title: Heart rate increment analysis is not effective for sleep-disordered breathing screening in patients with chronic heart failure.
abstract: Frequency domain analysis of heart rate variation has been suggested as an effective screening tool for sleep-disordered breathing (SDB) in the general population. The aim of this study was to assess this method in patients with chronic congestive heart failure (CHF). We included prospectively 84 patients with stable CHF, left ventricular ejection fraction (LVEF) <45% and sinus rhythm. The patients underwent polygraphy to measure the apnoea/hypopnoea index (AHI) and simultaneous Holter electrocardiogram monitoring to measure the power spectral density of the very low frequency component of the heart rate increment, expressed as the percentage of total power spectral density [% very low frequency increment (%VLFI)]. %VLFI could be determined in 54 patients (mean age, 52.8 +/- 12.3 years; LVEF, 33.5 +/- 9.8%). SDB defined as AHI > or =15 h(-1) was diagnosed in 57.4% of patients. Percent VLFI was not correlated with AHI (r = 0.12). Receiver-operating characteristic curves constructed using various AHI cut-offs (5-30 h(-1)) failed to identify a %VLFI cut-off associated with SDB. The 2.4% VLFI cut-off recommended for the general population of patients with suspected SDB had low specificity (35%) and low positive and negative predictive values (35% and 54%, respectively). Heart rate increment analysis has several limitations in CHF patients and cannot be recommended as an SDB screening tool in the CHF population.
authors.affiliation: Fédération de Cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier, Hôpital Henri Mondor, 51 Avenue Maréchal de Lattre de Tassigny, Créteil, France. thibaud.damy@hmn.aphp.fr
authors.forename: Thibaud
authors.initials: T
authors.lastname: Damy
authors.forename: Marie-Pia
authors.initials: MP
authors.lastname: D'Ortho
authors.forename: Brigitte
authors.initials: B
authors.lastname: Estrugo
authors.forename: Laurent
authors.initials: L
authors.lastname: Margarit
authors.forename: Gauthier
authors.initials: G
authors.lastname: Mouillet
authors.forename: Mohannad
authors.initials: M
authors.lastname: Mahfoud
authors.forename: Francoise
authors.initials: F
authors.lastname: Roudot-Thoraval
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Vermes
authors.forename: Luc
authors.initials: L
authors.lastname: Hittinger
authors.forename: Frederic
authors.initials: F
authors.lastname: Roche
authors.forename: Isabelle
authors.initials: I
authors.lastname: Macquin-Mavier
mesh_terms: D002908:Chronic Disease; D015897:Comorbidity; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000503:physiopathology