title: Prevalent hypertension and stroke in the Sleep Heart Health Study: association with an ECG-derived spectrographic marker of cardiopulmonary coupling.
abstract: OBJECTIVE
  The electrocardiogram (ECG)-based sleep spectrogram generates a map of cardiopulmonary coupling based on heart rate variability and respiration derived from QRS amplitude variations. A distinct spectrographic phenotype, designated as narrow-band elevated low frequency coupling (e-LFC(NB)), has been associated with central apneas and periodic breathing and predicts sleep laboratory failure of continuous positive airway pressure therapy. This study assesses, at a population level, the associations of this spectrographic biomarker with prevalent cardiovascular disease using the Sleep Heart Health Study (SHHS)-I dataset.
  
  
  METHODS
  Retrospective analysis of the Sleep Heart Health Study-I dataset.
  
  
  METHODS
  Laboratory for complex physiologic signals analysis.
  
  
  RESULTS
  The fully-automated ECG-derived sleep spectrogram technique was applied to 5247 (of the original 6441) polysomnograms from the SHHS-I. Associations were estimated with use of various drugs and pathologies including prevalent hypertension and cardiovascular and cerebrovascular disease. Increasing with age and more common in males, e-LFC(NB) is also associated with greater severity of sleep apnea and fragmented sleep. After adjustment for potential confounders, an independent association with prevalent hypertension and stroke was found.
  
  
  CONCLUSIONS
  An ECG-derived spectrographic marker related to low frequency cardiopulmonary coupling is associated with greater sleep apnea severity. Whether this biomarker is solely a sign of more severe disease or whether it reflects primary alterations in sleep apnea pathophysiology (which may either cause or result from sleep apnea) is unknown. This ECG-based spectral marker is associated with a higher prevalence of hypertension and stroke.
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. rthomas1@bidmc.harvard.edu
authors.forename: Robert Joseph
authors.initials: RJ
authors.lastname: Thomas
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Weiss
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Mietus
authors.forename: Chung-Kang
authors.initials: CK
authors.lastname: Peng
authors.forename: Ary L
authors.initials: AL
authors.lastname: Goldberger
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Gottlieb
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D016017:Odds Ratio; D017286:Polysomnography / Q000379:methods / Q000706:statistics & numerical data; D015995:Prevalence; D012119:Respiration; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology*; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*