title: Extraction of respiratory myogram interference from the ECG and its application to characterize sleep-related breathing disorders in atrial fibrillation.
abstract: OBJECTIVE
  Present methods to extract respiratory myogram interference (RMI) from the Holter-ECG and assess effect of supraventricular arrhythmias (SVAs) onto ECG-based detection of sleep-related breathing disorders (SRBDs) and AHI estimation.
  
  
  METHODS
  RMI was quantified as residual energy after ECG cancellation or high-pass filtering for different windowing constellations. In 140 cases without (SET_A) and 10 cases with persistent SVAs (SET_B), respiratory polysomnogram annotations served as reference for SRDB detection from Holter-ECGs. We applied our previously published method to identify SRDBs in 1-min epochs and estimate the AHI based on joint modulations in RMI and QRS-area.
  
  
  RESULTS
  Sensitivity and specificity of 0.855/0.860 in SET_A dropped to 0.831/0.75 in SET_B. A significantly higher number of wake events in SET_B likely contribute to the asymmetric decrease and is consistent with a tendency to overestimate the AHI.
  
  
  CONCLUSIONS
  Despite reduced accuracy, RMI and QRS-area appear relatively robust against SVA and promise Holter-based detection at least of medium to severe SRBDs also in patients with SVAs.
authors.affiliation: Heidelberg University, Institute of Medical Biometry and Informatics, Heidelberg, Germany; Heilbronn University, Faculty of Informatics, Heilbronn, Germany. Electronic address: christoph.maier@med.uni-heidelberg.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Maier
authors.affiliation: Heidelberg University, Institute of Medical Biometry and Informatics, Heidelberg, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Dickhaus
mesh_terms: D000368:Aged; D000465:Algorithms; D016477:Artifacts; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010363:Pattern Recognition, Automated / Q000379:methods; D015203:Reproducibility of Results; D015656:Respiratory Mechanics; D012680:Sensitivity and Specificity; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000175:diagnosis*
keywords: Atrial fibrillation; ECG; ECG-derived respiration; QRS amplitude; Respiratory myogram interference; Sleep apnea; Sleep-related breathing disorders; Supraventricular arrhythmia