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Can cardiorespiratory polygraphy replace portable polysomnography in the assessment of sleep-disordered breathing in heart failure patients?

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Abstract

Purpose

Portable polysomnography (PSG) and cardiorespiratory polygraphy are increasingly being used in the assessment of sleep-disordered breathing (SDB) in heart failure patients. Scoring of SDB from cardiorespiratory polygraphy recordings is based only on respiratory signals, while electroencephalographic, electrooculographic and electromyographic channels are taken into account when using PSG recordings. The aim of this study was to assess the agreement between these two scoring methods.

Methods

An overnight sleep study was performed in 67 heart failure patients using a standard portable polysomnograph. Each recording was scored twice, once using all acquired signals (PSG mode) and, after a median of 64 days, using only respiratory signals (cardiorespiratory mode). Agreement was assessed by Bland–Altman analysis and Cohen’s kappa.

Results

We found that (1) more respiratory events were detected using cardiorespiratory analysis [median (25th percentile, 75th percentile), 75 (39, 200) events] compared to analysis of portable PSG [69 (29, 173) events, p < 0.0001], the extra events being, for the vast majority, central in origin; (2) the apnea/hypopnea index (AHI) estimated by cardiorespiratory polygraphy [11.9 (5.7, 30.8)/h] showed a negligible negative bias relative to portable PSG [15.1 (5.7, 33.6)/h; bias, −0.8 (−2.9, 0.4)/h, p = 0.0002]; (3) limits of agreement between the two systems (−6.2/h, 1.7/h) were much smaller than those previously observed between two nights using the same scoring modality; and (4) the kappa coefficient using categorised AHI was 0.89 (95 % confidence interval (CI) 0.82, 0.96).

Conclusions

We found a high degree of agreement between the AHIs obtained from the two scoring methods, thus suggesting that cardiorespiratory polygraphy may be used as an alternative to portable PSG in the assessment of SDB in heart failure patients.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Fondazione S. Maugeri, IRCCS, Montescano, Italy

    Gian Domenico Pinna & Roberto Maestri

  2. Sleep Laboratory, Department of Pneumology, Fondazione S. Maugeri, IRCCS, Montescano, Italy

    Elena Robbi, Anna Eugenia Taurino & Caterina Pronzato

  3. Department of Cardiology, Fondazione S. Maugeri, IRCCS, Montescano, Italy

    Elena Robbi & Maria Teresa La Rovere

  4. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

    Fabio Pizza

  5. AUSL di Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

    Fabio Pizza

  6. Servizio di Bioingegneria, Fondazione S. Maugeri, IRCCS Istituto Scientifico di Montescano, 27040, Montescano, Pavia, Italy

    Gian Domenico Pinna

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  1. Gian Domenico Pinna
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  2. Elena Robbi
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  3. Fabio Pizza
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  4. Anna Eugenia Taurino
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  6. Maria Teresa La Rovere
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  7. Roberto Maestri
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Correspondence to Gian Domenico Pinna.

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Pinna, G.D., Robbi, E., Pizza, F. et al. Can cardiorespiratory polygraphy replace portable polysomnography in the assessment of sleep-disordered breathing in heart failure patients?. Sleep Breath 18, 475–482 (2014). https://doi.org/10.1007/s11325-013-0908-2

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  • DOI: https://doi.org/10.1007/s11325-013-0908-2

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