Apnea‐Related Heart Rate Variability and Its Clinical Utility in Congestive Heart Failure Outpatients

Tateishi, Osamu; Shouda, Toru; Honda, Youichi; Sakai, Takeharu; Mochizuki, Seibu; Machida, Katsuhiko

doi:10.1111/j.1542-474x.2002.tb00153.x

Cited by 10 publications

(8 citation statements)

References 17 publications

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“…The effect of SRBD in patients with HF on quality of life or depression has not been evaluated. It is known that an apnea/hypopnea‐index (AHI) of >30/h in HF is an independent predictor of poor prognosis [3], possibly due to adverse effects on heart rate and the incidence of ventricular arrhythmias [18,19]. But the clinical relevance of less severe SRBD in heart failure (AHI <30/h) remains unclear in respect to quality of life, depression scores, or indication for treatment and it is hypothesised that even minor breathing disorders show negative influence on these parameters in patients with HF, too.…”

Section: Introductionmentioning

confidence: 99%

Impact of sleep‐related breathing disorders on health‐related quality of life in patients with chronic heart failure

Skobel

Norra

Sinha

et al. 2005

European J of Heart Fail

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Background: Quality of life in patients with chronic heart failure (HF) is often severely compromised. Sleep-related breathing disorders (SRBD) like Cheyne-Stokes Respiration (CSR) or obstructive sleep apnea (OSAS) are often observed in patients with severe HF resulting in fragmentation of sleep, excessive daytime sleepiness and an increased mortality. While an apnea/hypopnea-index (AHI) N30/h represents an independent predictor of poor prognosis, clinical relevance of even minor SRBD with an AHI b30/h remains unclear with respect to quality of life, exercise capacity or depression rate. Methods: Sixty-nine consecutive ambulatory patients with stable HF (NYHA II-III, EF 25%) underwent two night polygraphies with a sixchannel ambulatory recording. Spiroergometry was performed, and patients were examined for sleep quality (PSQI), depressed mood (BDI) and health-related quality of life (SF-36). The data were compared to 10 age-matched healthy controls and 11 patients with OSAS (AHI 14-29/h) not suffering from HF. Results: Fifty-one patients completed follow up. 52% were positively diagnosed for SRBD (AHI 16-30/h: 12 patients CSR, 5 patients OSAS, 9 patients mixed); 25 patients (48%) showed no relevant SRBD. Patients with HF and SRBD had lower quality of life than patients without SRBD and HF. The severity of SRBD as indicated by the AHI significantly correlated with quality of life measures: Bodily pain, physical functioning and social functioning showed largest impairment in patients with HF and SRBD. Furthermore, elevated depression rates in correlation to the AHI were only observed in patients with SRBD similar to patients with OSAS without HF. Conclusion: Even minor SRBD in patients with HF independently influence quality of life and correlate with estimation of depression and sleep disturbances.

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Section: Introductionmentioning

confidence: 99%

Impact of sleep‐related breathing disorders on health‐related quality of life in patients with chronic heart failure

Skobel

Norra

Sinha

et al. 2005

European J of Heart Fail

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“…Not only our study but also other studies evaluating the use of HRV parameters from one channel electrocardiography show that these values were not convenient for the diagnosis of OSAS (17)(18)(19)(20)(21)(22). The reason for this is that the expectation from a screening test is high sensitivity rather than specificity.…”

Section: Study Limitationsmentioning

confidence: 47%

“…HRV parameters show the difference in people with OSAS compared to the normal population as a result of sympathovagal balance changes (18)(19)(20). These negative effects on sympathovagal balance are also considered to play an important role at the known complications of OSAS (3,21). Changes in the autonomic nervous system caused by sleep arousal state and the evidence indicating these changes show a difference compared to the healthy population; while, on the one hand, provide new knowledge to explain physiopathology of the cardiovascular results of OSAS, on the other hand, draw attention on some methods for OSAS diagnosis more inexpensive and Table 2.…”

Section: Discussionmentioning

confidence: 99%

“…Park et al (27) also have reported that of time-domain criteria, LF/HF could be a good indicator of OSAS severity. Data obtained analyzing of ECG records can provide quite valuable information not only in the patients with OSAS, but also in screening of the Cheyne-Stokes respiration (CSA) (21). CSA is an important but usually overlooked clinical diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Heart rate variability analysis of single channel electrocardiogram can help to differentiate high- risk patients with obstructive sleep apnea syndrome - a study on diagnostic accuracy

Karasulu¹,

Dalar²,

Sökücü³

et al. 2012

Anadolu Kardiyol Derg

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Heart rate variability analysis of single-channel electrocardiogram can help to differentiate high-risk patients with obstructive sleep apnea syndrome -a study on diagnostic accuracyTek kanal elektrokardiyografide kalp hızı değişkenliği analizi yüksek riskli obstrüktif uyku apne sendromlu hastaları tanımlamada yardımcı olabilir-Bir doğruluk değeri çalışması ABSTRACTObjective: To evaluate the usefulness of heart rate variability analysis (HRV) analysis from the long duration electrocardiogram (ECG) recordings as a screening test for the diagnosis of moderate-to-severe obstructive sleep apnea syndrome (OSAS). Methods: Recordings from 87 patients who were admitted to sleep laboratory for polysomnographic study (PSG) were evaluated. Finally 30 cases with apnea-hypopnea index (AHI)≥15/hour included in patient's group (male/female: 22/8; mean age: 49±10 years) and 21 cases with AHI<5 were included in control group (male/female: 10/11; mean age: 48±11 years). From the ECG recordings taken as a part of PSG, time -domain and frequency -domain HRV parameters were evaluated and their accuracy in the diagnosis of OSAS was investigated using ROC analysis.Results: Statistically significant differences were found in HRV variables in time-domain parameters such as SDNN, SDNN index; frequencydomain parameters VLF, LF, nuLF, nuHF, LF/HF and geometric parameter HRV triangular index values in between groups. Cut-off value of 16 for the HRV triangular index was found to be 50% sensitive and 85.7% specific with a positive likelihood ratio (LR) of 3.50% and negative LR of 0.58% When the total power was higher than 9.611, then the analysis sensitivity was 53.3%, specificity was 95.6%, positive LR was 11.2% and negative LR was 0.49% When the SDNN was higher than 83 then its sensitivity was 80%, specificity was 76.2%, positive LR was 3.36% and negative LR was 0.26% For the cut off value of 62 calculated for SDNN index, sensitivity was 73.3%, specificity was 85.7%, positive LR was 5.13% and negative LR was 0.31%, for the cut off value of 9.12 was calculated for VLF, sensitivity was 90.4% specificity was 50% positive LR was 1.81% and negative LR was 0.19%. Conclusion: Heart rate variability analysis done over routine single channel ECG data gathered through routine Holter applications may be helpful in distinguishing moderate-to-severe OSAS patients from mild OSAS patients and non-OSAS control subjects.(Anadolu Kardiyol Derg 2012; 12: 331-8) Key words: Diagnosis, electrocardiography, heart rate, polysomnography, sleep apnea, sensitivity, specificity Original Investigation Özgün Araşt›rma 331ÖZET Amaç: Çalışmanın amacı uzun süreli tek kanal elektrokardiyogram (EKG) kaydı üzerinden yapılan kalp atım hızı değişkenliği (HRV) analizinin orta ve ağır tıkayıcı uyku apne hipopne sendromu (TUA) hastalarının taranmasına katkısını araştırmaktır.Yöntemler: Hastanemizin uyku laboratuvarına başvurarak polisomnografi yapılan 87 hastanın kayıtları değerlendirildi. Değerlendirme sonucunda apne-hipopne indeksi (AHI)≥15/saatin üzerinde bulunan 30 kişi olgu ...

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“…As CSR is associated with adverse effect on heart rate, variability and the incidence of ventricular arrhythmia [14][15][16] treatment of CSR reduced mortality.…”

Section: Introductionmentioning

confidence: 99%

Effect of cardiac resynchronization therapy on sleep quality, quality of life, and symptomatic depression in patients with chronic heart failure and Cheyne-Stokes respiration

et al. 2005

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Patients with heart failure (HF) often suffer from sleep-related breathing disorders (SRBD) like Cheyne-Stokes respiration (CSR). Cardiac resynchronization therapy (CRT) improves myocardial function and exercise capacity in patients with HF and conduction disturbances. As CRT has been shown to reduce CSR in patients with HF, it is not clear whether CRT improves quality of life and symptomatic depression by improvement of apnea/hypopnea index (AHI) and sleep quality. Forty-two HF patients with conduction disturbance before CRT were screened for CSR and evaluated for sleep quality [Pittsburgh Sleep Quality Index (PSQI)], quality of life score [36-item short form (SF-36)], depression, and exercise capacity (VO2 peak) and ejection fraction (EF). Eighteen patients (three females, age 61+/-10, body mass index 24+/-4 kg m(-2), EF 24+/-4%, QRS complex duration 156+/-32 ms) presented CSR with an AHI of 18+/-8 (11 CSR, 7 mixed). Fourteen patients showed no SRBD (PSQI<5,AHI<5). All patients received CRT and were reevaluated after 18+/-7 weeks. CSR worsen quality of life in seven of eight terms compared to patients without SRBD. Symptomatic depressive symptoms (Beck Depression Inventory>10) were only present in patients with CSR. CRT results in improvement of peak VO2 and EF. There was no difference between patients with CSR and without SRBD on exercise capacity or EF under CRT, whereas CRT led to a significant decrease in AHI (18+/-8 to 3+/-2, p<0.0001), PSQI (18+/-4 to 6+/-3, p=0.0007), with reduction of depression score (12+/-3 to 4.8+/-3, p=0.004). In patients with HF, CSR is associated with symptomatic depressive syndromes and impaired quality of life. CRT reduced CSR with improvement of sleep quality and symptomatic depression.

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Apnea‐Related Heart Rate Variability and Its Clinical Utility in Congestive Heart Failure Outpatients

Abstract: HRV can act as an indicator of the presence of CSB in CHF patients, and could therefore be used, under outpatient conditions, to identify a CHF patients with a poor prognosis.

Cited by 10 publications

References 17 publications

Impact of sleep‐related breathing disorders on health‐related quality of life in patients with chronic heart failure

Impact of sleep‐related breathing disorders on health‐related quality of life in patients with chronic heart failure

Heart rate variability analysis of single channel electrocardiogram can help to differentiate high- risk patients with obstructive sleep apnea syndrome - a study on diagnostic accuracy

Effect of cardiac resynchronization therapy on sleep quality, quality of life, and symptomatic depression in patients with chronic heart failure and Cheyne-Stokes respiration

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