ECG‐derived Cheyne‐Stokes respiration and periodic breathing in healthy and hospitalized populations

Abstract

Background Cheyne-Stokes respiration has been investigated primarily in outpatients with heart failure. In this study we compare Cheyne-Stokes respiration (CSR) and periodic breathing (PB) between healthy and cardiac groups. Methods We compared CSR and PB, measured during 24 hours of continuous 12-lead electrocardiographic (ECG) Holter recording, in a group of 90 hospitalized patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome to a group of 100 healthy ambulatory participants. We also examined CSR and PB in the 90 patients presenting with acute coronary syndrome symptoms, divided into a group of 39 (43%) with confirmed acute coronary syndrome, and 51 (57%) with a cardiac diagnosis but non-acute coronary syndrome. SuperECG software was used to derive respiration and then calculate CSR and PB episodes from the ECG Holter data. Regression analyses were used to analyze the data. We hypothesized SuperECG software would differentiate between the groups by detecting less CSR and PB in the healthy group than the group of patients presenting to the emergency department with acute coronary syndrome symptoms. Results Hospitalized patients with suspected acute coronary syndrome had 7.3 times more CSR episodes and 1.6 times more PB episodes than healthy ambulatory participants. Patients with confirmed acute coronary syndrome had 6.0 times more CSR episodes and 1.3 times more PB episodes than cardiac non-acute coronary syndrome patients. Conclusion Continuous 12-lead ECG derived CSR and PB appear to differentiate between healthy participants and hospitalized patients.

ECG derived Cheyne–Stokes respiration and periodic breathing are associated with cardiorespiratory arrest in intensive care unit patients

“…28 Our research group has been exploring the use of continuous ECG data to measure respiration (Figure 1) and CSRPB (Figure 2) in both community-based healthy participants and hospitalized patients with suspected acute coronary syndrome (ACS). 10 In our prior work, using 12-lead ECG Holter data, we found that hospitalized telemetry unit patients with confirmed ACS had CSR episodes 6 times more frequently and PB episodes 1.3 times more frequently than patients with a non-ACS cardiac diagnosis (i.e. valvular heart disease, heart failure, pericarditis, aortic dissection).…”

“…This is an observational study using ECG data from two studies, one including a group of 461 ICU patients (Alarm Study General Electric Study number 123.042012-GES-0003) 35 and, the second including a group of 100 healthy community-based participants (T32 NR007088, F31 NR015196). 10 Both studies received Institutional Review Board approval, and the methods for these have been described previously. 10,35 A waiver of consent was granted for the ICU group, which allowed inclusion of all consecutive patients admitted to the ICU.…”

“…10 Both studies received Institutional Review Board approval, and the methods for these have been described previously. 10,35 A waiver of consent was granted for the ICU group, which allowed inclusion of all consecutive patients admitted to the ICU. A research nurse obtained written informed consent from participants in the healthy community-based group.…”

“…Cheyne-Stokes respiration (CSR) and periodic breathing (PB) have been associated with heart failure, [1][2][3][4][5][6][7][8] acute coronary syndrome, [9][10] arrhythmias, [11][12] cardioverter-defibrillator therapy in response to ventricular tachycardia, 11 stroke, [13][14][15] increased stroke severity, 16 and death. [1][2][4][5][6]8,17 Both CSR and PB are forms of central sleep apnea associated with change ventilation and loss of ventilatory drive.…”

“…valvular heart disease, heart failure, pericarditis, aortic dissection). 10 In the current study, we expand our research on this topic to the ICU setting.…”