title: Combined index of heart rate variability and oximetry in screening for the sleep apnoea/hypopnoea syndrome.
abstract: Many sleep centres employ a preliminary screening test in order to reduce the number of polysomnographies required in the routine diagnosis of the sleep apnoea/hypopnoea syndrome (SAHS). We investigated the combination of heart rate and oximetry information as a means of performing this test. A retrospective study of 100 patients with suspected SAHS was made. All patients had in-hospital polysomnography on one night. We estimated the number of respiratory event-related arousals by counting the number of autonomic arousals (assessed on the basis of changes in the heart interbeat interval) that were coincident with a rise in oximetry. The hourly index of such events was denoted the "cardiac-oximetry disturbance index" (CODI). The median apnoea/hypopnoea index (AHI) was 16.5 (range 1.0-93.6) h-1. The CODI correlated significantly with the AHI (Spearman correlation coefficient rs = 0.88, P < 0.01), and the area (+/- standard error) under the receiver operating characteristic (ROC) was 0.94 +/- 0.05. Oximetry alone (based on 4% dips) was a less effective screening test (rs = 0.80, P < 0.01; area under ROC 0.83 +/- 0.06). Using 2% dips in oximetry offered comparable performance with the CODI (rs = 0.91, P < 0.01; area under ROC 0.93 +/- 0.04). The CODI was better correlated with the electroencephalograph arousal index (rs = 0.84, P < 0.01) than was oximetry (2% dips, rs = 0.57, P < 0.01). The CODI algorithm also offers an informal measure of self-validation: a large discrepancy between the number of autonomic arousals and the number of rises in oximetry indicates the presence of autonomic arousals without changes in oximetry (or vice versa). This self-validation mechanism identified several patients in this study, and may be useful in identifying sleep disruption due to chronic pain or other causes.
authors.affiliation: Department of Respiratory Physiology, Birmingham Heartlands Hospital, Birmingham, UK. ben.raymond@aad.gov.au
authors.forename: Ben
authors.initials: B
authors.lastname: Raymond
authors.forename: R M
authors.initials: RM
authors.lastname: Cayton
authors.forename: M J
authors.initials: MJ
authors.lastname: Chappell
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015992:Body Mass Index; D004569:Electroencephalography; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000378:metabolism; D012372:ROC Curve; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology*
chemical_list: D010100:Oxygen