Robust, ECG-based detection of Sleep-disordered breathing in large population-based cohorts

Abstract Study Objectives Up to 5% of adults in Western countries have undiagnosed sleep-disordered breathing (SDB). Studies have shown that electrocardiogram (ECG)-based algorithms can identify SDB and may provide alternative screening. Most studies, however, have limited generalizability as they have been conducted using the apnea-ECG database, a small sample database that lacks complex SDB cases. Methods Here, we developed a fully automatic, data-driven algorithm that classifies apnea and hypopnea events based on the ECG using almost 10 000 polysomnographic sleep recordings from two large population-based samples, the Sleep Heart Health Study (SHHS) and the Multi-Ethnic Study of Atherosclerosis (MESA), which contain subjects with a broad range of sleep and cardiovascular diseases (CVDs) to ensure heterogeneity. Results Performances on average were sensitivity(Se)=68.7%, precision (Pr)=69.1%, score (F1)=66.6% per subject, and accuracy of correctly classifying apnea–hypopnea index (AHI) severity score was Acc=84.9%. Target AHI and predicted AHI were highly correlated (R2 = 0.828) across subjects, indicating validity in predicting SDB severity. Our algorithm proved to be statistically robust between databases, between different periodic leg movement index (PLMI) severity groups, and for subjects with previous CVD incidents. Further, our algorithm achieved the state-of-the-art performance of Se=87.8%, Sp=91.1%, Acc=89.9% using independent comparisons and Se=90.7%, Sp=95.7%, Acc=93.8% using a transfer learning comparison on the apnea-ECG database. Conclusions Our robust and automatic algorithm constitutes a minimally intrusive and inexpensive screening system for the detection of SDB events using the ECG to alleviate the current problems and costs associated with diagnosing SDB cases and to provide a system capable of identifying undiagnosed SDB cases.

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Abstract P105: Sleep Disordered Breathing and Cardiac Autonomic Modulation in Adolescents - Penn State Child Cohort (PSCC) Study

Circulation ◽

10.1161/circ.129.suppl_1.p105 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Edward O Bixler ◽

Fan He ◽

Sol Rodriguez-Colon ◽

Julio Fernandez-Mendoza ◽

Alexandros Vgontzas ◽

...

Keyword(s):

Heart Rate ◽

Sleep Disordered Breathing ◽

Population Based ◽

Apnea Hypopnea Index ◽

Autonomic Modulation ◽

Rr Intervals ◽

Cardiac Autonomic Modulation ◽

The Mean ◽

Frequency Power ◽

Disordered Breathing

Objectives: To investigate the relationship between sleep disordered breathing (SDB) and cardiac autonomic modulation (CAM) in a population-based sample of adolescents. Methods: We used available data from 400 adolescents who completed the follow up examinations in the population-based PSCC study. 1-night polysomnography was used to assess apnea hypopnea index (AHI). AHI was used to define no-SDB (AHI<1), mild SDB (1≤AHI<5), and moderate SDB (AHI≥5). CAM was assessed by heart rate variability (HRV) analysis of beat-to-beat normal R-R intervals from a 39-hour high resolution Holter ECG. The HRV indices in frequency domain [high frequency power (HF), low frequency power (LF), and LF/HF ratio] and time domain [standard deviation of normal RR intervals (SDNN), and the square root of the mean squared difference of successive normal RR intervals (RMSSD), and heart rate (HR)] were calculated on a 30-minute basis (78 repeated measures). Mixed-effects models were used to assess the SDB and HRV relationship. Results: The mean age was 16.9 yrs (SD=2.19), with 54% male and 77% white. The mean (SD) AHI were 0.52 (0.26), 2.38 (1.03), and 12.27 (14.54) for no-, mild-, and moderate-SDB participants. The age, race, sex, and BMI percentile adjusted mean (SE) HRV indices across three SDB groups are presented in Table 1. In summary, sleep disordered breathing was associated with lower HRV and higher HR in this population-based adolescent sample, with a significant dose-response relationship. Conclusion: moderate SDB in adolescents is already associated with lower HRV, indicative of sympathetic activation and lower parasympathetic modulation, which has been associated with cardiac events in adults.

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Abstract WP357: Prevalence of Pre- and Post-intracerebral Hemorrhage Sleep-disordered Breathing

Stroke ◽

10.1161/str.48.suppl_1.wp357 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Richard V Scheer ◽

Lynda D Lisabeth ◽

Chengwei Li ◽

Erin Case ◽

Ronald D Chervin ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Mexican American ◽

Sleep Disordered Breathing ◽

Population Based ◽

Apnea Hypopnea Index ◽

Berlin Questionnaire ◽

Portable Monitor ◽

Before And After ◽

Disordered Breathing

Background: Sleep-disordered breathing (SDB) is an independent risk factor for stroke. The reported prevalence of SDB after stroke ranges from 60 to >70%, while the pre-stroke prevalence of SDB is less well described. Moreover, much of these data are derived from ischemic stroke or mixed ischemic stroke and intracerebral hemorrhage (ICH) cohorts. Studies that assess the prevalence of SDB before and after ICH are lacking, with only one prior study (n=32) that reported a post-ICH SDB prevalence of 78%. We report herein the results of a second, larger, prospective study that assessed the prevalence of pre- and post-ICH. Methods: Participants enrolled in the population-based stroke surveillance study, the Brain Attack Surveillance in Corpus Christi (BASIC) project, with ICH from 2010-2015 were screened for SDB with the well validated ApneaLink Plus portable monitor (SDB defined as apnea-hypopnea index (AHI) ≥10). The Berlin questionnaire was administered, with reference to the pre-ICH state, to assess for possible pre-stroke SDB. Results: Of the 60 ICH participants screened, the median age was 63 years (interquartile range (IQR): 55.5, 74.5). Twenty-one (35%) were female, 54 (90%) were Mexican American, and 53 (88%) had a history of hypertension. The median Glasgow Coma Scale score was 15.0 (IQR: 15.0, 15.0) and the median NIHSS was 5.5 (IQR: 1.5, 8.0). Post-ICH, the median AHI was 9.5 (IQR: 5.5, 19.0); almost half (46.7%) met criteria for SDB. Thirty-four participants (56.7%) screened as high risk for SDB pre-ICH. Conclusion: Sleep-disordered breathing was highly prevalent after ICH, and also likely common before ICH, in this mostly Mexican American, community-based sample. If SDB increases risk for ICH, the findings suggest a potential new treatment target to prevent ICH and recurrent ICH.

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0890 Sleep Disordered Breathing is Associated With Endothelial Dysfunction and Atherosclerosis in Young Adults: Preliminary Longitudinal Findings in the Penn State Child Cohort

SLEEP ◽

10.1093/sleep/zsaa056.886 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A339-A339

Author(s):

J Fernandez-Mendoza ◽

Z Gao ◽

K Brandt ◽

L Houser ◽

S L Calhoun ◽

...

Keyword(s):

Young Adults ◽

Endothelial Dysfunction ◽

Young Adulthood ◽

Sleep Disordered Breathing ◽

Population Based ◽

Apnea Hypopnea Index ◽

Penn State ◽

State Child ◽

Disordered Breathing

Abstract Introduction Sleep disordered breathing (SDB) in middle-age is an established risk factor for cardiovascular disease. However, population-based studies supporting its cardiovascular contribution at earlier stages of development are lacking, particularly with long-term follow-ups. Methods The Penn State Child Cohort is a population-based longitudinal sample of 700 children (8.7±1.7y), of whom 421 were followed-up 8.3 years later during adolescence (17.0±2.3y) with in-lab polysomnography (PSG). To date, 425 have been followed-up another 7.4 years later during young adulthood (24.4±2.6y) via a standardized survey and 136 of them (55.1% female, 21.3% racial/ethnic minority) have undergone a repeat of their PSG to ascertain apnea/hypopnea index. Subjects (n=121) also underwent Doppler ultrasounds to assess flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT). Linear regression models stratified by body mass index in young adulthood. Results SDB was cross-sectionally associated with lower FMD (β=-0.239, p=0.008) and greater CIMT (β=0.330, p<0.001) in young adulthood. Longitudinally, childhood (n=121) and adolescence (n=90) SDB were significantly associated with CIMT (β=0.327, p<0.001 and β=0.286, p=0.006, respectively), but not with FMD (β=-0.158, p=0.08 and β=-0.101, p=0.35, respectively). These associations, particularly longitudinal ones between childhood and adolescence SDB with CIMT in young adulthood, were stronger in overweight than normal weight subjects (e.g., β=0.310, p=0.030 and β =0.089, p=0.582, respectively). Conclusion SDB and obesity appear to be synergistically associated with endothelial dysfunction and atherosclerosis in young adults from the general population. These data suggest that a childhood exposure to chronic SDB is associated with long-term atherosclerosis, while endothelial dysfunction may be a short-term outcome. This ongoing 16-year longitudinal study will test whether the natural history of SDB from childhood through adolescence into young adulthood shows differential trajectories for cardiovascular morbidity. Support National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

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Validation of the NoSAS Score for the Screening of Sleep-Disordered Breathing in a Sleep Clinic

Canadian Respiratory Journal ◽

10.1155/2020/4936423 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Yi Rong ◽

Shihan Wang ◽

Hui Wang ◽

Feng Wang ◽

Jingjing Tang ◽

...

Keyword(s):

Predictive Value ◽

Sleep Disordered Breathing ◽

Screening Tool ◽

Characteristic Curve ◽

Population Based ◽

Screening Tools ◽

Apnea Hypopnea Index ◽

Portable Monitor ◽

Number Of Patients ◽

Disordered Breathing

Background. There is a growing number of patients with sleep-disordered breathing (SDB) referred to sleep clinics. Therefore, a simple but useful screening tool is urgent. The NoSAS score, containing only five items, has been developed and validated in population-based studies. Aim. To evaluate the performance of the NoSAS score for the screening of SDB patients from a sleep clinic in China, and to compare the predictive value of the NoSAS score with the STOP-Bang questionnaire. Methods. We enrolled consecutive patients from a sleep clinic who had undergone apnea-hypopnea index (AHI) testing by type III portable monitor device at the hospital and completed the STOP-Bang questionnaire. The NoSAS score was assessed by reviewing medical records. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) of both screening tools were calculated at different AHI cutoffs to compare the performance of SDB screening. Results. Of the 596 eligible patients (397 males and 199 female), 514 were diagnosed with SDB. When predicting overall (AHI ≥ 5), moderate-to-severe (AHI ≥ 15), and severe (AHI ≥ 30) SDB, the sensitivity and specificity of the NoSAS score were 71.2, 80.4, and 83.1% and 62.4, 49.3, and 40.7%, respectively. At all AHI cutoffs, the AUC ranged from 0.688 to 0.715 for the NoSAS score and from 0.663 to 0.693 for the STOP-Bang questionnaire. The NoSAS score had the largest AUC (0.715, 95% CI: 0.655–0.775) of diagnosing SDB at AHI cutoff of ≥5 events/h. NoSAS performed better in discriminating moderate-to-severe SDB than STOP-Bang with a marginally significantly higher AUC (0.697 vs. 0.663, P=0.046). Conclusion. The NoSAS score had good performance on the discrimination of SDB patients in sleep clinic and can be utilized as an effective screening tool in clinical practice.

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478 The Relationship between Sleep Disordered Breathing, Markers of Ventricular Repolarization and Cardiovascular Mortality

SLEEP ◽

10.1093/sleep/zsab072.477 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A188-A189

Author(s):

Salma Patel ◽

Wojciech Zareba ◽

Bonnie LaFleur ◽

Jean-Philippe Couderc ◽

Xiaojuan Xia ◽

...

Keyword(s):

Sleep Disordered Breathing ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Ventricular Repolarization ◽

Health Study ◽

Apnea Hypopnea Index ◽

Qtc Prolongation ◽

Qt Variability ◽

The Relationship ◽

Disordered Breathing

Abstract Introduction Sleep disordered breathing (SDB) is associated with increased mortality. Obstructive apneas/hypopneas have been associated with an increase in both QTc duration and QT variability. These markers of ventricular repolarization are associated with arrhythmias and death. It is unknown whether SDB-related QTc changes are responsible for the relationship between QTc/QT variability and cardiovascular death (CVD). Methods From the Sleep Heart Health Study, we randomly selected 200 subjects in each of four groups based on overall apnea/hypopnea index: those with no SDB and those in either, mild, moderate or severe SDB at baseline, matched for gender, age and BMI. Respiratory-related channels and electrocardiograms (ECG) from each polysomnography were analyzed. QTc was calculated using Bazett’s heart rate correction. The following measures of QT variability were obtained: i) standard deviation of QT intervals (SDQT) at 1- and 5-minute intervals and ii) short-term interval QT variability (STVQT) at 5-minute intervals. Cox proportional hazards regression models were used to evaluate potential predictors of CVD. Results Twenty-nine subjects were excluded either due to missing data or low quality ECG. The 771 subjects included were 68±10 years of age, half were female. During follow-up, 220 subjects (28.5%) died of CVD among whom, 67 (30.5%) had comorbid severe SDB, 45 (20.5%) had no SDB, and the remaining CVD deaths had mild (47, 21.4%) and moderate 61 (27.7%) SDB. The CVD patients were more likely to be older(p<0.001), hypertensive (p<0.001), diabetic(p<0.001), and had increased SDQT(p<0.001), STVQT(p<0.001) and QTc (0.017). After adjusting for covariates, the presence of mild (p=0.562), moderate(p=0.439) and severe SDB (p=0.912) did not moderate the association between QTc prolongation and CVD. Additionally, mild (p=0.486), moderate(p=0.478) and severe SDB (p=0.849) did not moderate the association between SDQT and CVD. Similarly, mild (p=0.144), moderate(p=0.594) and severe SDB (p=0.508) did not moderate the association between STVQT and CVD. However, QTc, SDQT, STVQT, mild and severe SDB were individually associated with CVD (p=0.004, 0.000, 0.000, 0.014, 0.022, respectively). Conclusion SDB was not a factor in the relationship between QTc prolongation/QT variability and CVD. Support (if any) American Academy of Sleep Medicine Foundation (203-JF-18), National Institutes of Health (HL126140), University of Arizona Health Sciences Career and Development Award (5299903)

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Sleep characteristics and cognitive impairment in the general population

Neurology ◽

10.1212/wnl.0000000000003557 ◽

2016 ◽

Vol 88 (5) ◽

pp. 463-469 ◽

Cited By ~ 45

Author(s):

José Haba-Rubio ◽

Helena Marti-Soler ◽

Nadia Tobback ◽

Daniela Andries ◽

Pedro Marques-Vidal ◽

...

Keyword(s):

Cognitive Impairment ◽

General Population ◽

Sleep Disordered Breathing ◽

Neuropsychological Test ◽

Population Based ◽

Apnea Hypopnea Index ◽

Clinical Dementia Rating ◽

Sleep Complaints ◽

Confounding Variables ◽

Disordered Breathing

Objective:To assess the association between sleep structure and cognitive impairment in the general population.Methods:Data stemmed from 580 participants aged >65 years of the population-based CoLaus/PsyCoLaus study (Lausanne, Switzerland) who underwent complete sleep evaluation (HypnoLaus). Evaluations included demographic characteristics, personal and treatment history, sleep complaints and habits (using validated questionnaires), and a complete polysomnography at home. Cognitive function was evaluated using a comprehensive neuropsychological test battery and a questionnaire on the participant's everyday activities. Participants with cognitive impairment (global Clinical Dementia Rating [CDR] scale score > 0) were compared with participants with no cognitive impairment (global CDR score = 0).Results:The 291 participants with a CDR score > 0 (72.5 ± 4.6 years), compared to the 289 controls with CDR = 0 (72.1 ± 4.6 years), had significantly more light (stage N1) and less deep (stage N3) and REM sleep, as well as lower sleep efficiency, higher intrasleep wake, and higher sleepiness scores (all p < 0.05). Sleep-disordered breathing was more severe in participants with cognitive impairment with an apnea/hypopnea index (AHI) of 18.0 (7.8–35.5)/h (p50 [p25–p75]) (vs 12.9 [7.2–24.5]/h, p < 0.001), and higher oxygen desaturation index (ODI). In the multivariate analysis after adjustments for confounding variables, the AHI and the ODI ≥4% and ≥6% were independently associated with cognitive impairment.Conclusions:Participants aged >65 years with cognitive impairment have higher sleepiness scores and a more disrupted sleep. This seems to be related to the occurrence of sleep-disordered breathing and the associated intermittent hypoxia.

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479 The association of QTc and QT Variability with Severity of Sleep Disordered Breathing

SLEEP ◽

10.1093/sleep/zsab072.478 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A189-A189

Author(s):

Salma Patel ◽

Wojciech Zareba ◽

Jean-Philippe Couderc ◽

Xiaojuan Xia ◽

Raymond Woosley ◽

...

Keyword(s):

Sleep Disordered Breathing ◽

Health Study ◽

Apnea Hypopnea Index ◽

Qtc Prolongation ◽

Ecg Signals ◽

Qt Intervals ◽

University Of Arizona ◽

Qt Variability ◽

The Mean ◽

Disordered Breathing

Abstract Introduction The apneas and hypopneas that characterize sleep-disordered breathing (SDB) are associated with QTc prolongation and increased QT variability. There have been mixed results as to whether QTc and QT variability increase with increasing SDB severity. This study assesses whether QTc prolongation and QT variability are likely to increase with increasing severity of SDB in a large multi-center cohort. Methods 200 subjects with no SDB and approximately 600 with three levels of SDB (mild, moderate, severe) were randomly selected from the Sleep Heart Health study and matched by age, gender and BMI. SDB was defined as an apnea/hypopnea index ≥5. Respiratory and electrocardiograms (ECG) signals from polysomnography studies were analyzed. Bazett’s heart rate correction was used to calculate QTc. QT variability was measured as standard deviation of QT intervals (SDQT) and short-term interval QT variability (STVQT), at 5-minute intervals. Subjects were excluded if there were missing data or low-quality ECG. Results Seven hundred and seventy-one subjects (age 68±10 years, 51% female, 92% Caucasian) were included. One hundred and sixty-five subjects had no SDB, 235 mild, 195 moderate and 176 had severe SDB. The mean (SD) QTc was 422(29), 411(26), 419 (34) and 418 (36) ms for the no SDB, mild, moderate, and severe SDB groups, respectively (p=0.017). The mean (SD) STVQT was 7 (9), 11 (16), 8 (9) and 9 (11) for the no SDB, mild, moderate severe SDB groups, respectively (p=<0.001). The mean (SD) STVQT was 3 (2), 4 (4), 4 (3) and 4(4) for the no SDB, mild, moderate severe SDB groups, respectively (p=<0.001). There was no statistically linear relationship between QT prolongation or QT variability and SBD severity. Conclusion QTc duration and QT variability were not increased with SDB severity. Support (if any) American Academy of Sleep Medicine Foundation (203-JF-18), National Institutes of Health (HL126140), University of Arizona Health Sciences Career Development Award (5299903), and University of Arizona Faculty Seed Grant (5833261)

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Abstract 2034: Clinical Significance of Sleep-disordered Breathing (SDB) in a Large Population of Japanese Patients: Efficacy of CPAP Therapy in SDB-associated Arrhythmias

Circulation ◽

10.1161/circ.116.suppl_16.ii_440-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Hidetoshi Abe ◽

Matsumoto Kyoritsu ◽

Masafumi Takahashi ◽

Daisuke Yokota ◽

Katsuaki Tsukioka ◽

...

Keyword(s):

Sleep Disordered Breathing ◽

Sinus Bradycardia ◽

Large Population ◽

Japanese Patients ◽

Premature Ventricular Complex ◽

Control Group ◽

Apnea Hypopnea Index ◽

Cardiovascular Disorders ◽

Cpap Therapy ◽

Disordered Breathing

OBJECTIVES: The purpose of this study was to determine the relationship between Sleep-disordered breathing (SDB) and cardiovascular disorders in a large Japanese population, and to assess the efficacy of continuous positive airway pressure (CPAP) in the treatment of SDB-associated arrhythmias. BACKGROUND: SDB is associated with cardiovascular disorders, such as hypertension, ischemic heart disease, and arrhythmias, and CPAP is one of the effective treatments for SDB; however, this relationship and the efficacy of CPAP treatment in a large population of Japanese patients remain undefined. METHODS AND RESULTS: The study population comprised 1413 Japanese subjects (mean age: 56.6 years old, 1123 men and 290 women) who were divided into 2 groups: SDB group ( n = 1064, apnea-hypopnea index (AHI)≥20)and control group ( n = 349, AHI < 20) by polysomnography (PSG) analysis. In baseline characteristics, age (58.3±14.7vs.50.0±18.4, p <0.0001), gender (male: 88.4%vs.72.9%, p <0.0001), BMI (25.9±4.4vs.23.2±3.7, p <0.0001), hypertension (38.0%vs.19.3%, p <0.0001), diabetes (10.4%vs.5.2%, p =0.015), or hyperlipidemia (15.6%vs.9.3%, p =0.018) were significantly associated with SDB. PSG revealed predominant occurrence of paroxysmal atrial fibrillation (PAF: 108/1064 vs. 3/349, p=0.005), premature ventricular complex (PVC: 359/1064vs.17/349, p=0.0012) and pause (sinus arrest ≥2 sec: 172/859vs.6/349, p=0.002) in SDB group. In the SDB group, 291 patients underwent CPAP titration and were then re-evaluated. CPAP therapy significantly reduced the occurrences of PAF (59/291vs.2/291, p=0.005), sinus bradycardia (18/291vs.0/291, p=0.002), and sinus pause (26/291 vs. 4/291, p=0.016). CONCLUSIONS: The results of this study provide a significant relationship between SDB and several cardiac disorders, and efficacy of CPAP in preventing SDB-associated arrhythmias in a large population of Japanese patients. Effect of CPAP on the arryhthmic events in patients with SAS during PSG recording

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1208 Sleep Stage Prediction And Sleep Disordered Breathing Detection Using Raw Actigraphy And Photoplethysmography From Wearable Consumer Device

SLEEP ◽

10.1093/sleep/zsaa056.1202 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A461-A462

Author(s):

M Olsen ◽

H Sorensen ◽

P Jennum ◽

E Mignot

Keyword(s):

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Data Driven ◽

Sensor Data ◽

Sleep Stages ◽

Apnea Hypopnea Index ◽

Low Resolution ◽

Automatic Data ◽

Consumer Device ◽

Disordered Breathing

Abstract Introduction Wearable, multisensory consumer devices that estimate sleep are prevalent and hold great potential. Most validated actigraphic prediction studies of sleep stages (SS) have only used low resolution (30 sec) data and the Cole-Kripke algorithm. Other algorithms are often proprietary and not accessible or validated. We present an automatic, data-driven deep learning algorithm that process raw actigraphy (ACC) and photoplethysmography (PPG) using a low-cost consumer device at high (25Hz) and low resolution to predict SS and to detect sleep disordered breathing (SDB) events. Methods Our automatic, data-driven algorithm is a deep neural network trained and evaluated to predict SS and SDB events on 236 recordings of ACC data from a wrist-worn accelerometer and PPG data from the overlapping PSG. The network was tested on raw ACC and PPG data, which was collected at 25 Hz using the HUAMI Arc2 wristband from 39 participants that underwent a nocturnal polysomnography (PSG). Results Overall accuracy (Acc), recall (Re), specificity (Sp), and kappa (κ) per subject on the test dataset the prediction of wake, NREM, REM was Acc=76.6%, Re=72.4%, Sp=78.0%, kappa=0.42. On average, we found a 7 % higher performance using the raw sensor data as input instead of processed, low resolution inputs. PPG was especially useful for REM detection. The network assigned 55.6% of patients to the correct SDB severity group when using an apnea-hypopnea index above 15. Conclusion Current results show that SS prediction is significantly improved when using the raw sensor data; it indicates that the system holds promise as a potential pervasive monitoring device for patients with chronic sleep disorders. In contrast the system did not show potential as a sleep apnea screening tool. Additional studies are ongoing to examine the effects of pathology such as sleep apnea and periodic leg movement on SS prediction. Support Technical University of Denmark; University of Copenhagen, Copenhagen Center for Health Technology, Klarman Family Foundation.

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Association Between Sleep Disordered Breathing and Left Ventricular Function

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.119.009074 ◽

2020 ◽

Vol 13 (5) ◽

Cited By ~ 2

Author(s):

Rachel P. Ogilvie ◽

Michael V. Genuardi ◽

Jared W. Magnani ◽

Susan Redline ◽

Martha L. Daviglus ◽

...

Keyword(s):

Heart Failure ◽

Diastolic Dysfunction ◽

Sleep Disordered Breathing ◽

Survey Design ◽

Systolic Function ◽

Epidemiological Studies ◽

Left Ventricular ◽

Health Study ◽

Apnea Hypopnea Index ◽

Disordered Breathing

Background: Prior studies have found that sleep-disordered breathing (SDB) is common among those with left ventricular (LV) dysfunction and heart failure. Few epidemiological studies have examined this association, especially in US Hispanic/Latinos, who may be at elevated risk of SDB and heart failure. Methods: We examined associations between SDB and LV diastolic and systolic function using data from 1506 adults aged 18 to 64 years in the Hispanic Community Health Study/Study of Latinos ECHO-SOL Ancillary Study (2011–2014). Home sleep testing was used to measure the apnea-hypopnea index, a measure of SDB severity. Echocardiography was performed a median of 2.1 years later to quantify LV diastolic function, systolic function, and structure. Multivariable linear regression was used to model the association between apnea-hypopnea index and echocardiographic measures while accounting for the complex survey design, demographics, body mass, and time between sleep and echocardiographic measurements. Results: Each 10-unit increase in apnea-hypopnea index was associated with 0.2 (95% CI, 0.1–0.3) lower E′, 0.3 (0.1–0.5) greater E/E′ ratio, and 1.07-fold (1.03–1.11) higher prevalence of diastolic dysfunction as well as 1.3 (0.3–2.4) g/m 2 greater LV mass index. These associations persisted after adjustment for hypertension and diabetes mellitus. In contrast, no association was identified between SDB severity and subclinical markers of LV systolic function. Conclusions: Greater SDB severity was associated with LV hypertrophy and subclinical markers of LV diastolic dysfunction. These findings suggest SDB in Hispanic/Latino men and women may contribute to the burden of heart failure in this population.

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