Screening for Obstructive Sleep Apnea in Commercial Drivers Using EKG-Derived Respiratory Power Index

Lyons, M. Melanie; Kraemer, Jan F.; Dhingra, Radha; Keenan, Brendan T.; Wessel, Niels; Glos, Martin; Penzel, Thomas; Gurubhagavatula, Indira

doi:10.5664/jcsm.7562

Cited by 9 publications

(7 citation statements)

References 43 publications

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“…Most patients with a high risk of OSA could be distinguished by Holter. Similar results were reported by Lyons et al, who calculated the respiratory power index using common ECG data, combined with clinical indicators such as BMI, and predicted a sensitivity of 91.7% and a specificity of 27.3% for severe OSA (AHI ≥30/h) (11).…”

Section: Discussionsupporting

confidence: 87%

The predictive value of Holter monitoring in the risk of obstructive sleep apnea

Lao¹,

Ou²,

Li³

et al. 2021

J Thorac Dis

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Background: Patients with obstructive sleep apnea (OSA) often present with cardiovascular symptoms.Holter monitors were reported to predict sleep apnea, though were rarely used in everyday clinical practice. In this study, by comparing Holter monitoring to polysomnography (PSG), we try to find out an operable way for clinicians to use Holter to predict OSA risk. Methods: Patients (n=63) suspected of OSA underwent Holter monitoring with concurrent PSG at a sleep center. Respiration and heart rate variability (HRV) indices were calculated from the Holter and compared with PSG indices. Results: The sensitivity of the Holter-derived respiratory waveform for OSA was 90.0%, and the specificity was 82.6%. The time domain indices including standard deviation of all NN intervals during 24 hours, mean of standard deviation of the averages of NN intervals in all 5-minute segments, square root of the mean squared differences of successive NN intervals, percentage of beat-to-beat NN interval differences that were more than 50 milliseconds, and the frequency domain index of high frequency decreased in participants with OSA and correlated with the PSG derived indices including apnea-hypopnea index (AHI), oxygen reduction index (ODI) and nadir SaO 2 . Logistic regression showed that standard deviation of all NN intervals during 24 hours and gender could predict the risk of OSA (P<0.001), with a sensitivity for diagnosing moderate to severe OSA of 87.5% and could accurately distinguish the risk of OSA in 77.8% of patients. Males with standard deviation of all NN intervals during 24 hours ≤177 ms or females with standard deviation of all NN intervals during 24 hours ≤80.9 ms were considered to be at high risk for OSA. Conclusions: Commercial and common parameters from Holter monitoring could predict the risk of OSA with high sensitivity. Therefore, the risk of OSA may be assessed using the Holter examination to improve the diagnosis and treatment rate of OSA.

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Section: Discussionsupporting

confidence: 87%

The predictive value of Holter monitoring in the risk of obstructive sleep apnea

Lao¹,

Ou²,

Li³

et al. 2021

J Thorac Dis

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“…Babaeizadeh and Zhou (98) created a novel method of ECGderived respiration (EDR) combined with HRV for an accuracy of 88% and correct classification of 71%. Similarly, Lyons et al (99) developed an ECG-derived respiratory power index (RPI) as an estimate for AHI to identify severe OSA in commercial drivers (Figure 2).…”

Section: Influence Of Sleep Apnea On Hrv During Sleepmentioning

confidence: 99%

The Different Facets of Heart Rate Variability in Obstructive Sleep Apnea

et al. 2021

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Obstructive sleep apnea (OSA), a heterogeneous and multifactorial sleep related breathing disorder with high prevalence, is a recognized risk factor for cardiovascular morbidity and mortality. Autonomic dysfunction leads to adverse cardiovascular outcomes in diverse pathways. Heart rate is a complex physiological process involving neurovisceral networks and relative regulatory mechanisms such as thermoregulation, renin-angiotensin-aldosterone mechanisms, and metabolic mechanisms. Heart rate variability (HRV) is considered as a reliable and non-invasive measure of autonomic modulation response and adaptation to endogenous and exogenous stimuli. HRV measures may add a new dimension to help understand the interplay between cardiac and nervous system involvement in OSA. The aim of this review is to introduce the various applications of HRV in different aspects of OSA to examine the impaired neuro-cardiac modulation. More specifically, the topics covered include: HRV time windows, sleep staging, arousal, sleepiness, hypoxia, mental illness, and mortality and morbidity. All of these aspects show pathways in the clinical implementation of HRV to screen, diagnose, classify, and predict patients as a reasonable and more convenient alternative to current measures.

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“…a) This scale uses a seven-part questionnaire b) It correlates strongly with OSA severity c) It is suggested as a screening test for OSA diagnosis amongst candidates for drivers licences d) ESS has a low sensitivity for OSA detection in professional drivers Although portable monitors have been proposed as a cheaper and more accessible technology, an important proportion of professional drivers tested will likely require a follow-up with in-laboratory PSG due to invalid results, the relatively low sensitivity and specificity of this method, or potential barriers from human factors [45]. Recently, Lyons et al [46] described a promising approach in identifying commercial motor vehicle operators likely to be at risk for a sleepiness-related crash due to OSA, by using the spectral qualities of electrocardiography with portable diagnostic ability and without requiring overnight in-laboratory PSG. Nevertheless, portable monitors remain a challenge for large-scale screening and diagnosis of OSA among professional drivers.…”

Section: Self-evaluation Questionsmentioning

confidence: 99%

Screening for obstructive sleep apnoea in professional drivers

Schiza

Bouloukaki

2020

Breathe

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Professional drivers show a higher prevalence of obstructive sleep apnoea (OSA) compared with the general population. Furthermore, there is concern about the association between OSA and car crash risk given that drivers with OSA show an increased risk for car accidents. Despite this risk, OSA is often underdiagnosed and undertreated in this population, mainly due to lack of appropriate screening and sleep study referrals. Polysomnography (PSG), the gold standard test, is inappropriate for systematic screening because of its high expense, complexity and relative inaccessibility in this population. Therefore, there is a strong demand for good screening tools, including both subjective and objective data that may assist in early identification of possible OSA among professional drivers and, thus, aid in PSG examination referral and OSA management in an accredited sleep centre. However, there is considerable disagreement over screening methods and criteria for triggering a sleep study referral in different countries. There is also a strong need for further research in the area of OSA screening of commercial drivers in order to improve the diagnostic accuracy of screening tools and ensure that patients with OSA are accurately identified.Key pointsObstructive sleep apnoea (OSA) is often undiagnosed and undertreated in professional drivers.Professional drivers often under-report and are reluctant to report OSA symptoms.Barriers to OSA diagnosis include appropriate screening and sleep study referrals.Screening tools including both subjective and objective data may assist in early identification of possible OSA among professional drivers.Educational aimsTo evaluate screening instruments currently used to identify OSA risk in professional drivers.To provide guidance for developing an assessment strategy for OSA by professional driver medical examiners.

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Screening for Obstructive Sleep Apnea in Commercial Drivers Using EKG-Derived Respiratory Power Index

Cited by 9 publications

References 43 publications

The predictive value of Holter monitoring in the risk of obstructive sleep apnea

The predictive value of Holter monitoring in the risk of obstructive sleep apnea

The Different Facets of Heart Rate Variability in Obstructive Sleep Apnea

Screening for obstructive sleep apnoea in professional drivers

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