title: Night-to-night repeatability of measurements of nocturnal breathing disorders in clinically stable chronic heart failure patients.
abstract: BACKGROUND
  Portable sleep apnea monitors are often used to screen for sleep-disordered breathing in chronic heart failure patients (CHF), but night-to-night repeatability of obtained measurements of nocturnal breathing disorders has not been fully assessed.
  
  
  METHODS
  Fifty-six stable, moderate-to-severe CHF patients [male, 87%; age, 57 ± 9 years; NYHA class, 2.6 ± 0.6; left ventricular ejection fraction (LVEF), 32% ± 9%] underwent an unattended in-hospital cardiorespiratory recording using a portable sleep apnea monitor during two consecutive nights. The apnea/hypopnea index (AHI), apnea index (AI), oxygen desaturation index (ODI), and periodic breathing (PB) duration were computed. Intra-subject night-to-night variability was assessed by the 95% limits of random variation (LoV). We also estimated the contribution of intra-rater variability to the overall intra-subject variability. Dichotomizing the AHI and PB duration according to conventional cutoffs of, respectively, ≥5 events per hour, ≥15 events per hour, and ≥120 min, the percentage of patients concordantly classified by the two measurements was finally computed.
  
  
  RESULTS
  The 95% LoV were ±10.6, ±7.7, ±11.3 events per hour for AHI, AI and ODI, and ±63.2 min for PB duration, respectively. The contribution of intra-rater variability to total intra-subject variability was 1.7%, 1.4%, 2.5%, and 1.3% for AHI, AI, ODI, and PB duration, respectively. Most patients (85%, 82%, and 95% for AHI ≥ 5, AHI ≥ 15, and PB duration, respectively) were classified concordantly by the two measurements.
  
  
  CONCLUSIONS
  In patients with heart failure, measurements of severity of sleep-disordered breathing derived from portable sleep apnea monitors show significant night-to-night intra-subject variation with a negligible contribution from intra-rater variability; however, using the same measurements for classification purposes, as commonly performed in clinical practice to screen patients for sleep-disordered breathing, very stable results are obtained.
authors.affiliation: Department of Biomedical Engineering, Scientific Institute of Montescano, S. Maugeri Foundation-IRCCS, Montescano, Pavia, Italy. roberto.maestri@fsm.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Maestri
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: La Rovere
authors.forename: Elena
authors.initials: E
authors.lastname: Robbi
authors.forename: Gian Domenico
authors.initials: GD
authors.lastname: Pinna
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation; D008875:Middle Aged; D015588:Observer Variation; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D017286:Polysomnography / Q000295:instrumentation*; D011237:Predictive Value of Tests; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*