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21.06.2019 | Sleep Breathing Physiology and Disorders • Original Article

Electrocardiogram-based sleep analysis for sleep apnea screening and diagnosis

verfasst von: Yan Ma, Shuchen Sun, Ming Zhang, Dan Guo, Arron Runzhou Liu, Yulin Wei, Chung-Kang Peng

Erschienen in: Sleep and Breathing | Ausgabe 1/2020

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Abstract

Purpose

Despite the increasing number of research studies of cardiopulmonary coupling (CPC) analysis, an electrocardiogram-based technique, the use of CPC in underserved population remains underexplored. This study aimed to first evaluate the reliability of CPC analysis for the detection of obstructive sleep apnea (OSA) by comparing with polysomnography (PSG)-derived sleep outcomes.

Methods

Two hundred five PSG data (149 males, age 46.8 ± 12.8 years) were used for the evaluation of CPC regarding the detection of OSA. Automated CPC analyses were based on ECG signals only. Respiratory event index (REI) derived from CPC and apnea–hypopnea index (AHI) derived from PSG were compared for agreement tests.

Results

CPC-REI positively correlated with PSG-AHI (r = 0.851, p < 0.001). After adjusting for age and gender, CPC-REI and PSG-AHI were still significantly correlated (r = 0.840, p < 0.001). The overall results of sensitivity and specificity of CPC-REI were good.

Conclusion

Compared with the gold standard PSG, CPC approach yielded acceptable results among OSA patients. ECG recording can be used for the screening or diagnosis of OSA in the general population.

Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC (2016) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81. https://doi.org/10.1016/j.smrv.2016.07.002 CrossRefPubMed

Ma Y, Sun S, Peng CK, Fang Y, Thomas RJ (2017) Ambulatory blood pressure monitoring in Chinese patients with obstructive sleep apnea. J Clin Sleep Med 13(3):433–439. https://doi.org/10.5664/jcsm.6498 CrossRefPubMedPubMedCentral

Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, Hudgel D, Sateia M, Schwab R (2007) Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 3(7):737–747CrossRef

Collop NA, Tracy SL, Kapur V, Mehra R, Kuhlmann D, Fleishman SA, Ojile JM (2011) Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation. J Clin Sleep Med 7(5):531–548. https://doi.org/10.5664/jcsm.1328 CrossRefPubMedPubMedCentral

Yuceege M, Firat H, Demir A, Ardic S (2013) Reliability of the Watch-PAT 200 in detecting sleep apnea in highway bus drivers. J Clin Sleep Med 9(4):339–344. https://doi.org/10.5664/jcsm.2584 CrossRefPubMedPubMedCentral

Korkuyu E, Duzlu M, Karamert R, Tutar H, Yilmaz M, Ciftci B, Guven SF (2015) The efficacy of Watch PAT in obstructive sleep apnea syndrome diagnosis. Eur Arch Otorhinolaryngol 272(1):111–116. https://doi.org/10.1007/s00405-014-3097-0 CrossRefPubMed

Choi JH, Lee B, Lee JY, Kim HJ (2018) Validating the Watch-PAT for diagnosing obstructive sleep apnea in adolescents. J Clin Sleep Med 14(10):1741–1747. https://doi.org/10.5664/jcsm.7386 CrossRefPubMedPubMedCentral

Gehring J, Gesche H, Drewniok G, Kuchler G, Patzak A (2018) Nocturnal blood pressure fluctuations measured by using pulse transit time in patients with severe obstructive sleep apnea syndrome. Sleep Breath 22(2):337–343. https://doi.org/10.1007/s11325-017-1555-9 CrossRefPubMed

Li Y, Gao H, Ma Y (2017) Evaluation of pulse oximeter derived photoplethysmographic signals for obstructive sleep apnea diagnosis. Medicine 96(18):e6755. https://doi.org/10.1097/md.0000000000006755 CrossRefPubMedPubMedCentral

10.

Morgenthaler T, Alessi C, Friedman L, Owens J, Kapur V, Boehlecke B, Brown T, Chesson A Jr, Coleman J, Lee-Chiong T, Pancer J, Swick TJ (2007) Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. Sleep 30(4):519–529CrossRef

11.

Dumont M, Jurysta F, Lanquart JP, Migeotte PF, van de Borne P, Linkowski P (2004) Interdependency between heart rate variability and sleep EEG: linear/non-linear? Clin Neurophysiol 115(9):2031–2040. https://doi.org/10.1016/j.clinph.2004.04.007 CrossRefPubMed

12.

Penzel T, Kantelhardt JW, Bartsch RP, Riedl M, Kraemer JF, Wessel N, Garcia C, Glos M, Fietze I, Schöbel C (2016) Modulations of heart rate, ECG, and cardio-respiratory coupling observed in polysomnography. Front Physiol 7:460–460. https://doi.org/10.3389/fphys.2016.00460 CrossRefPubMedPubMedCentral

13.

Stein PK, Pu Y (2012) Heart rate variability, sleep and sleep disorders. Sleep Med Rev 16(1):47–66. https://doi.org/10.1016/j.smrv.2011.02.005 CrossRefPubMed

14.

Hill LK, Siebenbrock A (2009) Are all measures created equal? Heart rate variability and respiration - biomed 2009. Biomed Sci Instrum 45:71–76PubMed

15.

Billman GE (2011) Heart rate variability - a historical perspective. Front Physiol 2:86. https://doi.org/10.3389/fphys.2011.00086 CrossRefPubMedPubMedCentral

16.

Shaffer F, McCraty R, Zerr CL (2014) A healthy heart is not a metronome: an integrative review of the heart’s anatomy and heart rate variability. Front Psychol 5:1040. https://doi.org/10.3389/fpsyg.2014.01040 CrossRefPubMedPubMedCentral

17.

Ma Y, McCraty R (2016) Heart rate variability in mind-body interventions. Complement Ther Med 29:A1–A2. https://doi.org/10.1016/j.ctim.2016.05.003 CrossRefPubMed

18.

Ma Y, Tseng PH, Ahn A, Wu MS, Ho YL, Chen MF, Peng CK (2017) Cardiac autonomic alteration and metabolic syndrome: an ambulatory ECG-based study in a general population. Sci Rep 7:44363. https://doi.org/10.1038/srep44363 CrossRefPubMedPubMedCentral

19.

Ma Y, Wu CW, Peng CK, Ahn A, Bertisch SM, Lipsitz LA, Yeh GY, Manor B, Novak V, Hausdorff JM, Gow B, Wayne PM (2019) Complexity-based measures of heart rate dynamics in older adults following long- and short-term tai chi training: cross-sectional and randomized trial studies. Sci Rep 9(1):7500. https://doi.org/10.1038/s41598-019-43602-y CrossRefPubMedPubMedCentral

20.

Thomas RJ, Mietus JE, Peng CK, Goldberger AL (2005) An electrocardiogram-based technique to assess cardiopulmonary coupling during sleep. Sleep 28(9):1151–1161CrossRef

21.

Magnusdottir S, Hilmisson H (2018) Ambulatory screening tool for sleep apnea: analyzing a single-lead electrocardiogram signal (ECG). Sleep Breath 22(2):421–429. https://doi.org/10.1007/s11325-017-1566-6 CrossRefPubMed

22.

Hayano J, Watanabe E, Saito Y, Sasaki F, Fujimoto K, Nomiyama T, Kawai K, Kodama I, Sakakibara H (2011) Screening for obstructive sleep apnea by cyclic variation of heart rate. Circ Arrhythm Electrophysiol 4(1):64–72. https://doi.org/10.1161/circep.110.958009 CrossRefPubMed

23.

Berry RB, Brooks R, Gamaldo CE et al (2016) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. American Academy of Sleep Medicine, Illinois Version 2.3. Darien

24.

American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3rd edn. American Academy of Sleep Medicine, Darien

25.

Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force (1999). Sleep 22 (5):667–689

26.

Gupta MA, Simpson FC (2015) Obstructive sleep apnea and psychiatric disorders: a systematic review. J Clin Sleep Med 11(2):165–175. https://doi.org/10.5664/jcsm.4466 CrossRefPubMedPubMedCentral

27.

Guilleminault C, Connolly S, Winkle R, Melvin K, Tilkian A (1984) Cyclical variation of the heart rate in sleep apnoea syndrome. Mechanisms, and usefulness of 24 h electrocardiography as a screening technique. Lancet (London, England) 1(8369):126–131CrossRef

28.

Hilmisson H, Lange N, Duntley SP (2018) Sleep apnea detection: accuracy of using automated ECG analysis compared to manually scored polysomnography (apnea hypopnea index). In: Sleep & breathing = Schlaf & Atmung, vol 23, pp 125–133. https://doi.org/10.1007/s11325-018-1672-0 CrossRef

29.

Harrington J, Schramm PJ, Davies CR, Lee-Chiong TL Jr (2013) An electrocardiogram-based analysis evaluating sleep quality in patients with obstructive sleep apnea. Sleep Breath 17(3):1071–1078. https://doi.org/10.1007/s11325-013-0804-9 CrossRefPubMed

30.

Thomas RJ, Wood C, Bianchi MT (2018) Cardiopulmonary coupling spectrogram as an ambulatory clinical biomarker of sleep stability and quality in health, sleep apnea, and insomnia. Sleep 41(2):1–11. https://doi.org/10.1093/sleep/zsx196

31.

Hilmisson H, Sveinsdottir E, Lange N, Magnusdottir S (2019) Insomnia symptoms in primary care: a prospective study focusing on prevalence of undiagnosed co-morbid sleep disordered breathing. Eur J Intern Med 63:19–26. https://doi.org/10.1016/j.ejim.2019.01.011 CrossRefPubMed

32.

Schramm PJ, Thomas R, Feige B, Spiegelhalder K, Riemann D (2013) Quantitative measurement of sleep quality using cardiopulmonary coupling analysis: a retrospective comparison of individuals with and without primary insomnia. Sleep Breath 17(2):713–721. https://doi.org/10.1007/s11325-012-0747-6 CrossRefPubMed

33.

Yang AC, Yang CH, Hong CJ, Tsai SJ, Kuo CH, Peng CK, Mietus JE, Goldberger AL, Thomas RJ (2011) Sleep state instabilities in major depressive disorder: detection and quantification with electrocardiogram-based cardiopulmonary coupling analysis. Psychophysiology 48(2):285–291. https://doi.org/10.1111/j.1469-8986.2010.01060.x CrossRefPubMedPubMedCentral

34.

Schramm PJ, Poland RE, Rao U (2014) Bupropion response on sleep quality in patients with depression: implications for increased cardiovascular disease risk. Eur Neuropsychopharmacol 24(2):207–214. https://doi.org/10.1016/j.euroneuro.2013.09.007 CrossRefPubMed

35.

Ma Y, Yeung A, Yang AC, Peng CK, Clain A, Alpert J, Fava M, Yeung AS (2018) The effects of tai chi on sleep quality in Chinese American patients with major depressive disorder: a pilot study. Behav Sleep Med 16(4):398–411. https://doi.org/10.1080/15402002.2016.1228643 CrossRefPubMed

36.

Schramm PJ, Zobel I, Monch K, Schramm E, Michalak J (2016) Sleep quality changes in chronically depressed patients treated with mindfulness-based cognitive therapy or the cognitive behavioral analysis system of psychotherapy: a pilot study. Sleep Med 17:57–63. https://doi.org/10.1016/j.sleep.2015.09.022 CrossRefPubMed

37.

Thomas RJ, Mietus JE, Peng CK, Goldberger AL, Crofford LJ, Chervin RD (2010) Impaired sleep quality in fibromyalgia: detection and quantification with ECG-based cardiopulmonary coupling spectrograms. Sleep Med 11(5):497–498. https://doi.org/10.1016/j.sleep.2009.09.003 CrossRefPubMed

38.

Ibrahim LH, Jacono FJ, Patel SR, Thomas RJ, Larkin EK, Mietus JE, Peng CK, Goldberger AL, Redline S (2010) Heritability of abnormalities in cardiopulmonary coupling in sleep apnea: use of an electrocardiogram-based technique. Sleep 33(5):643–646CrossRef

39.

Thomas RJ, Mietus JE, Peng CK, Gilmartin G, Daly RW, Goldberger AL, Gottlieb DJ (2007) Differentiating obstructive from central and complex sleep apnea using an automated electrocardiogram-based method. Sleep 30(12):1756–1769CrossRef

40.

Schramm PJ, Thomas RJ (2012) Assessment of therapeutic options for mild obstructive sleep apnea using cardiopulmonary coupling measures. J Clin Sleep Med 8(3):315–320. https://doi.org/10.5664/jcsm.1924 CrossRefPubMedPubMedCentral

41.

Lee WH, Hong SN, Kim HJ, Rhee CS, Lee CH, Yoon IY, Kim JW (2016) A comparison of different success definitions in non-continuous positive airway pressure treatment for obstructive sleep apnea using cardiopulmonary coupling. J Clin Sleep Med 12(1):35–41. https://doi.org/10.5664/jcsm.5388 CrossRefPubMedPubMedCentral

42.

Choi JH, Thomas RJ, Suh SY, Park IH, Kim TH, Lee SH, Lee HM, Yun CH, Lee SH (2015) Sleep quality change after upper airway surgery in obstructive sleep apnea: electrocardiogram-based cardiopulmonary coupling analysis. Laryngoscope 125(7):1737–1742. https://doi.org/10.1002/lary.25101 CrossRefPubMed

43.

Lee WH, Ahn JC, We J, Rhee CS, Lee CH, Yun PY, Yoon IY, Kim JW (2014) Cardiopulmonary coupling analysis: changes before and after treatment with a mandibular advancement device. Sleep Breath 18(4):891–896. https://doi.org/10.1007/s11325-014-0961-5 CrossRefPubMed

44.

Ramar K, Desrues B, Ramar P, Morgenthaler TI (2013) Analysis of cardiopulmonary coupling to assess adaptive servo-ventilation success in complex sleep apnea management. Sleep Breath 17(2):861–866. https://doi.org/10.1007/s11325-012-0780-5 CrossRefPubMed

45.

Lee SH, Choi JH, Park IH, Lee SH, Kim TH, Lee HM, Park HK, Thomas RJ, Shin C, Yun CH (2012) Measuring sleep quality after adenotonsillectomy in pediatric sleep apnea. Laryngoscope 122(9):2115–2121. https://doi.org/10.1002/lary.23356 CrossRefPubMed

46.

Ma Y, Hou F, Yang AC, Ahn AC, Fan L, Peng C-K (2019) Symbolic dynamics of electroencephalography is associated with the sleep depth and overall sleep quality in healthy adults. Physica A 513:22–31. https://doi.org/10.1016/j.physa.2018.08.043 CrossRef

47.

Xiong H, Shang P, Hou F, Ma Y (2019) Visibility graph analysis of temporal irreversibility in sleep electroencephalograms. Nonlinear Dyn 96(1):1–11. https://doi.org/10.1007/s11071-019-04768-2 CrossRef

48.

Hou F, Yu Z, Peng CK, Yang A, Wu C, Ma Y (2018) Complexity of wake electroencephalography correlates with slow wave activity after sleep onset. Front Neurosci 12:809. https://doi.org/10.3389/fnins.2018.00809 CrossRefPubMedPubMedCentral

49.

Mao X, Shang P, Wang J, Ma Y (2018) Characterizing time series by extended complexity-entropy curves based on Tsallis, Renyi, and power spectral entropy. Chaos (Woodbury, NY) 28(11):113106. https://doi.org/10.1063/1.5038758 CrossRef

50.

Ma Y, Shi W, Peng CK, Yang AC (2018) Nonlinear dynamical analysis of sleep electroencephalography using fractal and entropy approaches. Sleep Med Rev 37:85–93. https://doi.org/10.1016/j.smrv.2017.01.003 CrossRefPubMed

51.

Shi W, Shang P, Ma Y, Sun S, Yeh C-H (2017) A comparison study on stages of sleep: quantifying multiscale complexity using higher moments on coarse-graining. Commun Nonlinear Sci Numer Simul 44:292–303. https://doi.org/10.1016/j.cnsns.2016.08.019 CrossRef

52.

Thomas RJ, Mietus JE, Peng CK, Guo D, Gozal D, Montgomery-Downs H, Gottlieb DJ, Wang CY, Goldberger AL (2014) Relationship between delta power and the electrocardiogram-derived cardiopulmonary spectrogram: possible implications for assessing the effectiveness of sleep. Sleep Med 15(1):125–131. https://doi.org/10.1016/j.sleep.2013.10.002 CrossRefPubMed

53.

Jonas DE, Amick HR, Feltner C, Weber RP, Arvanitis M, Stine A, Lux L, Harris RP (2017) Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US preventive services task force. Jama 317(4):415–433. https://doi.org/10.1001/jama.2016.19635 CrossRefPubMed

54.

Ma Y, Yeh J, Sun S, Qiao J, Peng C (2013) Detecting pediatric sleep apnea: consistency on cardiopulmonary coupling and oximetry measurement. Sleep Med 14:e189CrossRef

55.

Ma Y, Wei Y, Peng C-K (2016) Comparison of wristband-based and ECG-based sleep analyses. J Sleep Disord Ther 05. https://doi.org/10.4172/2167-0277.C1.005

56.

Young A, Home M, Churchward T, Freezer N, Holmes P, Ho M (2002) Comparison of sleep disturbance in mild versus severe Parkinson's disease. Sleep 25(5):573–577CrossRef

57.

Diederich NJ, Rufra O, Pieri V, Hipp G, Vaillant M (2013) Lack of polysomnographic non-REM sleep changes in early Parkinson’s disease. Mov Disord 28(10):1443–1446. https://doi.org/10.1002/mds.25520 CrossRefPubMed

58.

Martinez-Ramirez D, De Jesus S, Walz R, Cervantes-Arriaga A, Peng-Chen Z, Okun MS, Alatriste-Booth V, Rodriguez-Violante M (2015) A polysomnographic study of Parkinson’s disease sleep architecture. J Park Dis 2015:570375. https://doi.org/10.1155/2015/570375 CrossRef

59.

Parrino L, Smerieri A, Spaggiari MC, Terzano MG (2000) Cyclic alternating pattern (CAP) and epilepsy during sleep: how a physiological rhythm modulates a pathological event. Clin Neurophysiol 111(Suppl 2):S39–S46CrossRef

60.

Tseng PH, Lee PL, Hsu WC, Ma Y, Lee YC, Chiu HM, Ho YL, Chen MF, Wu MS, Peng CK (2017) A higher proportion of metabolic syndrome in Chinese subjects with sleep-disordered breathing: a case-control study based on electrocardiogram-derived sleep analysis. PLoS One 12(1):e0169394. https://doi.org/10.1371/journal.pone.0169394 CrossRefPubMedPubMedCentral

61.

Ma Y, Yeung A, Yang AC, Peng CK, Clain A, Alpert J, Fava M, Yeung AS (2016) The effects of tai chi on sleep quality in Chinese American patients with major depressive disorder: a pilot study. Behav Sleep Med 16:1–17. https://doi.org/10.1080/15402002.2016.1228643 CrossRef

Titel: Electrocardiogram-based sleep analysis for sleep apnea screening and diagnosis
verfasst von: Yan Ma
Shuchen Sun
Ming Zhang
Dan Guo
Arron Runzhou Liu
Yulin Wei
Chung-Kang Peng
Publikationsdatum: 21.06.2019
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 1/2020
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-019-01874-8

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Electrocardiogram-based sleep analysis for sleep apnea screening and diagnosis

Abstract

Purpose

Methods

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Conclusion

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