. SDB was defined as an apnoea-hypopnoea index ≥15/h. To identify SDB from the screening tests, the per cent very low frequency increment (%VLFI) component of heart rate variability was measured with a pre-specified cutoff ≥2.23%, and the 3% oxygen desaturation index was measured with a pre-specified cutoff >7.5 desaturations/h. Results: 173 patients with CHF had adequate sleep study data; SDB occurred in 77 (45%) patients. Heart rate variability was measurable in 78 (45%) patients with area under the %VLFI receiver operating characteristic curve of 0.50. At the ≥2.23% cutoff, %VLFI sensitivity was 58% and specificity was 48%. The 3% oxygen desaturation index was measurable in 171 (99%) patients with area under the curve of 0.92. At the pre-specified cutoff of >7.5 desaturations/h, the 3% oxygen desaturation index had a sensitivity of 97%, specificity of 32%, negative likelihood ratio of 0.08 and positive likelihood ratio of 1.42. Diagnostic accuracy was increased using a cutoff of 12.5 desaturations/h, with sensitivity of 93% and specificity of 73%. Conclusions: The high sensitivity and low negative likelihood ratio of the 3% oxygen desaturation index indicates that pulse oximetry would be of use as a simple screening test to rule out SDB in patients with CHF in a cardiology setting. The %VLFI component of heart rate variability is not suitable for detection of SDB in CHF.